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.
Other members of the coalition are: The American Academy of Neurology, American Association of Neurological Surgeons, American Association of Neuroscience Nurses, American College of Emergency Physicians, American Society of Interventional and Therapeutic Neuroradiology, American Society of Neuroradiology, Centers for Disease Control and Prevention, Congress of Neurological Surgeons, National Association of EMS Physicians, National Stroke Association, National Institute of Neurological Disorders and Stroke, Physical Medicine and Rehabilitation, Stroke Belt Consortium and the Office of the Director of Neurology for the Veterans Health Administration.
About Northwestern Memorial Hospital
Northwestern Memorial Hospital is one of the country's premier academic medical centers and is the primary teaching hospital of Northwestern University's Feinberg School of Medicine. Northwestern Memorial and its Prentice Women's Hospital and Stone Institute of Psychiatry have 744 beds and more than 1,200 affiliated physicians and 5,000 employees. Providing state-of-the-art care, Northwestern Memorial is recognized for its outstanding clinical and surgical advancements in such areas as cardiothoracic and vascular care, gastroenterology, neurology and neurosurgery, oncology, organ and bone marrow transplantation, and women's health.
Northwestern Memorial received the prestigious 2005 National Quality Health Care Award and is listed in eight specialties in this year's US News & World Report's issue of "America's Best Hospitals." The hospital is also cited as one of the "100 Best Companies for Working Mothers" by Working Mother magazine for the past 5 years and has been chosen by Chicagoans for a decade as their "most preferred hospital" in National Research Corporation's annual survey.