Stroke is a medical emergency and care provided in the first hours is critical in shaping patients’ long-term recovery and prognosis.1 There is robust evidence demonstrating significant reductions in death and disability with early interventions in acute stroke care, including antiplatelet therapy2 stroke unit (SU) care3 and thrombolysis.4International clinical guidelines for stroke provide key recommendations to guide clinical practice5–8; however, uptake of evidence-based care is variable and often less than optimal.9–14 For example, among patients with ischemic stroke, rates for treatment with intravenous recombinant tissue-type plasminogen activator (r-tPA) are relatively low in the USA (5%)9 and Australia (7%),10 compared with Canada (12%)11 and some European centers (14%).15