Limitations
stroke
STROKE
This study suffers from a few limitations that may limit generalizability. First, while 4 CSCs were included in the analysis, they are all a part of a single health care system, unified by a single electronic medical record and the same overarching stroke process workflows. Some physicians also rotated between several of the CSCs, resulting in a level of consistency across the hospitals. Also, the preintervention DTG times were near 100 minutes. It is possible that the effect size may be different in other settings, in which the preintervention DTG time is substantially longer or shorter. However, the 4 CSCs included in this study covered a wide range of hospital types, from a high-volume tertiary referral academic medical center to lower volume community-based hospitals without physician trainees. In addition, this value of 100 minutes for DTG is highly consistent with those seen in a large nationwide cohort of 231 hospitals and nearly 14 500 patients, in which median DTG time for patients arriving through the emergency department was 100 (IQR, 78-127) minutes and in another similar but more recent cohort of nearly 54 000 patients across 697 sites in the US, in which median DTG time was 108 (IQR, 66-164) minutes.