A Team-Based Stroke Practitioner–Led Workflow Achieves Comparable Outcomes to Neurohospitalist-Led Care in Acute Ischemic Stroke: A Real-World Study

Background/Objectives: Acute ischemic stroke (AIS) care depends on rapid, coordinated workflows. This study compared two real-world in-hospital stroke models—a neurohospitalist-led model and a stroke practitioner–led multidisciplinary model—in terms of time metrics, radiological outcomes, and 3-month clinical outcomes in patients undergoing reperfusion therapy. Methods: This retrospective, single-center cohort study evaluated patients across two sequential workflow periods. In the practitioner-led model, trained non-neurologist clinicians coordinated care with a stroke nurse under neurologist supervision. Time metrics included door-to-needle time (DNT) and door-to-puncture time (DPT). Clinical outcomes included intensive care unit (ICU) transfer and 3-month functional outcomes assessed by the modified Rankin Scale (mRS). Results: A total of 573 patients were included (284 neurohospitalist-led, 289 practitioner-led). Baseline NIHSS scores were similar between groups. The proportion achieving DNT <60 minutes was significantly higher in the practitioner-led period (74.0% vs. 52.5%, p<0.001), while mean DNT and DPT were comparable. Early radiological outcomes at 24 hours were similar between groups. ICU transfer rates were significantly lower in the practitioner-led period (17.6% vs. 28.2%, p=0.002). Three-month mRS outcomes did not differ significantly. Conclusions: A structured, practitioner-led multidisciplinary workflow was as safe and efficient as a neurohospitalist-led model. Improved adherence to DNT targets and reduced ICU transfers highlight the importance of system-level organization in optimizing AIS care.