Background: Stroke units are effective at improving outcomes after stroke, however they do not exist in all hospitals. In low and middle income countries, or settings with limited resources, it is not always feasible to implement all aspects of a stroke unit and it is unclear whether implementing even some aspects of organized stroke care could improve outcomes.
Methods: Based on the World Stroke Organizations Road Map for Quality Stroke Care, the Organized Stroke Care Across Income Levels (OSCAIL) Study will test the effectiveness of implementing key elements of stroke care in settings where stroke units do not exist. The study is using a stepped wedge design to collect data on current practice and outcomes (e.g. mortality, functional independence), implement ongoing training, and then reassess practice and outcomes to determine if there was an effect.
Results:  We have started the study in two (Rwanda, South Africa) of the four countries (India, Uganda), and at three sites. We have recruited 200 of the 500 participants for the observation phase and are starting the intervention phase at the three active sites. Data from the observational phase indicate that implementation of stroke specific care (e.g. documentation of standardized assessment scores, swallowing tests, early mobility, multidisciplinary team communication) is limited. We have developed the training program to address these gaps.
Conclusions:  The presentation will focus on the development of the training materials, the process for implementing training and preliminary data on effectiveness.

CAN KEY ELEMENTS OF A STROKE UNIT BE IMPLEMENTED IN RESOURCE SCARCE SETTINGS? WHERE DO WE START (THE OSCAIL STUDY)