By Annie Tsui, D.O., Chief Medical Officer, Neurology, Access TeleCare
Earlier this year, the American Heart Association and American Stroke Association released the much-anticipated 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke.
The field has advanced tremendously since the guideline was first published in 2018 and updated in 2019. The new guidance reflects that progress, expanding the possibilities for how, and for whom, we can intervene following an acute ischemic stroke.
For stroke programs, the work is translating recommendations into updated protocols, coordinated workflows, and more confident decision-making at the bedside.
Stroke Care Is a Team Activity
Stroke care has always been a complex team activity. A successful response typically requires coordination among emergency clinicians, nurses, neurologists, radiologists, pharmacists, imaging teams, EMS professionals, and transfer partners, all within an extraordinarily compressed time period.
When treatment guidelines change, updating a policy document is not enough. Every part of the response must be considered:
- Which patients meet the new eligibility criteria?
- What advanced imaging is required, and how quickly can it be obtained?
- Who activates the revised pathway?
- How will the neurologist coordinate with the emergency and imaging teams?
- Are pharmacy processes aligned with the updated thrombolytic recommendations?
- Does every team member understand the new workflow?
- How will the hospital evaluate early cases and identify opportunities for improvement?
Clear, standardized protocols allow each person on the team to understand what needs to happen, when it needs to happen, and who is responsible. That preparation is what enables a care team to move rapidly without sacrificing clinical rigor.
At Access TeleCare, our responsibility extends beyond placing a neurologist on a screen for a timely patient encounter. Our teleStroke programs become part of each hospital’s stroke response infrastructure and support the local team before, during, and after a patient encounter.
How Access TeleCare Responded
When the 2026 AHA/ASA stroke guideline was released, the Access TeleCare neurology team immediately began helping our hospital partners evaluate what the recommendations meant for their individual programs.
Our neurologists and clinical support teams reviewed existing protocols alongside local stroke leaders. We served as clinical thought partners as hospitals determined which recommendations to adopt and how to operationalize them safely. We helped design revised workflows, identify points of coordination, and educate care teams on the intricacies of the new recommendations.
This work was led by people who understand both the clinical evidence and the realities of running a hospital stroke program. Access TeleCare’s service excellence managers bring stroke coordination experience, while our neurology medical directors have vascular neurology training and are deeply invested in the performance of each partner program.
In addition, while a guideline may establish what the evidence supports, on-the-ground implementation must account for the capabilities, resources, and needs of an individual hospital.
For one facility, adopting the recommended extended time window for intravenous thrombolysis may require developing a pathway for obtaining an emergency MRI. For another, it may mean refining CT perfusion protocols, coordinating more closely with radiology, or updating transfer criteria. Effective implementation cannot be one-size-fits-all.
When Preparation Creates a New Opportunity for Treatment
The impact of that preparation became clear when one of our partner hospitals treated its first patient under the newly recommended extended time window for thrombolysis administration.
Under the previous guideline, the patient would not have been eligible to receive IV thrombolysis. Following the updated guideline, the care team used advanced imaging to evaluate the patient based on the condition of the brain tissue rather than the time of symptom onset alone.
This required a STAT MRI in the emergency department—no small undertaking. The teleNeurologist and local care team had to coordinate quickly with imaging and other hospital departments, assess the results, and determine whether treatment could be administered safely.
Because the teams had already completed the foundational work, they were ready. The protocol was in place. Responsibilities were understood. The teleNeurologist and bedside clinicians were able to act as one care team.
Most importantly, the patient received treatment and ultimately experienced an excellent outcome.
For everyone involved, it was an extraordinary moment. It demonstrated that the updated evidence could do more than change a written protocol. Properly implemented, it could change the trajectory of a patient’s life.
Clinical Excellence Requires Continuous Partnership
New clinical guidelines should prompt more than a one-time policy revision. They should begin an ongoing process of education, implementation, measurement, and refinement.
Hospitals need to know not only that their protocols reflect current evidence, but that those protocols will work under the pressure of a real stroke activation.
A well-integrated teleNeurology program can help hospitals build that readiness. TeleNeurologists can support time-sensitive patient evaluations and treatment decisions, while the broader clinical team helps strengthen protocols, training, and performance-improvement efforts across the stroke program.
We have seen what this type of collaboration can accomplish. At one partner program, a collaborative teleStroke model reduced average door-to-needle time by 52.9 minutes and increased the number of patients treated for acute ischemic stroke by 43%. At another, an integrated program reduced door-to-needle times by nearly 19 minutes and neurologist response times by 42%.
The 2026 AHA/ASA stroke guideline has expanded what may be possible for patients experiencing acute ischemic stroke. Our job now is to make sure hospitals have the clinical partnership, operational support, and confidence needed to put that progress into practice.
