{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:19:32Z","timestamp":1792685972734,"version":"4.5.0"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>\n                    In-hospital stroke is associated with delayed evaluation and poorer outcomes than community-onset stroke. We implemented the Musashino In-Hospital Stroke Action Team (MISAT), a nurse-initiated system that summons stroke-specialist nurses when stroke is suspected, and evaluated its association with early imaging and response standardization in non-specialist wards. This single-center retrospective observational study analyzed 80 consecutive MISAT activations for suspected in-hospital stroke in October 2023\u2013December 2025. A pre-implementation cohort served as reference. The primary outcome was time from symptom recognition to brain imaging. Secondary analyses assessed process time metrics and phase-based trends in non-specialist wards. Of 80 MISAT activations, 52 (65.0%) were cerebrovascular events and 28 (35.0%) were stroke mimics. The median [interquartile range] recognition-to-imaging time was significantly shorter post-implementation than in the pre-implementation reference cohort (44.0 [30.0\u201368.3] min vs. 72.0 [48.0\u2013122.5] min;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.002). Recognition-to-activation and activation-to-imaging times were 12.0 [5.0\u201328.0] min and 28.5 [20.5\u201338.0] min. In non-specialist wards, recognition-to-activation time improved across phases from 54.0 [21.5\u201388.0] min to 8.0 [3.0\u201322.0] min and 10.0 [5.0\u201317.0] min (Kruskal\u2013Wallis\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.0039), with reduced variability (Fligner\u2013Killeen\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.0020). Recognition-to-imaging time also decreased across phases, with reduced variability. The MISAT system facilitated earlier evaluation of suspected in-hospital stroke. In non-specialist wards, improved recognition-to-activation time and reduced variability indicate potential educational and standardization benefits. This nurse-initiated system may be a practical stroke-specific complement to existing emergency response systems.\n                  <\/jats:p>","DOI":"10.3389\/fneur.2026.1860811","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:46:23Z","timestamp":1785926783000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Implementation of a nurse-initiated in-hospital stroke response system: association with early imaging and response standardization in non-specialist wards"],"prefix":"10.3389","volume":"17","author":[{"given":"Masahiko","family":"Ichijo","sequence":"first","affiliation":[{"name":"Department of Neurology, Musashino Red Cross Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Enatsu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Musashino Red Cross Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuki","family":"Kyoya","sequence":"additional","affiliation":[{"name":"Department of Neurology, Musashino Red Cross Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keitaro","family":"Chiba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Musashino Red Cross Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Ogishima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Musashino Red Cross Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Musashino Red Cross Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Tamaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Musashino Red Cross Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Kamata","sequence":"additional","affiliation":[{"name":"Department of Neurology, Musashino Red Cross Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1001\/jamaneurol.2015.0284","article-title":"Care and outcomes of patients with in-hospital stroke","volume":"72","author":"Saltman","year":"2015","journal-title":"JAMA Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.1001\/jamaneurol.2020.3362","article-title":"Trends in reperfusion therapy for in-hospital ischemic stroke in the endovascular therapy era","volume":"77","author":"Akbik","year":"2020","journal-title":"JAMA Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1177\/1941874415588319","article-title":"In-hospital ischemic stroke","volume":"5","author":"Cumbler","year":"2015","journal-title":"Neurohospitalist"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e165","DOI":"10.1161\/STR.0000000000000402","article-title":"Identifying best practices to improve evaluation and management of in-hospital stroke: a scientific statement from the American Heart Association","volume":"53","author":"Nouh","year":"2022","journal-title":"Stroke"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1056\/nejmra0910926","article-title":"Rapid-response teams","volume":"365","author":"Jones","year":"2011","journal-title":"N Engl J Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1161\/01.str.0000044170.46643.5e","article-title":"Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test","volume":"34","author":"Harbison","year":"2003","journal-title":"Stroke"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2096","DOI":"10.1161\/strokeaha.118.022107","article-title":"Emergent large vessel occlusion screen is an ideal prehospital scale to avoid missing endovascular therapy in acute stroke","volume":"49","author":"Suzuki","year":"2018","journal-title":"Stroke"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2926","DOI":"10.1161\/strokeaha.123.042868","article-title":"Nursing and institutional responsibilities for in-hospital stroke","volume":"54","author":"Snavely","year":"2023","journal-title":"Stroke"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.10.003","article-title":"Nurses are as specific and are earlier in calling in-hospital stroke alerts compared to physicians","volume":"26","author":"George","year":"2017","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1161\/01.str.20.7.864","article-title":"Measurements of acute cerebral infarction: a clinical examination scale","volume":"20","author":"Brott","year":"1989","journal-title":"Stroke"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"104398","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104398","article-title":"Effectiveness of an interdisciplinary, nurse-driven in-hospital code stroke protocol on in-patient ischemic stroke recognition and management","volume":"28","author":"Yang","year":"2019","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"317","DOI":"10.4037\/aacnacc2025924","article-title":"Use of rapid response teams to expedite imaging and treatment for inpatients with acute stroke","volume":"36","author":"Siaron","year":"2025","journal-title":"AACN Adv Crit Care"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1860811\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:46:23Z","timestamp":1785926783000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1860811\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":12,"alternative-id":["10.3389\/fneur.2026.1860811"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1860811","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]},"article-number":"1860811"}}