Table S1. Self-Rated Questionnaire Assessing the Eligibility of Ascam Hospitals

BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Stroke Vasc Neurol

Table S1. Self-rated questionnaire assessing the eligibility of ASCaM hospitals.

Evaluation Serial Evaluation Evaluation factors Score Scoring standards items number method The hospital selected for the thrombolysis map should have a person responsible for View the thrombolysis project for acute ischemic personnel Deduct 3 points if no relevant 1 3.0 stroke who is also responsible for registration personnel are identified. coordinating communication between the status

) project and the emergency center.

20 Set up a special reception telephone and set it to record in the prehospital emergency dispatching command system to ensure smooth 24-hour calls, and designated staff Field members are responsible for answering and inspection of Deduct 1 point for each missing 2 recording calls. If a related WeChat public 3.0 equipment and item until the score is zero. platform, mobile APP or intelligent digital staffing monitoring transmission system is

available, the hospital must guarantee that anyone can reply immediately at any time within 24 hours. In case of inadequate or loss of medical capacity due to special circumstances (e.g., CT failure), the hospital's general-on-duty Field or project leader must inform the EMS inspection and Deduct 3 points for no relevant 3 3.0 command center by fax or dedicated regular spot capacity. landline in advance. The hospital must checks

Connection between prehospital and between Connection in-hospital( accept (suspected) cerebrovascular disease patients who are transferred by EMS 24/7. Deduct 2 points for no specific Designated parking spaces are available in Field parking space; deduct 2 points 4 front of the ED. In the case of traffic 3.0 inspection for no designated guidance congestion, the hospital has designated personnel until the score is zero.

Sui Y, et al. Stroke Vasc Neurol 2020;0:1–8. doi: 10.1136/svn-2020-000332 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Stroke Vasc Neurol

personnel to guide emergency vehicles into the parking spaces. Dedicated beds or stroke unit in the ED with Field Deduct 1 point for each missing 5 prominent signage and sufficient beds 4.0 inspection item until the score is zero. (stretcher beds) for patient turnover. The ED doctor shall immediately check a Deduct 3 points for no relevant Check staffing personnel; deduct 2 points for 6 patient’s status and sign receipt 4.0 and actual confirmation upon the insufficient ability until the patient’s arrival. capability score is zero. Field Tertiary hospitals: 5 points, Certification of a secondary or tertiary inspection of secondary hospitals: 4 points, 1 hospital, a specialty hospital, or an EMS 5.0 hospital grade unrated hospitals: 3 points;

(5) (5)

Medical Medical networking hospital and approval EMS networking hospitals: 2

institution institution

qualification documents points. Independent departments exist, such as Emergency Medicine, Neurology, Check hospital Neurosurgery, Intensive Care Medicine, Deduct 1 point for the absence practice permit 1 Anesthesiology, Medical Imaging (with a 5.0 of each mentioned department and field neuroimaging section), Medical Laboratory until the score is zero.

setting setting (5) inspection Department Department (with an emergency section), and Rehabilitation Medicine. The hospital is equipped with an electrocardiogram, ECG monitor, defibrillator, resuscitation equipment and Deduct half a point for the medications, and an oxygen supply. The Field absence of each mentioned 1 hospital owns an ambulance(s) with GPS 2.0 inspection equipment until the score is positioning and an on-board information zero. transmission system, walkie talkie, car

and and facilities (10)

Medical equipment Medical telephone or other communication equipment.

Deduct half a point for the Equipped with CT (24/7), an emergency Field absence of each mentioned 2 laboratory (24/7), MRI, and transcranial 2.0 inspection equipment until the score is Doppler zero. In the emergency department, set up a Deduct 1 point for the absence dedicated observation room and a of each mentioned item until the resuscitation room for IV thrombolysis score is zero. Assign a score of patients equipped with the required Field 3 4.0 zero if alteplase is not routinely neurological assessment tools, evaluation inspection stored in the emergency forms and medications. Alteplase is package or emergency routinely stored in the emergency pharmacy. package/emergency pharmacy. An in-hospital data transmission system (such as the PACS) and APP that can Deduct 1 point for the absence transmit and receive medical information, of an in-hospital data Field 4 such as an electrocardiogram and 2.0 transmission system. Deduct 1 inspection neuroimages, is established. A point for the absence of a neurointervention facility (such as a DSA neurointervention facility. suite) is established. Deduct 3 points for the absence Inspection of of a 24/7 stroke team. Deduct 1 A 24/7-coverage stroke team consisting of institutional point for the absence of each 1 neurologists, neurosurgeons, ED doctors, 4.0 documents and role with incomplete staffing. neurointerventionists and stroke nurses. field inspection Deduct 1 point for no 24/7 coverage. At least one senior neurologist and Inspection of Deduct 1.5 points for the neurosurgeon having received professional personnel 2 3.0 absence of either a neurologist training in cerebrovascular disease are on registration

