Background: Timely activation of in-hospital stroke (IHS) codes is critical for acute stroke management, yet delayed remain common. We aimed to identify factors associated with inpatient units with frequent delays in IHS code activation.
Methods: We analyzed 264 consecutive patients undergoing stroke code activation for suspected IHS at a single tertiary stroke center. Inpatient units were categorized as “no-delay” (≥50% of activations within 1 hour of symptom recognition) or “delay” (<50%). Clinical characteristics and workflow factors were compared. Multivariable logistic regression adjusted for age and sex was performed.
Results: The delay group comprised 106 patients from 15 units, and the no-delay group 158 patients from 21 units. Compared with the no-delay group, the delay group had fewer male patients (46% vs. 63%, p = 0.01), fewer patients with cancer (26% vs. 47%, p <0.01), fewer direct calls to stroke physicians (42% vs. 74%, p <0.01), and more activations in intensive care units (90% vs. 60%, p <0.01). Independent factors associated with delay were non-cancer status (OR 0.52, 95% CI 0.28–0.96, p=0.04), absence of direct calls to stroke physicians (OR 0.27, 95% CI 0.15–0.49, p<0.01), and ICU location (OR 3.84, 95%CI 1.88-7.82, p<0.01). Mechanical thrombectomy was less frequently performed in the delay group (4% vs. 14%, p=0.01).
Conclusions: Delays in IHS code activation are associated with modifiable workflow factors, particularly lack of direct communication with stroke physicians. Targeted interventions to promote direct activation pathways may improve timely stroke care.