Delays in the Identification and Assessment of in-Hospital Stroke Patients

•In-hospital strokes are severe and are often periprocedural.•In-hospital strokes are associated with long delays from last known normal to symptom detection and from symptom detection to stroke team alerting.•Delays are strongly associated with intubation, and protocols should be used to allow for rapid anesthesia offset after procedures and intermittent lightening of sedation for more frequent and reliable neuro assessments.•Large vessel occlusion is common, yet many patients were not able to receive an intervention, likely due to delays.