1. Test Form Completion
Medical institutions must complete a preliminary self-assessment by filling out an evaluation form. The system will automatically analyze the following based on the WSO Stroke Center classification standards:
- The hospital's positioning within the classification system;
- The compliance rate of recommended elements;
- If the minimum standards for a classification are not met, you will see the items requiring improvement to achieve the classification higher-level standards.
2. Certification Application
2.1 Submission of Certification Application Form
Medical institutions must submit a formal certification application form through the system, which must include:
- Basic qualification proofs;
- Organizational structure of the stroke center;
- Key facility and equipment lists (e.g., CT, MRI, number of stroke unit beds, etc.).
2.2 Mandatory Requirements
All mandatory items are prerequisites for the certification application and must be 100% met.
2.3 Recommended Element Compliance Requirements
- Initial certification: Recommended element coverage must be ≥75%;
- Re-certification: Recommended element coverage must be ≥85%;
- Stage-by-stage improvement data for quality indicators must also be submitted.
2.4 Data Submission Requirements
Continuous 4-month stroke patient treatment registration data and key performance indicators must be uploaded for baseline assessment.
3. Pre-certification & On-site Evaluation
Through preliminary self-assessment, potential candidate units are selected. After the system confirms compliance with the standards, the hospital will receive pre-certification and a request for further documentation (in preparation for the on-site evaluation). The on-site evaluation will be conducted within 2 to 6 months after the application. During this period, the center can prepare for certification (e.g., completing training, initiating improving quality indicator registration).
3.1 The following documents should be uploaded to the platform (must be uploaded at least 1 month before the on-site evaluation):
① Hospital and stroke center structure (infrastructure—number of hospital beds, ICU, CT scanners, MRI machines, stroke unit beds, etc., as well as a list of stroke team members and professionals).
② Continuing Medical Education (CME)—Training certificates (to be provided during the evaluation).
③ NIHSS certificates: All neurologists and one representative each from emergency care services, the stroke unit, and the ICU must obtain this certificate.
④ Modified Rankin Scale: Evaluation results must be available for all neurologists and specialized assessors.
⑤ Stroke training for nurses, nursing assistants, and other multidisciplinary team professionals—4 hours annually—covering swallowing, fever management, blood glucose management, mobility, secondary prevention, anticoagulation therapy, etc. Certificates can be provided on-site, along with attendance lists, training plans, and learning assessment mechanisms.
⑥ Training for nurses and nursing assistants on acute stroke patient management—2 hours annually. Certificates can be provided on-site, along with attendance lists, training plans, and learning assessment mechanisms.
⑦ Emergency physician training—4 hours annually. Certificates can be provided on-site, along with attendance lists, training plans, and learning assessment mechanisms.
⑧ Training for stroke unit, vascular intervention room, and neurocritical care doctors—8 hours annually. Certificates can be provided on-site, along with attendance lists, training plans, and learning assessment mechanisms.
⑨ Training for physical therapists and occupational therapists—4 hours annually. Certificates can be provided on-site, along with attendance lists, training plans, and learning assessment mechanisms.
3.2 Written protocols used (reference description).
3.3 Stroke patient pathways.
3.4 Performance indicators:
What indicators are evaluated? Is it a local registry? National registry? International registry? (If international, which registry?) Frequency of evaluation? How are results handled? (Action plan). A data utilization plan should be in place. Typically, the stroke center’s interdisciplinary team reviews this monthly quarterly. Quality improvement projects should arise from gaps deficiencies revealed by the data.
3.5 Who is responsible for data collection? (Quality control)—Name and profession (usually the nurse coordinator).
3.6 What quality improvement strategies are used? How frequently? Discussions on quality indicators, case reviews, etc.
3.7 Stroke center meetings: During the on-site visit, upload display attendance lists for training, case discussions, scientific meetings, quality indicator discussions, etc.
3.8 Report whether there is a stroke network and the organization of pre-hospital care. Describe the situation.
You will be contacted by the certification committee to assist in preparing for the on-site certification and to explain the relevant process.
4. On-site Hospital Evaluation (Applicable to All Types of Centers)
4.1. Opening Meeting: A session between the evaluators and hospital representatives (stroke center coordinator, nurse in charge of the stroke program, stroke unit team, stroke team, emergency coordinator).
a. Introductions of evaluators and hospital team.
b. Explanation of the certification process.
c. Explanation of the on-site evaluation by the physician evaluator.
d. Overview of the stroke program (20-minute presentation by the stroke program coordinator):
• Program development (when it started, how it evolved?).
• Infrastructure.
• Program organization.
• Interdisciplinary teams across hospital departments (emergency department, stroke unit team general ward, ICU).
• Continuity of medical care/care pathways.
• Program quality monitoring (quality indicators, outcome review meetings, weekly stroke team meetings, education for the stroke team and related departments—emergency, ICU).
e. Nurse evaluator reports on the center’s application results (based on the roadmap—what is available, what is missing).
f. Organization of the tour.
4.2. Prepare a list of stroke patients for evaluation to assess their treatment pathways. Track the medical process from admission to discharge, evaluating hospital policies, evidence-based practices, and system implementation.
4.3. Review records of 3-5 patients and compare them with their medical records (nurse).
4.4. Review quality improvement projects and performance indicators.
4.5. Review local network structure, pre-hospital coordination, protocols, and personnel qualifications.
4.6. Tour the emergency room, ICU, stroke unit/ward, and vascular intervention room (for advanced stroke centers), and meet with the stroke center coordinator, stroke team representatives, and other professionals from the hospital and emergency department.
4.7. Before the evaluation, 4 months of data and performance indicators must be registered on the platform.
4.8. Closing Meeting.
4.9. Evaluators must complete forms (during the visit, regarding structure, personnel, protocols) and fill out specific checklists.
Evaluators will identify potential deficiencies/areas for improvement and require the center to develop an action plan for service improvement (to be presented during the next certification).
After the evaluation and receipt of the improvement plan, the certification committee will review the application and make a final approval decision. The hospital will receive the results within 1 month.