The Importance of Primary and Comprehensive Stroke Centers

Much is known about how to treat stroke victims swiftly and effectively, but access to first rate stroke care varies tremendously. The Joint Commission-a nonprofit that accredits more than 20,000 health care organizations across the country-has developed a set of certifications to identify a hospital's capacity for stroke care.

For someone having a stroke caused by a blocked artery in the brain, there are several levels of treatment. The first begins with basic care: identifying the type of stroke and when it occurred, observing blood pressure, and ensuring the patient is breathing safely. Such needs can be met at local hospitals certified as "stroke ready." From that point, a determination can be made whether the patient should be treated locally or transferred to facilities with more advanced care. Some of these local hospitals can administer "clot buster" therapy using a drug called tPA if the patient is seen within 4.5 hours of the onset of stroke. The decision to do so typically involves consultation with a remote stroke specialist by telephone or video "telestroke" evaluation.

The Primary Stroke Center certification is awarded to hospitals fully capable of acute stroke treatment, including tPA and extended evaluation and customized treatment. Staffed by fully qualified stroke specialists, they have dedicated intensive care beds and provide rehabilitation services.

However, for some patients with complex or severe cases, administration of tPA is not enough. They may have a type of stroke caused by a broken artery bleeding into the brain, for example. For such critical cases, specialized neurointerventionalists and neurosurgeons are required to stop the bleeding and such patients need to be monitored very closely. To identify the stroke treatment programs best equipped to handle the most difficult cases, The Joint Commission established a new certification in 20 12 called Comprehensive Stroke Center certification. To attain it, organizations must meet all the requirements for primary stroke center certification and numerous others including:

• Have dedicated neurointensive care unit beds that provide neurocritical care 24 hours a day, seven days a week for complex stroke patients
• Have in-house access to advanced imaging capabilities, including catheter, CT, MR angiography, and a host of others
• Have complication rates better than national guidelines
• Meet minimum patient volume requirements for patients needing advanced medical and surgical care
• Coordinate post-hospital care for patients, including three months of follow-up
• Actively participate in stroke research

Recognizing a hospital's relative readiness for stroke treatment is a useful tool in providing appropriate levels of care for stroke patients and identifying resources when higher levels of expertise are called for.