Criteria for Stroke Center Certification


1a. Door-to-needle time (median)______ min

% of patients with door-to-needle time < 60 min _______ (target > 50%)
% of patients with door-to-needle time < 45 min _______

1b. Door-to-puncture time (median) _____ min 

% of patients with door-to-puncture < 120 min _____ (target > 50%)
% of patients with door-to-puncture < 90 min ______

2. Elegibility for reperfusion
                   Total elegibility _____% (number of patients reperfused / total number of ischemic stroke patients)
                   Elegibility within the window for IV thrombolysis ____% (number of thrombolyzed patients / number of ischemic stroke patients arriving ≤ 4.5h of symptom onset)     

3a. % Final TICI 2b-3 _____ (for Advanced Centers only)

3b. Puncture-to-recanalization time ___ (Advanced Centers)

4. Dysphagia assessment _________ %

5. Patients with suspected stroke who performed NCCT/MRI______%

6. Discharge with prescription of antiplatelets in ischemic stroke patients _____% (target 100%)

7. Discharge with prescription of oral anticoagulants in patients with AF ________ % (target 90%)

8. Stroke patients attended in a stroke unit _______ (number of patients with “U-AVC = sim” / total number of patients with ischemic stroke, hemorrhagic stroke or TIA (target 90%)

9. Median length of stay _____days  (IQR 25-75)

10. Inhospital mortality _______%

Deaths by ischemic stroke/TIA_____%
Deaths by hemorrhagic stroke _____%

11. Mean of the Modified Rankin Score in 90 days _____

Modified Rankin Score 0 to 1 in 90 days ______%
Modified Rankin Score 0 to 2 in 90 days ______%
Modified Rankin Score 6 in 90 days _____%

Criteria Essential Stroke Center Advanced Stroke Center
Access to hyperacute stroke care
Protocols for rapid evaluation and diagnosis of stroke patients in Hospital/
Emergency department 24hours/day, 7days/week, with time metrics assessment
Mandatory Mandatory
Access to basic diagnostic services
Laboratory blood test 24/7 (CBC, electrolytes, urea, glucose, INR, PT) Mandatory Mandatory
Electrocardiogram (12 lead) 24/7 Mandatory Mandatory
Computed Tomography (CT) scan brain 24h/7 days Mandatory Mandatory
Capability to do CT Angiography (CTA) 24/7 Recomendado Mandatory
Transthoracic Echocardiogram Mandatory Mandatory
Vascular Doppler ultrasound Mandatory Mandatory
Holter monitors Recommended Recommended
Access to advanced diagnostic services
Magnetic Resonance Imaging (MRI) Mandatory
Capability to do MR Angiography Mandatory
CT or MR Perfusion scans Recommended
Prolonged ECG monitoring devices Recommended
Transcranial Doppler Recommended
Transesophageal Echocardiogram Recommended
Access to emergency medical services –EMS– (ambulance)? ( ) Yes ( ) No Recommended Recommended
If yes:
Training of ambulance crews to identify stroke signs
using FAST mnemonic or similar
Recommended Recommended
Work with ambulance systems to have stroke identified as
a high priority transport emergency
Recommended Recommended
Access to nurses and nursing assessment with stroke training
Acute care settings (the training should be documented, at least 4 hours/year
- the documentation can be uploaded in the platform or should
be presented during the onsite visit)
Mandatory Mandatory
Stroke unit settings (the training should be documented, at least 4 hours/year
- the documentation can be uploaded in the platform or should be presented during the onsite visit,
including stroke unit protocols, neurological assessment and swallow screen)
Mandatory Mandatory
Access to physicians with stroke expertise in acute stroke care available 24h/7 days Mandatory Mandatory
Check below the specialist responsible for thrombolysis treatment in your hospital
(check all available)
Neurologist ( ) ( )
Neurosurgeon ( ) ( )
Emergency physician
Intensivist ( ) ( )
Other speciality ( ) ( )
Access to stroke specialists through telestroke modalities, and teleradiology ( ) ( )
Access to physicians with expertise in stroke prevention and stroke rehabilitation Recommended
Program to develop and maintain core competencies and stroke care Mandatory Mandatory
Access to acute inpatient stroke care, where admitted stroke patients are cared for on: Mandatory (1 available, the item is positive) Mandatory (1 available, the item is positive)
Stroke Unit (a defined group of beds, staff, and protocols that are used
for the acute care of patients with a stroke)
( ) ( )
Clustered model on same ward ( ) ( )
Access to acute Intravenous thrombolysis
IV thrombolysis Mandatory Mandatory
Members of a interdisciplinary stroke team
Neurologist with stroke expertise (or Stroke physician in some countries) Mandatory Mandatory
Stroke Nurses Mandatory Mandatory
Nursing assistants Mandatory Mandatory
Pharmacist Recommended Recommended
Social worker/case manager Recommended Recommended
Palliative Care team Recommended Recommended
Physiotherapist Mandatory Mandatory
Occupational Therapist Recommended Recommended
Speech-Language Pathologist Mandatory Mandatory
Neurosurgeon Recommended Mandatory
Neurointerventionalist (Interventional Neurologist OR Endovascular
Neurosurgeon, OR Interventional Neuroradiologist)
Access to stroke unit protocols to guide acute stroke care based on best practice guidelines
(Medical and nursing assessments)
Swallowing assessment performed Mandatory Mandatory
Nutrition, hydration Recommended Recommended
Functional status, mobility, DVT risk Recommended Recommended
Level of dependency Recommended Recommended
Skin Integrity Recommended Recommended
Bladder and bowel continence Recommended Recommended
Temperature management Recommended Recommended
Positioning, mobilization Recommended Recommended
Access to stroke prevention therapies such as antiplatelet therapy,
anticoagulants, lifestyle change recommendations, blood pressure management
Recommended Recommended
Access to advanced interventions:
Endovascular thrombectomy 24/7 Mandatory
Neurosurgery for hemorrhagic stroke 24/7 (including clipping and intraventricular drain placement) Recommended Mandatory
Hemicraniectomy for ischemic stroke 24/7 Mandatory
Acute inpatient stroke units Recommended Recommended
Intensive care unit on site Recommended Mandatory
Products to reverse coagulopathy Recommended Recommended
Access to stroke rehabilitation services
Early access to rehabilitation therapies – including cross training of skills to nurses,
nursing assistants and family members
Recommended Recommended
Early functional assessments, goal setting and individualized rehab plans developed Recommended Recommended
Organization of Stroke Care
Stroke Director Mandatory Mandatory
Nurse Coordinator Mandatory
Stroke Task Force (meets monthly) discusses data, guides, performance, improvement Mandatory Mandatory
Interdisciplinary meetings weekly to discuss patient progress against
treatment goals; update management plans
Recommended Recommended
Patient and family education, skills training, and involvement in care planning Recommended Recommended
Discharge planning Recommended Recommended
Stroke training programs for all levels of healthcare providers Recommended Recommended
Participation in quality assessment of services (registry) - 4 months of data
collection in the registry and performance measures must be included in the platform before the visit
Recommended Mandatory
Printed stroke patient educational materials Recommended Recommended
Treatment Requirements
Thrombolysis (minimum number recommended per year) 10 20
Thrombectomy (minimum number recommended per year) 10
Coordinated stroke care provided across geographically discrete regions
Stroke pathways that define movement of stroke patients across
region to higher and lower levels of services as required
Recommended Recommended
Coordinated referral system Recommended
Provide telestroke consultations to smaller and more rural centers Recommended
Education of population Recommended Recommended
Implement research in stroke Recommended