I consider all these certifications bogus because they are using the tyranny of low expectations to declare success. Reperfusion and survival are not enough, survivors want 100% recovery. Will you talk to them sometimes without telling them they'll be lucky to recover at all?
Why Stroke Certification Matters
Every minute matters after someone has a stroke. Access to the highest level of stroke center certification makes a difference.
There's been great advancement in the treatment of stroke. The use of intravenous clot busting medication (tPA) and catheter techniques to remove blood clots from brain arteries (thrombectomy) have become the standard of care in treating patients in the emergency setting.
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These
treatments are highly time sensitive – in the situation of a stroke, a
person will lose 1.9 million brain cells, or neurons, per minute. Even a
15-minute improvement in time to treatment can allow more patients to
walk and live at home without disability. It's truly a situation where
every second and every minute counts.
Stroke Care Improvements
With
this in mind, there have been great efforts in the stroke community to
create processes to make assessment and treatment of patients coming
into the emergency room as quick, safe and efficient as possible.
Critical minutes have been shaved off through improvements including:
- Pre-hospital notification by EMS.
- Rapid triage.
- Taking patients directly to CT scanners for brain imaging.
- Training of emergency room personnel on mixing and administering clot-busting medications.
All of
these measures improve patient outcomes and lessen disability.
Similarly, use of stroke severity scales by our EMS colleagues and
potentially bypassing hospitals to get patients to facilities capable of
performing high-quality thrombectomy procedures can avoid multiple
transfers of patients, which are known to add substantial time to care.
Certain
areas of the country have also provided excellent transparency into
their treatment processes, with public reporting of times to treatment
and patient outcomes after stroke. This transparency allows patient and pre-hospital caregivers to be able to make objective assessments about the quality of stroke care in their areas.
Stroke Levels of Care
High-quality stroke care can also be assessed through standards. Several certification bodies now assess stroke centers for their level and capabilities in care.
Three main stroke levels of care exist:
- Primary Stroke Centers, which are able to provide standard stroke care, including use of clot-busting medications.
- Thrombectomy Stroke Centers, which are able to perform the functions of a Primary Stroke Center, with the addition of performing high-quality thrombectomy care 24 hours a day, 7 days a week, 365 days a year.
- Comprehensive Stroke Centers, which are able to care for the most ill of stroke patients, including those with brain bleeding.
Also, rapid access to thrombectomy and neurosurgical expertise, as well as the care delivered in neurological intensive care units are just a few of the critical elements which certified thrombectomy stroke centers and comprehensive stroke center are required to maintain at all times.
READ:
Stroke Rehabilitation: What to Know ]Understanding Stroke Certification Status
With the large number of hospitals around the country, it is important for patients and pre-hospital caregivers to have access to knowledge of the stroke certification status of hospitals in their region. Achieving certification means these hospitals have placed great effort into process development and optimization, as well as safety and quality to ensure they meet appropriate national standards to perform procedures appropriate to the level of their hospital. These hospitals ensure they are continuously working on processes and monitoring to ensure optimal patient outcomes.
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