Hospitals and Study Participants
stroke, acute ischemic stroke, Stroke
STROKE, SECONDARY, STROKE
We planned to recruit 51 hospitals in mainland China from the Chinese Stroke Center Alliance hospitals located in 29 provinces, autonomous regions, and municipalities. To ensure the diversity and representativeness of the included hospitals, hospitals were enrolled considering their economic-geographic regions (Eastern, Central, and Western) and hospital level (secondary or tertiary). To be eligible, hospitals were required to be secondary or tertiary public hospitals with emergency department and neurologic wards, have a 24/7 on-call stroke team, have the capacity for IVT or EVT, have administered IVT or EVT to at least 10 patients during the whole year before enrollment, and have at least 5 patients admitted within 6 hours after stroke onset per month. All hospitals had to want to improve the workflow of treating patients with acute ischemic stroke and have good collaboration among the multidisciplinary team. Hospitals that participated in other research projects of reperfusion quality improvement in patients with acute ischemic stroke were all excluded after a questionnaire survey.At participating hospitals, patients were consecutively enrolled if they were older than 18 years; presented with symptoms of acute ischemic stroke, which was confirmed by computed tomography (CT) or magnetic resonance imaging (MRI); and arrived at the hospital within 6 hours of symptom onset.