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 between and 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. 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 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 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 The emergency stroke team can complete Sampling of 3 the NIHSS and preliminary assessment Deduct 1 point for incompletion cases in the within 10 minutes after arrival; all stroke of each requirement. This item past year. 1 team members present within 15 minutes; 4.0 does not score if not all stroke Simulation complete CT scan and interpretation within team members can be present exercise when 30 minutes; collect all necessary laboratory within 15 minutes. necessary examination results within 45 minutes. The radiology department can perform MRI scans (including T1, T2, SWI, FLAIR, Sampling of 3 Deduct 1 point for the absence DWI, PWI, MRA, MRV and gadolinium cases in the 2 4.0 of each item until zero. contrast), CTA, CTP, DSA, past year and transesophageal echocardiography and field inspection bubble echocardiography. Mean DNT < 60 min for intravenous Inability to carry out thrombolysis. Patients who receive bridging intravenous thrombolysis does Sampling of 3 therapy and cannot undergo endovascular not score. Deduct 5 points for a cases in the 3 treatment at the end of intravenous 8.0 mean DNT > 60 minutes. past year and thrombolysis for various reasons must be Deduct 3 points for failure to field inspection transferred within 30 minutes (DI-DO) to transfer within 30 minutes or to Technical Technical ability(40) capable hospitals. conduct endovascular therapy. 1 In-hospital therapies such as antiplatelets, antihypertensives, and statins can be used reasonably according to the guidelines. 2 Preventive measures targeting aspiration Sampling of 3 pneumonia, deep vein thrombosis, Deduct 1 point for not cases in the 4 gastrointestinal bleeding and malnutrition 4.0 delivering standardized therapy past year and can be properly applied. for each item. field inspection 3 Physical and physiological assessments such as limb, language, swallowing function assessments and early rehabilitation can be applied. 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 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).