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NSA Stroke Center Network Stroke Center Recommendations
NationalStrokeAssociationRecommendations
NSA Stroke Center Network Stroke Center Recommendations Operational
Recommendations
The NSA Stroke Center Network recommends that: The Center's administration, medical staff, and nursing staff demonstrate a commitment to providing high quality health care to persons with stroke and persons at risk for stroke including stroke prevention, acute stroke education, and rehabilitation, e.g. protocol, standing orders, etc. The Center's commitment includes policy and procedures for the maintenance of services essential to the Stroke Center; assurance that all stroke patients receive medical care at the level of the hospital's designation; proof of commitment of the financial, human and physical resources required for the stroke program; and proof of establishment of a priority admission for the stroke patient to the full services of the institution.
2
Stroke Centers should accept all acute stroke patients appropriate for the level of care at the hospital regardless of race, sex, nationality, creed or ability to pay.
The Center has a designated medical director committed to acute stroke care. The director should take an active role in acute intervention and be a member of the stroke call roster, facilitate stroke education and training of the medical and nursing staff, and have continuing personal medical education in stroke care. The stroke team has the appropriate experience to maintain skill and proficiency in the care of stroke patients. (Curriculum Vitaes of the stroke team personnel should be reviewed by the medical director regularly.) Stroke Centers have a designated nurse coordinator. The coordinator position may be part-time, but should require at least 50% of a full-time position. The nurse coordinator should continue personal medical education in stroke care.
6
All members of the stroke team continue medical education in stroke care. See the Organizational Recommendations for a definition of the stroke team. The Center has an established EMS protocol for the emergency treatment and delivery of stroke patients.
8
All members of the stroke team comply with the availability and response requirements of a 24 hour Stroke Center. 299
The Center has a written stroke team activation protocol that establishes the criteria for notification of the stroke team and identification of acuity or degree of symptoms of stroke. The protocol should also identify the stroke team members who are to be notified when a stroke patient is enroute or has arrived at the facility. r-~ A stroke registry ~orm be completed on every stroke patient admitted to the K . J hospital and identified as such through the Emergency Department or the Admissions Department.
11
The Center has appropriate support services available for the patient's family from time of entry through time of discharge.
12
The Center demonstrate an adequate post-discharge and rehabilitation follow-up on stroke patients.
3
The Center performs Continuous Quality Improvement including systematic monitoring, reviewing and evaluating the quality of care. In addition to other key data, the assessment is to include morbidity and mortality review.
Organizational Recommendations The NSA Stroke Center Network recommends that: The Stroke Center team include a specialist and support in: a. Neurology b. Neurological Surgery c. Neuroradiology d. Emergency Medicine e. Rehabilitation Medicine The Stroke Center team should include, on an as needed basis, a specialist and support in: a. Primary Care b. Cardiology c. Vascular Surgery d. Internal Medicine e. Hematology f. Infectious Diseases g. Gastroenterology h. Pathology i. Critical Care 300
Patient Care Services Recommendations The NSA Stroke Center Network recommends that:
EmergencyDepartment
1 2
The emergency room doctors be a part of the stroke team.
3
Equipment for resuscitation and life support meet JCAHO standards for the type of institution.
The emergency department has written protocols defining the requirements of emergent stroke treatment.
Imaging Capabilities Imaging equipment include: In-house computed tomography, angiography, neurovascular sonography, echocardiography (transthoracic and transesophageal), nuclear cardiology, and coronary and cerebral angiography. In addition, the Center should have access to magnetic resonance imaging equipment and adequate personnel for 24 hour a day service.
Intensive Care Unit (or the equivalent)
1
A neurologist or a neurosurgeon be on-call and available within 30 minutes of notification.
The ICU equipment should include hemodynamics, resuscitation and life support. The equipment should meet JCAHO standards for the type of institution.
Operating Room The Operating Room have access to surgical services including vascular and neurosurgery 24 hours a day.
2
Operating Room equipment include the proper equipment and services for carotid endarectomy, craniotomy, intracerebral and intracerebellar hematoma
removal. 301
Clinical Laboratory Services
1
Laboratory services be available 24 hours a day.
2
Acute stroke patients be treated as high priority.
3
Equipment and capabilities meet the JCAHO standards for the type of institution.
Community Education A public education program be established to provide educational tools and guidance to the general public, EMS personnel, and other professionals. Community education should include prevention, acute care treatment and rehabilitation services. Education, as defined, should be performed at least on an annual basis.
Rehabilitation Services The Center ensures that quality rehabilitation services are available to stroke patients. Services are not required to be in-house; however, a referral and follow-up system should be in place.
Research The Center should remain current with evidence based medicine, available science, and cerebrovascular research practices. Centers should evaluate such information and apply where applicable in the treatment of stroke patients.
