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.