Northwestern Memorial neurologist is lead author of comprehensive stroke center recommendations


Brain Attack Coalition recommends establishment of comprehensive stroke centers capable of delivering full spectrum of care to seriously ill patients with stroke

Recommendations for establishing comprehensive stroke centers (CSC) to treat patients with complex types of stroke or cerebrovascular disease who require more specialized care and technological resources than are available at Primary Stroke Centers (PSC) will be published in an upcoming issue of Stroke: Journal of the American Heart Association and are currently available online. Developed by the Brain Attack Coalition (BAC), a group of professional, voluntary and governmental organizations committed to improving stroke care, the recommendations state that CSCs need stroke specialists, advanced imaging and surgical capabilities, and a specialized infrastructure.

Nearly five years ago, the BAC proposed two types of stroke centers: primary and comprehensive. Recommendations for PSCs, which have the necessary staffing, infrastructure and programs to stabilize and treat most acute patients, were published in the Journal of the American Medical Association and efforts are now underway to credential these facilities.

"While PSCs provide stroke patients with high-quality care, we acknowledged that 30 to 35 percent of stroke patients with complex stroke types, severe deficits or multiple organs affected would benefit from an even higher level of specialized care, hence our recommendations for CSCs," explains Mark J. Alberts, MD, director of the Stroke Program at Northwestern Memorial Hospital, and the lead author on the guidelines for both PSCs and CSCs. "These recommendations for CSCs vs. PSCs approximate different levels of care and capabilities, which is akin to what different levels of trauma centers do."

"When our recommendations for PSCs were published, a survey showed that less than 34 percent of hospitals had appropriate stroke protocols in place and less than 18 percent had rapid identification for patients experiencing acute stroke," said Dr. Alberts. "Today, there are over 120 PSCs certified by the Joint Commission on Accreditation of Healthcare Organizations, and several hundred more are moving in that direction. Overall, the level and quality of care for stroke patients have increased dramatically in the past two-three years. Now, it's time to take stroke care to the next level."

This consensus statement provides patients, physicians, administrators, and health care planners with the most advanced and detailed recommendations for the structure and process of high level stroke care. To be a comprehensive stroke center, a hospital needs to be a primary stroke center, along with several dozen additional elements in terms of staffing, personnel, infrastructure, programs, expertise and outcomes.

"CSCs require a multidisciplinary team of health care professionals who are well trained in the care of stroke patients, as it relates to their disciplines," Dr. Alberts said. "In addition to the need for advanced diagnostic technology, CSCs should offer operating rooms and interventional radiology suites that are staffed 24 hours a day, seven days a week, when feasible."

The BAC reviewed medical literature and surveyed expert physicians nationwide to arrive at the consensus statement. Dr. Alberts said the key areas that characterize a CSC are:

  • Health care personnel with specific expertise in a number of medical disciplines, including vascular neurology, neurosurgery, vascular surgery, advanced practice nurses, physical therapists, and social workers;
  • Advanced imaging capabilities, such as magnetic resonance imaging (MRI), computerized tomography angiography (CTA), digital cerebral angiography and transesophageal echocardiography;
  • Ability to perform advanced surgical and endovascular procedures, including carotid endarterectomy; and
  • Special infrastructure and programmatic elements, such as an intensive care unit and a stroke registry.

The panel noted that there are no data yet on a cost-benefit analysis for a CSC.

"Individual hospitals will have to develop business plans that consider the volume of stroke patients, payor mix, average costs and revenue per case and future growth plans," the authors wrote.

"These objective set of recommendations are meant to help guide healthcare professionals and hospitals in terms of what it expected from a CSC in terms of programs and personnel and expertise. They may also help assist patients in terms of where to go with complex problems related to stroke," concludes Dr. Alberts.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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