Real-World Comparison of Stroke Practitioner-Led and Neurohospitalist-Led Acute Ischemic Stroke Workflows †

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). Multivariable logistic regression analyses were performed to explore variables associated with achievement of DNT < 60 min and ICU transfer. Results: A total of 573 patients were included (284 neurohospitalist-led, 289 practitioner-led). Baseline NIHSS scores were similar between groups. Among patients receiving intravenous thrombolysis, the proportion achieving DNT < 60 min did not differ significantly between periods (77.9% vs. 72.5%, p = 0.124), while mean DNT and DPT were comparable. Early radiological outcomes at 24 h were similar between groups. ICU transfer rates were significantly lower in the practitioner-led period (17.6% vs. 28.2%, p = 0.002). In multivariable analyses, the stroke practitioner-led period was not independently associated with achieving DNT < 60 min among thrombolysed patients, but remained independently associated with a lower likelihood of ICU transfer. Three-month mRS outcomes did not differ significantly. Conclusions: A structured, practitioner-led multidisciplinary workflow was associated with lower ICU transfer rates, while no statistically significant differences were detected in DNT target achievement among thrombolysed patients, safety outcomes, or functional outcomes compared with the neurohospitalist-led period. The observed associations between workflow organization and ICU utilization highlight the potential importance of system-level factors in AIS care delivery.