We concur with Alexandrov in her recent editorial that "late arrival to the hospital after the onset of acute stroke symptoms is a plague of unheralded proportion. ". We are currently conducting a large multicenter, clustered randomized trial in 19 acute stroke units in NSW, Australia. This study, funded by Australia’s National Health and Medical Research Council, aims to rigorously evaluate a multidisciplinary, team-building intervention to improve evidence-based management of fever, hyperglycemia and dysphagia in patients after acute stroke. Like most acute stroke therapies, our intervention is aimed at salvaging the ischemic penumbra and, as such, admission to an acute stroke unit within 48 hours of stroke symptom onset is one of our inclusion criterion. Patients arriving at an acute stroke unit after this time are unlikely to benefit from our intervention.