Acute Suspected Stroke Clinical Pathway Use in Tasmanian Emergency Departments: A Retrospective Study

INTRODUCTION: Stroke is a leading cause of disability and healthcare burden in Australia, affecting over 440,000 people. Timely diagnosis and intervention are essential for improving outcomes, and national ED standards emphasise rapid assessment, imaging and treatment. Clinical pathways aim to standardise care and reduce delays, yet regional disparities persist. This study examined suspected acute stroke pathway use in Tasmanian EDs, assessing guideline adherence, waiting times and inter-hospital variation. METHODS: This retrospective observational study analysed 205 suspected stroke presentations across four public Tasmanian EDs in 2021. Data from digital medical records were evaluated for pathway utilisation, adherence to key clinical elements and time metrics. RESULTS: The mean patient age was 70.5 years, with 56% male. Suspected stroke pathway use varied significantly between hospitals (27%-62%). In unadjusted analyses, pathway-managed patients more frequently completed ROSIER and NIHSS assessments (p < 0.0025) and were more likely to receive thrombolysis, though causality cannot be inferred. Pathway use was also associated with shorter times to initial ED assessment (< 10 min) and faster CT imaging (< 45 min) compared with non-pathway care (> 50 and > 130 min) across EDs statewide. CONCLUSION: Use of the suspected acute stroke pathway appeared to vary across the four EDs, suggesting differences in pathway use and integration into everyday clinical workflows. Pathway use was associated with higher adherence to evidence-based guidelines and improved timeliness of care. However, these findings are subject to confounding by other factors and should therefore be interpreted with caution.