Prioritization and strategy selection

We presented these results to the 12-member acute stroke leadership team who formed a smaller task force to review the results in more depth and determine a response. The multidisciplinary task force was comprised of the lead stroke neurologist, stroke and neuro-ICU nursing leadership, and a hospital administrator who reviewed the identified determinants and discussed possible implementation strategies to address the locally identified gaps. The discussion was guided by the APEASE criteria: affordable, practical, effective, acceptable, safe, and equitable [10]. Each member was given a worksheet that listed implementation strategy options including feedback reports, restructured consent forms for stroke treatment, creation of an acute stroke team, nomination of a stroke champion, and improving documentation of the last time the stroke patient was known to be well (which is the time used as the basis for treatment decisions). Each member was asked to score each implementation strategy from 1—strongly disagree to 5—strongly agree on each of the APEASE criteria (see Additional file 2). The absolute scores were discussed and used to spur conversation regarding prioritization, but were not used as a quantitative assessment. The decision of which implementation strategy to move forward was ultimately determined by consensus.