Stroke is a serious health emergency, and timely, high-quality treatment is essential to reduce the risk of death and disability. Yet not all hospitals are created equal when it comes to stroke care. To provide patients a clearer understanding of the level of stroke care a hospital provides, the Joint Commission, in coordination with the American Heart Association and American Stroke Association, has established a certification program recognizing the capabilities of stroke centers across the country.

Levels of stroke care

The Joint Commission, an accrediting group for healthcare organizations nationwide, provides certification to hospitals based on their ability to meet strict standards for stroke treatment. There are now four levels of certification, with higher levels representing higher degrees of expertise and more extensive treatment options. Some of the key differentiators for each are outlined here:

» Acute stroke ready hospitals are able to provide standardized treatment for patients experiencing strokes. Specifically, they are able to conduct imaging that differentiates between hemorrhagic strokes, which result from bleeding in the brain, and ischemic strokes, caused by a blocked blood vessel in the brain. For eligible patients, ASRHs can administer clot-busting drugs, also called thrombolytics, through a patient’s vein. After administering the medication, however, an ASRH must transfer patients to another center that has the capacity to monitor patients for complications.

» Primary stroke centers provide the same standardized and evidence-based approach to treating stroke patients, but also have a dedicated stroke unit or beds specifically designated for stroke patients. PSCs provide monitoring after treatment with thrombolytics and can perform more advanced diagnostic assessments, due to the availability of high-tech imaging. PSCs may have access to neurosurgeons, but if not offering 24/7 access to neurosurgical services, they must have a plan to transfer patients urgently if needed.

» Thrombectomy-capable stroke centers do all that PSCs do, plus have the tools and the expertise to perform mechanical thrombectomy, a minimally invasive surgical procedure to remove a blood clot from an artery. These centers also have neurointensive care and 24/7 on-site critical care coverage.

» Comprehensive stroke centers offers the full spectrum of advanced treatments for both ischemic stroke and hemorrhagic stroke. A team of experienced specialists, including neuro-interventionalists, neurointensivists, neuroradiologists, neurologists and neurosurgeons, is available 24/7 to care for the most complex stroke cases. In addition, CSCs have a demonstrated commitment to advancing stroke care through clinical research.

Note that the Joint Commission is not the only accrediting organization that certifies stroke centers, but it is the oldest and largest. Another group, DNV, more recently began certifying stroke centers based on different standards and with different certification levels. These levels are, in order: primary, primary plus and comprehensive. These accreditations are not the same as those awarded by the Joint Commission, so it’s important to do your research if you have a choice of stroke providers.

The comprehensive difference

To be certified as a CSC by the Joint Commission, a stroke center must undergo a rigorous application and review process every two years. Only around 3% of hospitals across the country achieve this highest recognition, and the University of Virginia Stroke Center is one of them. Some of the attributes of the UVa program that set it apart include:

» A dedicated neurointensive care unit staffed around the clock by a team that includes nurses, doctors and advanced practice providers specially trained in stroke management.

» The ability to care for both ischemic stroke and hemorrhagic stroke.

» The expertise to perform advanced neurovascular surgical procedures, such as coiling and clipping of aneurysms that cause hemorrhagic stroke.

» The rapid delivery of clot-busting drugs to treat ischemic stroke.

» An established telemedicine network that spans from Orange to Augusta, which allows UVa specialists to assist other physicians and emergency personnel with stroke diagnosis and treatment using videoconferencing technology.

» Top-notch rehabilitative care provided by a specialized team of physiatrists, occupational therapists, physical therapists, speech-language pathologists and others.

» Multiple clinical trials, offering novel acute and preventative stroke treatments.

Not every stroke patient requires the highly advanced care of a CSC. Some strokes can be treated at primary or thrombectomy-capable stroke centers. However, it can be difficult to tell when stroke symptoms begin if there may be complexities or complications for which the round-the-clock expertise of a CSC is needed to minimize the risks of disability or death from stroke.

That’s why having a CSC like the UVa Stroke Center within reach helps create a solid network of care that patients throughout Virginia can rely on. This statewide network of hospitals and providers — through collaboration, proven protocols, rapid response and advanced technology — works together to meet one important goal: to help ensure the best outcome for all stroke patients by getting them the right care at the right time and at the right place. For the most complex stroke patients, the right place is a CSC.

To learn more about stroke treatment at UVa, visit uvahealth.com/services/stroke.

Dr. Nicole Chiota-McCollum is medical director of the UVa Comprehensive Stroke Center.

VITAL SIGNS

This column, which promotes community health, is sponsored by Sentara Martha Jefferson Hospital, Region Ten Community Services Board, Thomas Jefferson Health District and the University of Virginia Health System.

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