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Methods: Study design: Multicentre cluster RCT with included health economic and process evaluations Study setting: Ambulance services, local stroke units and CSCs in England Cluster randomisation: Ambulance stations or teams Intervention: Specialist pre-hospital redirection pathway involving semi-structured telephone communication of information from ambulance to CSC clinicians, who then recommend admission destination according to the likelihood of treatable LVO being present Control: Standard care Study population: All suspected and confirmed stroke in participating regions Participant enrolment: Waiver of consent Co-primary outcome: Thrombectomy rate and time to treatment Secondary outcomes: Key aspects of emergency care including time intervals and receipt of other treatments including thrombolysis Sample size: Powered on a primary analysis population(ischaemic stroke), 564 thrombectomy procedures will detect at least 30-minutes difference in time to treatment

Kanehisa M, Goto S

Identify Gaps: Audits help pinpoint areas where protocols are not being followed or where existing procedures are insufficient

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