Staffing (10) or neurosurgeon. duty 24/7. status The hospital has neuroradiologists, Inspection of Deduct 1 point for the absence anesthesiologists, neurointerventionists, personnel 3 3.0 of each staffing role until the nurses, neurorehabilitators and a registration score is zero. neurovascular sonographer. status

Sui Y, et al. Stroke Vasc Neurol 2020;0:1–8. doi: 10.1136/svn-2020-000332 Supplemental material

Technical ability (40) 4 3 2 1 BMJ PublishingGroupLimited(BMJ)disclaimsallliabilityandresponsibilityarisingfromany reliance ucin seset ad early and swallowing assessments language, rehabilitationbecan applied. limb, function as such assessments physiological and Physical thrombosis, 3 vein becan properlyapplied. malnutrition and bleeding deep gastrointestinal pneumonia, aspiration targeting measures Preventive 2 reasonably guidelines.the to according used be can statins and antihypertensives, In-hospital1 therapies suchas antiplatelets, intravenous capablehospitals. to (DI-DO) minutes of 30 within transferred end be must reasons various the for thrombolysis at treatment endovascular undergo DSA, cannot intravenous and therapy for min 60 thrombolysis. Patients who receive bridging < CTP, DNT Mean and bubble echocardiography. CTA, echocardiography transesophageal contrast), gadolinium and FLAIR, MRV MRA, SWI, PWI, T2, DWI, T1, (including scans The radiology department can perform MRI examination minutes. resultswithin 45 allnecessarylaboratoryminutes; collect 30 withininterpretation scanandCT complete minutes; 15 within present members team stroke all arrival; assessment after minutes preliminary 10 within and NIHSS the complete can team stroke emergency The placed onthissupplementalmaterialwhichhasbeensuppliedbytheauthor(s) 4.0 4.0 4.0 4.0 8.0 4.0 Sampling Sampling Sampling inspectionfield and year the past in cases 3 of Sampling necessary when year. exercise Simulation the past in cases field inspectionfield and year th past in cases inspectionfield and year the past in cases of of of Sui Y 3 3 3 e , etal. conduct endovascular conduct therapy. minutes. to or minutes 30 withintransfer to failure 60 for points 3 > Deduct DNT mean a for points 5 Deduct score. not does thrombolysis intravenous eut pit o not for eachitem.for point therapy standardized delivering 1 Deduct In itemofeach zero. until absence the for point 1 Deduct minutes. within15 present be can members team stroke all not if score not does item This requirement. each of Deduct 1 point for incompletion ability Stroke Vasc Neurol to carry out out carry 2020; 0 :1 –8. doi: 10.1136/svn-2020-000332 Stroke Vasc Neurol BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Stroke Vasc Neurol

4 Neurosurgeries such as decompressive craniectomy, hematoma evacuation, and ventricular drainage can be applied. 1 Admission of more than 100 AIS patients per year will collect 5 points, and 1 point will be deducted for every 10 Review the patients below 100 (the full electrical 1 The hospital admitted more than 100 score is 5 points). medical patients with AIS in the past year. 2 Accumulated completion of records in the 2 The hospital managed no fewer than 30 fewer than 10 thrombolysis wards, cases of intravenous thrombolysis in the cases or 5 cases/ year warrants a thrombolysis past 3 years, or the cases per annum was not 10-point deduction, and each 5 20.0 records in the fewer than 20/year. additional 10 cases will collect ER and 3 The hospital managed no fewer than 10 1 point (the full score is 10 alteplase usage cases of endovascular therapy in the past 3 points). in the years, or the cases per annum was not fewer 3 Accumulated completion of pharmacy in than 5/year. fewer than 10 endovascular the past therapy cases or 5 cases/year calendar year warrants a 5-points deduction, each additional 2 cases will collect 1 point (the full score is 5 points). This item does not score if the An established express in-hospital system hospital has not established an for acute stroke patients exists. The entire express system for acute stroke system is chaired by the president/CEO or Inspection of patients. 1 vice-president/vice-CEO of the hospital, 5.0 institutional If the hospital president/CEO or and the directors and head nurses of the documents vice-president/vice-CEO does

measures (10)measures relevant departments are responsible for not serve as the head of the in- quality and safety control. hospital system, then 3 points

Management system system Management are deducted.