Stroke Center Network National Stroke Association 96 Inverness Drive East, Suite I Englewood, Colorado 80112-5112 Ph: (303) 754-0921 Fax: (303) 649-1328 Web Site: http://www.stroke.org
302
NSA Stroke Center Network Stroke Center Recommendations Operational
Recommendations
The NSA Stroke Center Network recommends that: The Center's administration, medical staff, and nursing staff demonstrate a commitment to providing high quality health care to persons with stroke and persons at risk for stroke including stroke prevention, acute stroke education, and rehabilitation, e.g. protocol, standing orders, etc. The Center's commitment includes policy and procedures for the maintenance of services essential to the Stroke Center; assurance that all stroke patients receive medical care at the level of the hospital's designation; proof of commitment of the financial, human and physical resources required for the stroke program; and proof of establishment of a priority admission for the stroke patient to the full services of the institution.
2
Stroke Centers should accept all acute stroke patients appropriate for the level of care at the hospital regardless of race, sex, nationality, creed or ability to pay.
The Center has a designated medical director committed to acute stroke care. The director should take an active role in acute intervention and be a member of the stroke call roster, facilitate stroke education and training of the medical and nursing staff, and have continuing personal medical education in stroke care. The stroke team has the appropriate experience to maintain skill and proficiency in the care of stroke patients. (Curriculum Vitaes of the stroke team personnel should be reviewed by the medical director regularly.) Stroke Centers have a designated nurse coordinator. The coordinator position may be part-time, but should require at least 50% of a full-time position. The nurse coordinator should continue personal medical education in stroke care.
6
All members of the stroke team continue medical education in stroke care. See the Organizational Recommendations for a definition of the stroke team. The Center has an established EMS protocol for the emergency treatment and delivery of stroke patients.
8
All members of the stroke team comply with the availability and response requirements of a 24 hour Stroke Center. 299
The Center has a written stroke team activation protocol that establishes the criteria for notification of the stroke team and identification of acuity or degree of symptoms of stroke. The protocol should also identify the stroke team members who are to be notified when a stroke patient is enroute or has arrived at the facility. r-~ A stroke registry ~orm be completed on every stroke patient admitted to the K . J hospital and identified as such through the Emergency Department or the Admissions Department.
11
The Center has appropriate support services available for the patient's family from time of entry through time of discharge.
12
The Center demonstrate an adequate post-discharge and rehabilitation follow-up on stroke patients.
3
The Center performs Continuous Quality Improvement including systematic monitoring, reviewing and evaluating the quality of care. In addition to other key data, the assessment is to include morbidity and mortality review.
Organizational Recommendations The NSA Stroke Center Network recommends that: The Stroke Center team include a specialist and support in: a. Neurology b. Neurological Surgery c. Neuroradiology d. Emergency Medicine e. Rehabilitation Medicine The Stroke Center team should include, on an as needed basis, a specialist and support in: a. Primary Care b. Cardiology c. Vascular Surgery d. Internal Medicine e. Hematology f. Infectious Diseases g. Gastroenterology h. Pathology i. Critical Care 300
Patient Care Services Recommendations The NSA Stroke Center Network recommends that:
EmergencyDepartment
1 2
The emergency room doctors be a part of the stroke team.
3
Equipment for resuscitation and life support meet JCAHO standards for the type of institution.
The emergency department has written protocols defining the requirements of emergent stroke treatment.
Imaging Capabilities Imaging equipment include: In-house computed tomography, angiography, neurovascular sonography, echocardiography (transthoracic and transesophageal), nuclear cardiology, and coronary and cerebral angiography. In addition, the Center should have access to magnetic resonance imaging equipment and adequate personnel for 24 hour a day service.
Intensive Care Unit (or the equivalent)
1
A neurologist or a neurosurgeon be on-call and available within 30 minutes of notification.
The ICU equipment should include hemodynamics, resuscitation and life support. The equipment should meet JCAHO standards for the type of institution.
Operating Room The Operating Room have access to surgical services including vascular and neurosurgery 24 hours a day.
2
Operating Room equipment include the proper equipment and services for carotid endarectomy, craniotomy, intracerebral and intracerebellar hematoma
removal. 301
Clinical Laboratory Services
1
Laboratory services be available 24 hours a day.
2
Acute stroke patients be treated as high priority.
3
Equipment and capabilities meet the JCAHO standards for the type of institution.
Community Education A public education program be established to provide educational tools and guidance to the general public, EMS personnel, and other professionals. Community education should include prevention, acute care treatment and rehabilitation services. Education, as defined, should be performed at least on an annual basis.
Rehabilitation Services The Center ensures that quality rehabilitation services are available to stroke patients. Services are not required to be in-house; however, a referral and follow-up system should be in place.
Research The Center should remain current with evidence based medicine, available science, and cerebrovascular research practices. Centers should evaluate such information and apply where applicable in the treatment of stroke patients.
Stroke Center Network National Stroke Association 96 Inverness Drive East, Suite I Englewood, Colorado 80112-5112 Ph: (303) 754-0921 Fax: (303) 649-1328 Web Site: http://www.stroke.org
302