Saint Luke's also implemented key program initiatives to drive excellence in stroke care, including standardized care sets and care paths, and interventional stroke reversal protocols to extend the treatment window. By showing improved outcomes, Saint Luke's has reached agreements with other community hospitals for a regionalized program in which its hospital staff evaluates and offers assistance to others, she says. Other facilities in a 150-mile area, through agreements with Saint Luke's, have 24/7 access to its stroke expertise.
"We decided to organize stroke care in 1993, before any therapies were available," Rymer says. "Early in the game we evolved, and engaged these 60 or 70 emergency service providers in the area, and we have streamlined our process for transporting patients for referral hospitals."
Success key No.2: Dedicated critical care unit
For many hospitals, being named a center of excellence means possibly gaining the services of a neurosurgeon they were courting or developing grant proposals that may bring dollars that otherwise they could not obtain.
The Joint Commission has certified several dozen hospitals across the country as primary stroke centers or centers of excellence for treatment of stroke. As such, these hospitals have specialty-trained staff with innovative equipment and proven strategies to offer better overall care.
Those strategies include focusing their work on an interdisciplinary unit such as the University of Alabama at Birmingham Hospital's 64-bed combined neurology-neurosurgery unit, which includes an ICU for stroke patents.
"The patient needs to be coming on time to the hospital; there needs to be public education, so the comprehensive stroke center should be visible to the community," Alexandrov says. "We need to provide therapy as a standard of care, 24/7 and 365 days. That's a commitment as an institution. Physicians are recruited and prepared for that."
Although academic institutions may have access to resources needed for complex clinical and research programs, it is important for large community hospitals to expand their reach to include clinical research in stroke care as well, says Chere Gregory, MD, medical director of neurosciences for the 921-licensed-bed Forsyth Medical Center in Winston-Salem, N.C., a nonprofit regional medical center. Forsyth received the Get with the Guidelines Gold Plus Performance designation.
Coordinated, comprehensive care is important for dealing with a wide array of neurological issues, says Gregory. Smaller hospitals must transfer patients to another location, she adds. Forsyth Medical Center has its own neurological intensive care unit, with 28 beds in the stroke unit to focus on patients with stroke, brain injuries, and other neurological conditions. "We decided to create a center of excellence for stroke care by having a comprehensive interdisciplinary approach to providing that care," Gregory adds.
A key part of the program is having a neurosurgeon and neurointerventional radiologist available around-the-clock "for those acute therapies when needed," Gregory says. Because timing is so critical in stroke care, "even accounting for that 15-minute drive that a patient makes to the hospital is crucial, and we can make a difference having a neurosurgeon and neurointerventional radiologist there, ready," she adds. "It has become important to shave off time any way we can. Few hospital systems have a neuro-critical care unit dedicated to the critically ill. In effect, we are changing the face of neuro-stroke care."