In order to bridge the great gaps, Chinese Stroke Association (CSA) and American Heart Association (AHA) sought to develop, conduct, and assess a multifaceted quality improvement intervention to increase the adherent rate of IV tPA and ET and improve 3-month clinical outcomes for these patients through our cluster-randomized stepped-wedge IMPROVE: Stroke in China trial.

Inclusion Criteria:

Hospitals：

1. Voluntary.
2. Hospitals from CSCA.
3. Secondary or tertiary public hospitals with an emergency department and neurologic wards that receive patients with AIS.
4. Have a 24*7 on-call stroke team.
5. Have the capacity of IV rt-PA thrombolytic therapy or/and endovascular treatment.
6. Implement at least 10 patients' rt-PA or/and endovascular treatment during the last year.
7. Admit at least 5 patients of acute ischemic stroke within 24 hours after onset each month.
8. Have full desire to improve the procedure of treatment of acute ischemic stroke.
9. Have good cooperation among Neurology department, Emergency department, Interventional department, Neurosurgery department, Laboratory and Radiology department.

Patients： Patients who are ≥18 years old were eligible for inclusion if they presented with acute ischemic stroke diagnosed by CT and/or MRI and arrived at hospital within 6 hours after symptom onset.

Exclusion Criteria:

Hospitals：

1. Hospitals that can not comply with the protocol and finish the research.
2. Grade-one hospitals and non cerebral vascular disease specialized hospitals.
3. Hospitals involved in other stroke care quality improvement projects or relevant clinical trials.

Patients：

1）Patients refuse to participate in this study