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Earlier administration of intravenous thrombolysis for acute ischemic stroke is associated with improved outcomes. Yet, despite nearly two decades of practical experience developing systems of care to rapidly deliver tissue plasminogen activator (TPA), in-hospital delays are still common. To address this challenge, the American Heart Association/American Stroke Association and partner organizations launched the “Target: Stroke” quality improvement initiative in 2010 among hospitals that were participating in the Get With The Guidelines–Stroke registry. The stated goal was to enable participating hospitals to treat at least 50% of eligible patients with TPA within 60 minutes of hospital arrival through the use of a multimodal implementation …