Powers et al 2019 Guidelines for Management of AIS e351 1.4. Hospital Stroke Capabilities 1.4. Hospital Stroke Capabilities COR LOE New, Revised, or Unchanged Certification of stroke centers by an independent external body, such as Center for Improvement in Healthcare Quality, Det Norske Veritas, Healthcare Facilities Accreditation Program, and The Joint Commission (TJC),* or designation by a state health department, is recommended. *AHA has a cobranded, revenue-generating stroke certification with TJC. I B-NR Recommendation reworded for clarity from 2013 AIS Guidelines. COR unchanged. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. Data support the development of stroke centers to improve patient care and outcomes.43 Differences in stroke quality of care are associated with differences in certifying organization. Between 2010 and 2012, an analysis of 477297 AIS admissions from 977 certified primary stroke centers (73.8% TJC, 3.7% Det Norske Veritas, 1.2% Healthcare Facilities Accreditation Program, and 21.3% state based) participating in AHA GWTG-Stroke was conducted. Composite care quality was generally similar among the 4 groups of hospitals, although state-certified primary stroke centers underperformed TJC-certified primary stroke centers in a few key measures. The rates of alteplase use were higher in TJC- and Det Norske Veritas (9.0% and 9.8%) and lower in state- and Healthcare Facilities Accreditation Program certified hospitals (7.1% and 5.9%; P<0.0001). DTN times were significantly longer in Healthcare Facilities Accreditation Program hospitals. State primary stroke centers had higher in-hospital risk-adjusted mortality (OR, 1.23 [95% CI, 1.07 1.41]) compared with TJC-certified primary stroke centers.44 See Table V in online Data Supplement 1. 1.5. Hospital Stroke Teams 1.5. Hospital Stroke Teams COR LOE New, Revised, or Unchanged An organized protocol for the emergency evaluation of patients with suspected stroke is recommended. 