3 Hospitals First to Receive Comprehensive Stroke Designation

Additionally, the team asked for response times, Albers says, like "How long does it take your neurosurgeons to get to the operating room from the time they receive the phone call at home. ... And they don't accept, 'Well, I think it takes them 30 minutes.' They said, 'Show me where you recorded this data.'"

The rationale for a higher-tier stroke center credential is that, in addition to handling any stroke patient, comprehensive centers should be better equipped to deal with the toughest, most complex patients—those requiring neurosurgical and neuroradiological expertise for, say, complicated arteriovenous malformation (AVM) procedures, Hampel says.

These newly designated centers have higher standards for brain imaging capability as well as physician and stroke team expertise, she says.

Comprehensive designation is much more expensive for hospitals than primary certification, because it requires facilities to make available multidisciplinary teams of neurointerventionalists, neuroradiologists, neurosurgeons, and endovascular technicians. And more time is required for documentation and review.

The certification also requires that the hospitals and their operators have the latest high-tech surgical equipment for complex aneurism clipping and endovascular coiling techniques to find and remove clots.

For example, the comprehensive level stroke care requires the following:

• Catheter angiography available on site 24 hours a day, 7 days a week
• CT angiography available on site 24 hours a day, 7 days a week
• Extracranial ultrasonography
• MR angiography (MRA) available on site 24 hours a day, 7 days a week
• MRI, including diffusion-weighted MRI, available on site 24 hours a day, 7 days a week
• Transcranial Doppler
• Transesophageal echocardiography and transthoracic echocardiography.