The Brain Attack Coalition, a multidisciplinary group dedicated to improvements in stroke care, supports the development of primary and comprehensive stroke centers. Primary stroke centers provide basic stroke care and refer to a comprehensive center as needed. A comprehensive stroke center provides a complete range of care for complex stroke patients requiring specialized testing and interventions at all levels.
Some of the key elements recommended by the Coalition for primary stroke centers are:
- Acute stroke team
Includes a physician and one or more other healthcare professionals (i.e., nurse, physician’s assistant, nurse practitioner) who are available on an around-the-clock basis.
- Written care protocols
General guidelines ordering the process of care delivery
- Emergency medical services (EMS)
It is vital that EMS have effective communication with the Emergency Department during transportation of suspected stroke patients.
- Emergency department
ED personnel should be well trained in the diagnosis and treatment of all types of stroke.
- Stroke unit
Studies have shown that stroke patients who receive care in a specialized stroke unit had decreased rates of death, decreased lengths of stay, and increased rates of being able to live at home after the stroke.
- Neurosurgical services
Because some patients with acute stroke will require evaluation and/or intervention by a neurosurgeon, neurosurgical care should be available within two hours of such a requirement being deemed necessary, either onsite or by transfer to another facility.
- Medical organization
Commitment to and support of the primary stroke center
The primary stroke center should be able to provide either a cranial computerized tomography (CT scan) or brain magnetic resonance imaging (MRI) within 25 minutes of the order being written on an around-the-clock basis. In addition, physicians with experience in interpretation of CT and/or MRI studies should be available to interpret the scans within 20 minutes of their completion.
- Laboratory services
- Outcomes and quality improvement
Data collection systems provide valuable checks and balances to continually improve stroke care.
The stroke center’s professional staff should receive a minimum of eight hours/year of continuing education programs to maintain and expand their knowledge of stroke care (JAMA, June 21, 2000: 283(23); 3102-3109).