Cheryl Clark, for HealthLeaders Media
, September 6, 2011
Designate a hospital stroke unit, which is a defined group of beds, staff, and protocols. Patients treated in these settings show reduced death rates of 17% to 28%, an 8% reduction in length of hospital stay, and a 7% increase in ability to live at home.. These units should be staffed by personnel with training and expertise in stroke.
Establish policies so that neurosurgical care is available within two hours of the time deemed clinically necessary, in case the patient requires decompressive hemicraniectomy, a ventricular drainage catheter, or evacuation of a hematoma.
Be able to conduct brain MRI scans, which are more sensitive than head CT scans for detecting small strokes, acute strokes, and many lesions and processes that could produce stroke-like symptoms, such as small tumors or areas of infection. Brain magnetic resonance angiography techniques, with CT angiography, "are capable of detecting abnormalities that can be missed by routine carotid Doppler," the authors say. Most hospitals already have MRI and CT in place, and the angiographic capability "accrues only modest additional costs for equipment and software." MRA and CT angiography do not need to be available on a "hyperacute" basis.
Provide early assessment for rehabilitation services. These services do not need to be on site, however.
Assure administrative support and a Primary Stroke Center director who, if he or she is not a neurologist or neurosurgeon, should have expertise in stroke, such as the experience of a vascular neurology fellowship or board certification and other specialty education. A study of more than 38,000 Medicare patients with stroke found that those "cared for by a neurologist had a 90-day mortality rate of 16%, compared with 23% for internists and 25% for family practitioners."
Obtain certification for the PSC, such as that offered by the Joint Commission, Healthcare Facilities Accreditation Program, or a state health department, rather than relying on self-certification.
Research validates that these actions "have improved the overall care for these patients with stroke throughout the United States and in many other countries," say Alberts and other members of the coalition.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.