The hospitals also must retain quality experts who meet monthly to monitor performance indicators. These centers also must treat a minimum number of certain types of patients, and staff must have baseline levels of training and procedural experience.
For example, facilities must perform at least 15 endovascular coiling or surgical clipping procedures per year.
These centers must also hold dedicated neuro-intensive care unit beds and maintain specific procedures for communicating with paramedic EMS teams. They have to be capable of evaluating two or more stroke patients simultaneously and perform specific follow-up tasks after discharge. They also have a requirement to enroll patients in clinical trial stroke research, use a stroke registry, and have certain peer review processes.
Albers acknowledges that the new stroke certification program may be a tough sell to other would-be referral hospitals. "This will not be popular among some of the primary stroke centers. They will say, 'Hey, we can do all these things and we don't want diversion.'"
In time, Stanford and other comprehensive stroke programs will have to convince potential referring hospitals that they can do a faster, better job for patients, by showing better outcomes resulting from their around-the-clock capabilities and because of their experience with tougher cases. That may be easier in Stanford's region, Albers says, because San Mateo County and Santa Clara County both have paramedic stroke diversion protocols in place, similar to a trauma system.