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Table 1 Health system factors associated and not associated with higher thrombolysis rates

From: How can we improve stroke thrombolysis rates? A review of health system factors and approaches associated with thrombolysis administration rates in acute stroke care

Health system factors Studies finding no association with higher thrombolysis rate Studies finding a significant association with higher thrombolysis rate
Travel time and location (environmental restructuring)a
 Shorter transport time or distance to hospital [4851] [52, 53]
 Urban (vs rural) [5456]
 Centralised (hub model) [57]
Training, skills and expertise (training and education)a
 Treated by a neurologist [49, 56], [58] (no statistical test)
 Admitted to or treated in a neurology department or stroke unit [59] [60, 61]
 Academic/teaching hospital [56] [55, 60, 6264], [65]b
 Continuing medical education/formal stroke training [33, 62] [25]
 Higher volume of stroke admissions/number of neuro beds [56, 59] [49, 61, 66]
 Accreditation as medical centre [49]
Facilities and staffing (service provision)a
 Emergency medical service or emergency department [33] [25]
 Neurologists, stroke nurse, stroke unit or team [33] [25, 61, 62, 67]
 Neurological/neuroimaging services [62] [25, 68]
 Laboratory services [25, 62]
 Larger/higher volume hospital [56, 61] [69]
 Arrival during “on” hours [57, 70]
 Arrival on weekend [70] [49, 71]
 24 h or rapid CT/MRI [62]
 Intensive care unit (cat 1) [72]
 Stroke allocated beds [33]
Organisational elements (guidelines and regulations)a
 Commitment of medical organisation or stroke centre director [25] [62]
 Quality improvement outcomes or activities [25, 62]
 Pre-hospital notifications or triage tool [73, 74] [75]
 Stroke-related certification [76] [77]
 Ambulance agreements/protocols or training [33] [33] (borderline positive association)
 Who interprets CT [33]
 Stroke-specific protocols [62] (acute stroke protocol) [25, 33, 62]
 Transfer by a mobile emergency team or ambulance [48, 50, 78, 79]
  1. aTerms in parentheses refer to BCW intervention functions and policy categories
  2. bSignificant in univariate analysis only