Approximately 795,000 Americans suffer from a stroke each year which results in about 25% of these patients dying, and 15–30% remain permanently disabled. The direct and indirect costs of stroke care exceed $73 billion annually with more than a million Americans and their families dealing with the aftermath. To help reduce the nation's stroke burden, beyond the efforts to prevent strokes, the quality of care provided to stroke patients needs to improve in order to reduce death and disability from these events (American Stroke Association [ASA], 2011). The National Stroke Association (NSA), American Stroke Association (ASA), and Institute of Medicine (IOM), have collaborated and developed guidelines specifically called a stroke system, to help reduce the nation’s stroke burden. The stroke system addresses primordial and primary prevention, community education, pre-hospital services, acute stroke treatment, sub-acute care, secondary prevention, rehabilitation, and evaluation of care. The purpose of the project was in collaboration with Douglas County Hospital (DCH) to conduct a practice improvement project to implement and evaluate the voluntary Minnesota Department of Health (MDH) Acute Stroke Ready Hospital Designation (ASRH). The project specifically addresses the vulnerable rural population in Douglas County. The acute stroke ready hospital designation process is the principal component of the Minnesota Stroke System. Previously DCH in Alexandria, Minnesota did not have a stroke designation. In addition, the DCH facility did not utilize a national stroke registry to track stroke outcomes. Both of these facts contributed to DCH not adhering to the national and state evidence based standards for stroke care. Ultimately, as a result of this project, DCH will both practice and document in adherence to national and state evidence based standards for stoke. Upon successful completion of the project, DCH was awarded a three year acute stroke hospital designation and became part of the national stroke registry program. As a result of becoming a designated stroke facility and participation in the national stroke registry, DCH is now a participant in the MDH State wide initiative to improve systems of stroke care.