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

 Shorter transport time or distance to hospital

[48–51]

[52, 53]

 Urban (vs rural)

–

[54–56]

 Centralised (hub model)

–

[57]

 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, 62–64], [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]

 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]

–

 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]