If the relevant department directors and head nurses are not responsible for quality and safety control, then deduct 0.5 points/person until the score is zero. Sound regulations are in place for stroke management and responsibilities; a Inspection of Each part of insufficient complete thrombolysis workflow is institutional regulations warrants a 0.5-point established; a registry of acute stroke documents, deduction until the score is zero. 2 thrombolysis and interventional surgery 2.0 medical This item does not score if a exists; archives of paperwork such as records and thrombolysis workflow is not informed consent and ER medical records archives established. for thrombolysis and interventional cases are available. A database for acute stroke cases enabling Each part of insufficiency or case registration and continuous quality absence warrants a 0.5-point improvement is established; a follow-up Field deduction until the score is zero. 3 database and clinics for stroke patients are 3.0 inspection This item does not score if the established; regular communication with in-hospital stroke registry is not the Urban Cerebrovascular Disease Quality established. Control Center. Total 100

Appendix

List of in-house registries/investigators of participating hospitals of Greater Shenyang

Acute Stroke Care Map:

Shenyang First People’s Hospital: Yi Sui (Principal Investigator, PI), Bing Xu, Yunxin

Zhai, Xia Wang, Li Ren, Jin Zhou, Xu Wang, Li Li, Ying Xiao, Haoyue Zhu

The 202th Hospital of People’s Liberation Army: Zhilin Jiang (PI)

The First Affiliated Hospital of China Medical University: Zhiyi He (PI), Jun Yang,

Jiuhan Zhao, Ruixia Zhu, Qu Li, Ying Zhu, Jialu Wang, Xi Lu, Na Liu, Meiqing Lin, Yuehan

Hao, Fang Liu, Xiaoqian Zhang, Xu Liu, Jiahui Liu, Huiyuan Zhang, Yuming Zheng, Lei Li,

Su Meng, Feng Jin, Hefei Fu, Yiling Jiang, Fan Lou, Pan Hu, Jirui Wang, Ling Tang, Jinwei

Shengjing Hospital of China Medical University: Juan Fen (PI), Yan Gao, Lulu Wen,

YongChuan Xu, Dong Han

Shenyang Emergency Medical Service Center Affiliated Hospital: Min Chang (PI)

The 463th Hospital of People’s Liberation Army: Yansong Li (PI), Zuozheng Zhao, Te

Liu

Shenyang Tenth People’s Hospital: Jing Chen (PI), Li Sun

The Fourth Affiliated Hospital of China Medical University: Lianbo Gao (PI), Shen Tian,

Huan Zhou, Yuan Jiang, Hui Jia, Qiansuo Liu, Changjiang Yu, Xiaofei Yu, Jie Li, Zhihua

Yu, Zhenwei He, Yongliang Gao, Honghua Gao

Shenyang Fourth People’s Hospital: Liyang Zhang (PI), Yan Liu, Mingming Dong

The Second Affiliated Hospital of Shenyang Medical College: Yisha Wang (PI), Qing

Chang, Mei Guo, Jia Hao, Bo Chen

Shenyang 739 Hospital: Lihong Zhang (PI), Jing Yang

Shenyang 242 Hospital: Hui Liu (PI), Fenghui Liu, Hong Guo, Luwei Zhang, Li Zhang

The First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine:

Ying Hai (PI), Zhi Li

The General Hospital of Shenyang Military Region: Huisheng Chen (PI)

The People’s Hospital of Liaoning Province: Xiaohong Chen (PI)

Jinqiu Hospital of Liaoning Province: Fusheng Bai (PI), Hongyan Lei, Yu Han, Lin You

Shenyang Medical College Affiliated Central Hospital: Runhui Li (PI), Hanshu Li,

Tianming Cao, Chang Liu

Shenyang Fifth People’s Hospital: Jinchun Wang (PI), Bin Zhao

Sujiatun District Central Hospital: Xiangjun Zhang (PI), Yang Zhao

Shenyang Second Hospital of Traditional Chinese Medicine: Kefei Fu (PI), Jian Yang, Qi

Wang, Yunfa Xu, Lei Shi, Xun Wang, Deyuan Jiang, Zhe Jin, Yuxian Zhu, Li Guo, Chang

Xu, Lin Lin, Yueqi Cui, Jun Chen, Hongyan Jing, Jian Li

Sui Y, et al. Stroke Vasc Neurol 2020;0:1–8. doi: 10.1136/svn-2020-000332