Background:Reperfusion strategies in acute stroke over the past decade have dramatically altered functional outcomes in stroke patients. Strategies such as QuICR have focused on increasing the number of patients that present within the time window, thereby increasing the total number of stroke patients receiving acute stroke interventions (ASI).  However, the population of patients who present with acute In Hospital Strokes (IHS), have been largely excluded from educational strategies targeting outcome. Review of the outcomes of IHS, relative to “out of hospital strokes” (OHS), indicate common trends of fewer proportions treated with ASI and poorer outcomes.  IHS patients who do undergo ASI have demonstrated comparably good outcomes. A related cohort is that of patients with relapsing symptoms occurring in the emergency room (IHS-Er) setting.  Methods: These groups were excluded from the first phase of the ongoing QuICR initiative of the Alberta Stroke Program. A three component strategy of: 1. Data Collection; 2. Knowledge Attitude and Practices Survey (KAPS) and 3. Education targeting this population of patients was implemented in phase 2.  Results: Post implementation; an increase in the number of stroke codes called and proportion of acute strokes treated that were IHS was seen ( p = 0.02 for 2017 vs 2014).  Conclusion: Concerted provincial strategies can improve access of IHS to ASI  at representative Comprehensive and Primary Stroke Centres.

QuICR-Alberta Stroke Program: Targeting Inpatient Stroke Outcomes