There’s been great advancement in the treatment of stroke. The use of intravenous clot busting medication (tPA) and catheter techniques to remove blood clots from brain arteries (thrombectomy) have become the standard of care in treating patients in the emergency setting.
These treatments are highly time sensitive — in the situation of a stroke, a person will lose 1.9 million brain cells, or neurons, per minute. Even a 15-minute improvement in time to treatment can allow more patients to walk and live at home without disability. It’s truly a situation where every second and every minute counts.
Stroke Care Improvements
With this in mind, there have been great efforts in the stroke community to create processes to make assessment and treatment of patients coming into the emergency room as quick, safe and efficient as possible. Critical minutes have been shaved off through improvements including:
— Pre-hospital notification by EMS.
— Rapid triage.
— Taking patients directly to CT scanners for brain imaging.
— Training of emergency room personnel on mixing and administering clot-busting medications.
All of these measures improve patient outcomes and lessen disability. Similarly, use of stroke severity scales by our EMS colleagues and potentially bypassing hospitals to get patients to facilities capable of performing high-quality thrombectomy procedures can avoid multiple transfers of patients, which are known to add substantial time to care.
Certain areas of the country have also provided excellent transparency into their treatment processes, with public reporting of times to treatment and patient outcomes after stroke. This transparency allows patient and pre-hospital caregivers to be able to make objective assessments about the quality of stroke care in their areas.
Stroke Levels of Care
High-quality stroke care can also be assessed through standards. Several certification bodies now assess stroke centers for their level and capabilities in care.
Three main stroke levels of care exist:
1. Primary Stroke Centers, which are able to provide standard stroke care, including use of clot-busting medications.
2. Thrombectomy Stroke Centers, which are able to perform the functions of a Primary Stroke Center, with the addition of performing high-quality thrombectomy care 24 hours a day, 7 days a week, 365 days a year.
3. Comprehensive Stroke Centers, which are able to care for the most ill of stroke patients, including those with brain bleeding.
Also, rapid access to thrombectomy and neurosurgical expertise, as well as the care delivered in neurological intensive care units are just a few of the critical elements which certified thrombectomy stroke centers and comprehensive stroke center are required to maintain at all times.
Understanding Stroke Certification Status
With the large number of hospitals around the country, it is important for patients and pre-hospital caregivers to have access to knowledge of the stroke certification status of hospitals in their region. Achieving certification means these hospitals have placed great effort into process development and optimization, as well as safety and quality to ensure they meet appropriate national standards to perform procedures appropriate to the level of their hospital. These hospitals ensure they are continuously working on processes and monitoring to ensure optimal patient outcomes.
The state of Ohio has embraced the need for certified stroke centers and requires hospitals to report their certification level to a statewide registry. Also, Ohio now requires pre-hospital providers to assess the severity of patient’s stroke symptoms in order to determine which hospital to transport the patient to for care. Patients benefit from transport to the right hospital the first time, rather than experiencing delays by being transported to hospitals that are not certified to provide the thrombectomy procedure, neurosurgical care or neurological intensive care that their condition requires.
Studies have also established that certified centers have better patient outcomes than non-certified centers. Ultimately, we can say with confidence that certification matters.
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