PLAT and Cerebral ischemia: As compared to hospitals that were not certified PSCs at the time of study enrollment but eventually achieved certification, hospitals that had already achieved PSC designation at the time of enrollment had a statistically significant reduction in the time from ED arrival to first brain scan, from 47 to 33 min (p = 0.014); a statistically significant increased rate of tPA utilization in cases of cerebral ischemia, from 27 to 43% (p < 0.001); and a statistically significant reduction in the time from ED arrival to tPA initiation, from 98 to 71 min (p = 0.003).