Strategies to consider: telestroke and 24-hour primary stroke centres.

The stroke team in Hong Kong only performs duty during office hours due to limited resources,1 but 57% of strokes occur during non-office hours (from Queen Elizabeth Hospital [QEH]; data unpublished). Queen Elizabeth Hospital, the only hospital with 24-hour stroke service, treats roughly 1800 patients a year (QEH; data unpublished). Since there are approximately 18 000 stroke patients annually, this amounts to a whooping 9234 or so of stroke patients unable to receive immediate care. In developing countries like Pakistan, 25% of stroke patients arriving at one hospital within the recommended 3-hour time frame2 were eligible for recombinant tissue plasminogen activator (rtPA) treatment, but as of 2011, only 10% of Hong Kong stroke patients were able to achieve that (QEH; data unpublished). This rate has not been improved since 1999,3 rendering new measures necessary.