BY SARAH OWENS
If you had a stroke, where would you go? That decision—whether made by family members or by EMS providers—might be made in a matter of seconds, but it can have a tremendous long-term impact on the patient's outcome. That's one of the reasons why the American Heart Association (AHA)/American Stroke Association (ASA) wants every hospital and stroke care center to get certified according to the levels of care they provide—acute, primary, or comprehensive. To that end, the AHA/ASA is encouraging states to pass legislation that requires stroke care centers to adopt this three-tier certification system. In just the past few years, 15 states have passed such legislation, and the AHA/ASA hope more states will follow.
Three Levels of Certification
The AHA/ASA currently recommends that hospitals adopt one of three designations for their stroke centers: acute stroke ready, primary, or comprehensive. Certifications are awarded through a partnership between the AHA/ASA and The Joint Commission, the nation's largest independent healthcare evaluation body.
Acute stroke ready hospitals (bit.ly/AcuteStrokeReady) have basic stroke care capabilities, including access to stroke specialists and imaging and laboratory testing services, available at any time. These hospitals can treat stroke patients who have a blood clot (ischemic stroke) with tissue plasminogen activator (tPA), but they typically do not have a designated stroke unit.
Primary stroke centers (bit.ly/AHA-PrimaryStrokeCenter) typically have a designated stroke unit, and offer round-the-clock stroke team expertise. While they can treat patients with tPA, they can also provide advanced stroke treatment, including neurosurgical care.
At the top of the pyramid, comprehensive stroke centers (bit.ly/ComprehensiveStrokeCenter) can treat the most complex cases of stroke using the newest techniques, including endovascular surgery and stent retrievers. Comprehensive stroke centers also have a neurological intensive care unit, where patients can stay to continue receiving care post-surgery.
Why Certification Matters
Getting certified benefits both hospitals and patients. For hospitals, it "creates accountability," says Olajide Williams, MD, FAAN, associate professor of neurology at Columbia University Medical College and director of acute stroke services at New York-Presbyterian Hospital. "Not every hospital can decide to start using" advanced techniques like endovascular surgery, he says. "They have to have a comprehensive set of skills, a set of resources, and [also] be able to manage potential complications to maximize the patient's outcomes."
Certifications help patients and EMS services make more informed decisions about which hospital to travel to for stroke treatment. "You want to make sure that whatever hospital or part of the state a patient goes to, the patient will be able to receive good stroke care.(No you don't, you want results) The way to do that is to standardize the quality of care across the different stroke hospitals," Dr. Williams says. (Wrong, wrong, wrong, you standardize results you blithering idiot) I don't deal well with stupid people.
Demographic differences mean the quality and availability of services vary across the nation. In New York State, for example, where stroke center designation legislation is currently awaiting State Assembly approval, "lots of hospitals have comprehensive capability," says Dr. Williams, including four in New York City alone.
By contrast, in New Mexico, there are only four advanced primary stroke centers, most in urban areas, like Albuquerque, and no comprehensive stroke centers, says Christopher Calder, MD, PhD, clinical assistant professor of neurology at the University of New Mexico. And since much of the population lives in rural areas, getting to a stroke center can be a challenge. Many people live "30 to 40 miles away from the nearest paved road, let alone the nearest hospital, without electricity or running water," he says. A patient may have to drive a long way to get to a hospital, or be transported by helicopter, which is expensive, Dr. Calder adds. And once the patient arrives, "the hospital might not even have a CT scanner," he says. "That makes transportation to the correct center that much more important."
Does Your Area Have a Stroke Center?
Knowing what to do and where to go in the event that you, or a friend or loved one, have a stroke can make the difference between a full recovery and a lifelong disability. Here are ways to be prepared.
- Know the Signs. Becoming familiar with the FAST acronym, a handy way to memorize the signs and symptoms of stroke, can improve chances of recovery—and survival. To learn more, see our recent blog post by Dr. Sarah Song at bit.ly/NN-ActFAST.
- Identify Local Stroke Centers. You can use the National Stroke Association's online tool at bit.ly/FindStrokeCenter to find a primary, comprehensive, or acute stroke ready hospital in your area. The website also has resources for locating stroke rehabilitation facilities and connecting with neurologists who specialize in stroke care.
- Find a Stroke Specialist. You can also use the AAN's Find a Neurologist tool (patients.aan.com/findaneurologist) to find a neurologist who specializes in stroke in your area. Select subspecialty 'Stroke' and enter your state.