The Stroke CenterAbout Stroke & The BrainThe Gold Standard Printer Friendly Page

New drugs, medical technology and devices as well as innovative surgical and minimally invasive procedures have greatly improved the prognosis for stroke patients. For patients who once might have spent weeks in the hospital, only to return to a more restricted lifestyle, it now is possible to leave in days and resume the activities they enjoy. The key to their successful recoveries is in receiving the treatment most appropriate for their stroke circumstances during the critical early hours following the onset of symptoms.

Not all hospitals have the necessary staff and equipment to diagnose and care for acute stroke patients in the rapid, efficient manner required. Where the patient is taken for treatment is just as important as how quickly he or she arrives there.

Comprehensive Stroke Centers

Hospitals designated as “comprehensive stroke centers” offer patients the best chance for survival and return to their normal life. Mounting research shows that stroke victims receive better treatment and recover with fewer disabilities at such hospitals.

Comprehensive stroke centers are staffed and equipped around the clock to swiftly and accurately diagnose and treat acute stroke victims on an emergency basis. They have access to the latest diagnostic and therapeutic developments in the field and offer the widest range of interventional options to stop a stroke in progress and minimize the potential damage. They also tend to have the most extensive ongoing experience with stroke because of the high volume of cases they see.

In addition, they provide the specialized monitoring and intensive care that stroke patients require beyond the emergency room treatment, as well as any early rehabilitative services that might be needed. And they offer the widest range of expertise and therapeutic options for preventing stroke or its recurrence.

This does not mean that some facilities are delivering lower-quality care. Rather, the data demonstrate that high-volume centers tend to generate better medical outcomes due to a multiplicity of factors related to specialized stroke care.

What Makes a Hospital a Comprehensive Stroke Center?

The Brain Attack Coalition — an alliance of the nation’s leading professional, non-profit and government entities in the fight against stroke – has issued standards that hospitals must meet in order to be designated a comprehensive stroke center.

These requirements include:

• An Acute Stroke Team with training and expertise in stroke must be available around-the-clock, seven days a week in order to evaluate within 15 minutes of arrival any patient who may have suffered a stroke.
  
• A neurosurgeon must be available 24/7. The hospital should be able to provide Neurosurgical Services to stroke patients within two hours of when the services are deemed necessary.
  
• The hospital must have written guidelines (care protocols) for emergency treatment of stroke patients. This standardizes, streamlines and accelerates the diagnosis and treatment of stroke patients, which is critical in minimizing complications.
  
• The hospital should be well-known to area Emergency Medical Services (EMS) or rescue squads as the place to take suspected stroke victims. There should well-established and effective lines of communication between EMS and the stroke center during transport so that the proper diagnostic tests and treatment can begin as soon as possible upon the patient’s arrival.
  
• The hospital’s Emergency Department staff should be trained in diagnosing and treating stroke and have good lines of communication with both EMS and the acute stroke team.
  
• The hospital must be capable of performing and evaluating a brain imaging (neuroimaging) study (such as a CT or MRI scan) within 45 minutes of the time it is ordered. And a specialist must be present at all hours who can interpret the findings. This is essential in making a fast, accurate diagnosis.
• Laboratory services must be available around-the-clock.
  
• The hospital must have a dedicated neurological intensive care unit where patients with brain trauma can receive specialized monitoring and care beyond the initial life-threatening period.

Primary Stroke Center certification is given by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This certification is based on published guidelines from the Brain Attack Coalition and American Stroke Association.

The National Institute of Neurologic Disorders and Stroke (NINDS), a division of the National Institutes of Health (NIH), has recommended that all U.S. hospitals designate whether they have the facilities for comprehensive stroke care. According to these recommendations, emergency medical responders should transport possible acute stroke victims to comprehensive centers whenever possible.

Cities and states around the country are starting to adopt protocols to ensure that stroke patients receive the rapid and comprehensive treatment required for the best outcome. In Cincinnati, for example, area hospitals can page a team of experts for on-site help whenever a stroke victim arrives. San Diego has a similar system. In Nevada, where patients can be hundreds of miles from the nearest primary stroke center, a team of experts is available around the clock to advise rural hospitals by phone and computer on immediate treatment. Subsequently, the patient may be transported to a comprehensive stroke center for follow-up care.

In New Jersey and the New York metropolitan area, which has one of the highest incidences of stroke in the country, UMDNJ-University Hospital’s Stroke Center is a leader in providing around-the-clock comprehensive stroke services.

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