It has been more than a decade since the initial publication of Langhorne and his colleagues’ systematic review¹ which demonstrated that organised stroke care is superior to other systems of care for patients with stroke. Since then, this message has been repeated, advertised, and written about extensively, and has formed the basis of many national stroke care guidelines and consensus statements around the world. Unfortunately, in many (some would say most) places, the actual organisation of acute stroke care services has not yet been formalised, and the relatively simple messages of the systematic review have not been adopted in a consistent manner, to the detriment of countless people with stroke and their families. Fortunately, this is beginning to change—a change that is beginning to happen in Nova Scotia, and throughout Canada.

Nova Scotia is one of Canada’s Maritime provinces, and is home to just under one million people. Many of the population are descendents of the British, Irish, and French, but the province is becoming increasingly multi-ethnic. Approximately 60% of the population live outside major cities. As a …