Table 1.

Strategies implemented among Shenyang ASCaM hospitals (with selected references)

Strategies	Description	References
EMS prenotification	Ambulance staff prenotifies hospital stroke neurologists regarding medical history and abnormalities.	10 27 28 39
Advanced ED preparation	Preparation in advance of intravenous lines, catheters, infusion/infiltration pump, electrocardiographic monitoring or DSA suite if needed.	*
Dedicated stroke neurologists 24/7 availability	Assign dedicated stroke fellows or at least neurology residents in ED with 24/7 availability, and neurointerventionists as conditioned.	11
Rapid stroke triage/notification	Rapid stroke triage protocol and stroke team notification must be applied.	10 39
Staff accompany	Thrombolysis-indicated patients must be accompanied by ED staffs (generally stroke nurses) all way through before the actual administration of intravenous tPA.	*
Immediate neuroimaging interpretation	Brain imaging was read and interpreted by ED neurologist on the spot once yielded.	10 12 39
First-line neurologist decision	Thrombolysis decision is made by the first-line neurologists and confirmed by stroke fellow by phone or in person.	10
First priority for thrombolysis indicated patients	Hospital-wide first priority such as access to neuroimaging and laboratory facilities for thrombolysis-indicated patients must be strictly applied.	13
Stroke toolkits 24/7 availability	Stroke toolkits including assessment scales, written inform and consent form and tPA are 24/7 available in ED.	10 39
Laboratory and neuroimaging in nearest location	Laboratory and neuroimaging facilities were required to be renovated or relocated to the nearest possible location within the radius of ED.	10 12 27 40

*Strategies adapted to local healthcare system.

DSA, digital subtraction angiography; ED, emergency department; EMS, emergency medical services; tPA, tissue plasminogen activator.