Pathways to further boost treatment rates and clinical outcomes in hospitalized stroke patients.

Inpatient quality improvement initiatives have been associated with impressive improvements in evidence-based discharge treatment rates in hospitalized stroke patients. However, these programs have generally focused only on optimizing recurrent stroke prevention strategies among ischemic stroke patients. Many patients hospitalized with recent symptomatic cerebral ischemia are also at risk for future ischemic episodes emanating from other vascular beds, and the inpatient setting could represent an opportunity to screen and appropriately manage such patients who harbor cross-vascular risk. The stroke hospitalization may also be ideal for identifying stroke patients susceptible to a highly preventable yet common trigger of vascular events and poor clinical outcomes like influenza infection. Finally, several hospital-based prevention measures are underutilized in patients hospitalized with intracerebral hemorrhage (ICH) compared with those with ischemic stroke or transient ischemic attack, and so protocols geared at enhancing prevention of ICH recurrence, are certainly warranted. This article presents pathways (algorithms, pocket cards, preprinted orders) developed from expert consensus prevention guidelines and implemented within a broader stroke inpatient quality improvement program, which target patients highly vulnerable to future coronary events, poor clinical outcomes following influenza infection, and recurrent ICH.