Hospital Stroke Teams COR LOE New, Revised, or Unchanged An organized protocol for the emergency evaluation of patients with suspected stroke is recommended. I B-NR Recommendation and COR unchanged from 2013 AIS Guidelines. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. Designation of an acute stroke team that includes physicians, nurses, and laboratory/radiology personnel is recommended. Patients with stroke should have a careful clinical assessment, including neurological examination. I B-NR Recommendation wording modified from 2013 AIS Guidelines to match COR I stratifications. COR unchanged. LOE added to conform with ACC/AHA 2015 Recommendation Classification System. Multicomponent quality improvement initiatives, which include ED education and multidisciplinary teams with access to neurological expertise, are recommended to safely increase IV fibrinolytic treatment. I A New recommendation. Multicomponent quality improvement programs to improve stroke care demonstrate clear utility in safely increasing alteplase use in the community hospital setting in multiple settings. The US cluster-randomized INSTINCT trial (Increasing Stroke Treatment Through Interventional Change Tactics) demonstrated increased rates of alteplase use among all stroke patients. In the intervention group hospitals, alteplase use increased from 59 of 5882 (1.00%) before intervention to 191 of 7288 (2.62%) after intervention. This compared favorably with the change in the control group hospitals from 65 of 5957 (1.09%) to 120 of 6989 (1.72%), with a relative risk (RR) of 1.68 (95% CI, 1.09 2.57; P=0.02). Safety was also demonstrated with symptomatic intracranial hemorrhage (within 36 In the PRACTISE trial (Penumbra and Recanalisation Acute Computed Tomography in Ischaemic Stroke Evaluation), a multilevel intervention was conducted in a sample of 12 Dutch hospitals. 