Delayed Diagnosis of Stroke (Claims Corner CME)


In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients. The following highlights the importance of recognizing the signs and symptoms of a stroke. Factors contributing to delay diagnosis and treatment included failure to recognize the window (“last known well time”) for tissue plasminogen activator-clot buster (tPA) failure to order a stat MRI and neurology consult, failed communication among providers regarding changes of recurring symptoms of ischemic stroke, failure to appreciate new signs and symptoms of a stroke and poor or inconsistent documentation. The National Academy of Medicine (NAM) has identified the top three causes of serious harm from diagnostic failure. Number one is ischemic stroke. 

Course ID #: TDE 210999.0 Issue Date: 11/01/2021 Expiration Date: 11/01/2024


After completing this activity, learners will be able to:

  • Calculate the last known well time and identify the window for administration of tPA (3-4.5 hours of stroke onset).
  • Conduct an accurate and thorough review of chief complaints and a neurological examination, and thoroughly document findings.
  • Demonstrate enhanced communication and coordination among multiple providers.
  • Evaluate when an urgent/emergent action is required such as a neurology consultation, stroke code or order for an MRI.
  • Identify at least two strategies that can reduce the risk for a malpractice claim involving the failure to timely diagnosis and treat a stroke.


No individual in a position to control or influence the content of this activity has reported relevant financial relationships with commercial interests. No commercial support was provided for this activity.


The information and guidelines contained in this activity are generalized and may not apply to all practice situations. We recommend that legal advice be obtained from a qualified attorney for specific application to your practice. The information is intended for educational purposes and should be used as a reference guide only.

Course Developers
Kathrine Soulsby, BSN, RN, Senior Patient Safety Analyst, Department of Patient Safety and Risk Management, The Doctors Company
Susan Shepard, MSN, MA, RN, CPHRM, Senior Director, Patient Safety and Risk Management Education, Department of Patient Safety and Risk Management, The Doctors Company

Johanna Lackner, MPH, MSW, Senior Director, Continuing Professional Development, Department of Patient Safety and Risk Management, The Doctors Company

Continuing Education Credit

The Doctors Company is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical educational activities for physicians.

The Doctors Company designates this activity for a maximum of 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Complies with State Requirements

Please SEE the Federation of State Medical Boards overview of Continuing Medical Education requirements by State. 

Technical Requirements

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If you have questions, contact or call 800.421.2368.


Visit our Resource document for this program.