Outcomes were measured over a 6-year period from May 2016 to May 2024. The NP provided continuity of care with 4 touchpoints: 1) participated in daily discharge round;, 2) evaluated each patient at least once during their hospital stay; 3) contacted each patient within 48h of discharge for medication reconciliation and symptom management; and 4) in-person or telemedicine clinic within 7-14-days post-discharge based on complexity and LACE score. The NP was the point provider until seen by outpatient neurologist. The NP coordinated with the inpatient and outpatient neurologist during the transitional period to ensure care coordination.