Stroke center

Stroke Center
SystemStroke certification
FocusStroke triage, health care efficiency, improved outcomes
Significant diseasesstroke
SpecialistFirst responder

Stroke centers are medical centers having health professionals specially trained in emergency stroke care.[1] They are considered preferred first responders in the diagnosis and treatment of strokes. Certifying authorities recognize four levels of certification, highest to lowest,[2] as follow:

  • comprehensive stroke center
  • thrombectomy-capable stroke center
  • primary stroke center
  • acute stroke-ready hospital

The Stroke Center Certification Program was developed by The Joint Commission in collaboration with the American Heart Association[2] and the American Stroke Association. These organizations offer guidance for the development of state-level policy standards in stroke care, including the designation of qualified facilities.

In order to be recognized as a stroke center, a medical center must meet national guidelines for specialized medical care as recommended by a certifying authority. A facility must either obtain certification by training or by being recognized by a certification or accreditation authority for its existing level of skilled care.[3] Certifying authorities include DNV GL Healthcare;[4] Healthcare Facilities Accreditation Program (HFAP), now a division of Accreditation Commission for Health Care (ACHC); or The Joint Commission (TJC). In some states a state health department or medical board may be the certifying authority. For example, in New York, centers are designated by the New York State Department of Health (NYSDOH).[5][6]

Pre-admission triage by Emergency Medical Service (EMS) technicians dictate the level of stroke center to which a stroke patient will be routed; considerations include severity of the symptoms, evaluation of the level of medical care that may be needed, and the relative distance of various certified stroke centers in the vicinity of each medical event.[7][8] Upon patient arrival, the qualified medical center should follow recommended protocols for stroke triage, developed by the American Heart Association and American Stroke Association.[9] These include specified, time-sensitive medical care at exact intervals between ten minutes and one hour, starting at the time of arrival at the hospital's emergency department.[9] Typically, medical interventions are timed using a stopwatch, while a qualified member of the stroke team announces each interval.[10]

Adherence to this critical one-hour time scale recognizes that speedy care creates a better chance of recovery.[1] Nursing Management says, "Research has shown that early evaluation and treatment are directly linked to reduced motor and cognitive deficits, as well as lower mortality."[11] Protocols generally include physical examination, obtaining a summary of the patient's medical history, cursory physical coordination and speech tests, blood tests, CT scans[12] or MRI, scan evaluation, and recommended treatment (such as administering blood-thinners, thrombolysis,[12] or preparation for surgery).

  1. ^ a b "Stroke". Centers for Disease Control and Prevention (CDC). U.S. Department of Health & Human Services. 2021. Archived from the original on April 16, 2021. Retrieved April 19, 2021 – via Wayback.
  2. ^ a b "Healthcare Certification". American Heart Association. 2021. Retrieved March 8, 2021. The American Heart Association with the Joint Commission collaborate to provide hospitals Acute Stroke Ready Certification, Primary Stroke Certification, Thrombectomy-Capable Stroke Certification, and Comprehensive Stroke Certification to qualifying hospitals.
  3. ^ "A Summary of Primary Stroke Center Policy in the United States" (PDF). Centers for Disease Control and Prevention. Atlanta: U.S. Department of Health and Human Services. 2011. p. 4. Archived from the original (PDF) on October 21, 2020. Retrieved March 8, 2021.
  4. ^ "Stroke Care Certification Programs". DNV GL Healthcare. 2019. Archived from the original on December 31, 2020. Retrieved March 12, 2021 – via Wayback Machine.
  5. ^ "New York State Stroke Designation Program". New York State Department of Health (NYSDOH). New York State Department of Health. 2021. Retrieved March 8, 2021.
  6. ^ "NYSDOH Stroke Designated Centers". New York State Department of Health (NYSDOH). New York State Department of Health. 2021. Retrieved March 8, 2021.
  7. ^ Nguyen, T. Truc My; van den Wijngaard, Ido R.; Bosch, Jan; van Belle, Eduard; van Zwet, Erik W.; Dofferhoff-Vermeulen, Tamara; Duijndam, Dion; Koster, Gaia T.; de Schryver, Els L. L. M.; Kloos, Loet M. H.; de Laat, Karlijn F.; Aerden, Leo A. M.; Zylicz, Stas A.; Wermer, Marieke J. H.; Kruyt, Nyika D. (2021-02-01). "Comparison of Prehospital Scales for Predicting Large Anterior Vessel Occlusion in the Ambulance Setting". JAMA Neurology. 78 (2): 157–164. doi:10.1001/jamaneurol.2020.4418. hdl:1887/3182694. ISSN 2168-6149.
  8. ^ Xu, Yaqian; Parikh, Neal S.; Jiao, Boshen; Willey, Joshua Z.; Boehme, Amelia K.; Elkind, Mitchell S.V. (April 2019). "Decision Analysis Model for Prehospital Triage of Patients With Acute Stroke". Stroke. 50 (4): 970–977. doi:10.1161/STROKEAHA.118.023272. ISSN 0039-2499. PMC 6435279. PMID 30908159.
  9. ^ a b Powers, William J.; Rabinstein, Alejandro A.; Ackerson, Teri; Adeoye, Opeolu M.; Bambakidis, Nicholas C.; Becker, Kyra; Biller, José; Brown, Michael; Demaerschalk, Bart M.; Hoh, Brian; Jauch, Edward C.; Kidwell, Chelsea S.; Leslie-Mazwi, Thabele M.; Ovbiagele, Bruce; Scott, Phillip A. (December 2019). "Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. 50 (12): e344–e418. doi:10.1161/STR.0000000000000211. ISSN 1524-4628. PMID 31662037.
  10. ^ Fousse, Mathias; Grün, Daniel; Helwig, Stefan A.; Walter, Silke; Bekhit, Adam; Wagenpfeil, Stefan; Lesmeister, Martin; Kettner, Michael; Roumia, Safwan; Mühl-Benninghaus, Ruben; Simgen, Andreas; Yilmaz, Umut; Ruckes, Christian; Kronfeld, Kai; Bachhuber, Monika (October 2020). "Effects of a Feedback-Demanding Stroke Clock on Acute Stroke Management: A Randomized Study". Stroke. 51 (10): 2895–2900. doi:10.1161/STROKEAHA.120.029222. ISSN 0039-2499.
  11. ^ Cite error: The named reference NUMA was invoked but never defined (see the help page).
  12. ^ a b Campbell, Bruce C.V. (2020). "Optimal Imaging at the Primary Stroke Center". Stroke. 51 (7) (published June 17, 2020): 1932–40. doi:10.1161/STROKEAHA.119.026734. PMID 32568641.