How to Build Regional Collaborations to Enhance Stroke Care

During a June 20 webinar hosted by Becker's Hospital Review, Therese Poland, RN, and Susan Lautner, RN, experts from the Healthcare Facilities Accreditation Program in Chicago, and Jeanne M. Robinson, APN, coordinator of the stroke response and neurology teams at Kettering Medical Center in Dayton, Ohio, explained the different levels of stroke center designation and how regional partnerships between the tiers can enhance patient care.

The panelists began by defining the three levels of stroke care centers as certified by HFAP. An objective assessment of a hospital's stroke care program helps to improve care by identifying evidence-based best practices and reducing clinical risk, as well as ensuring all patients have access to the right level of care and serving as the foundation for inter-hospital partnerships, said HFAP's Ms. Poland.

Stroke Ready: Also known as emergent stroke centers, these centers provide timely access to stroke care and are ready to meet the initial needs of stroke patients, said HFAP's Ms. Lautner. These hospitals "provide all patients basic access to stroke care," as well as provide their communities with information about strokes, she said.

"Out of the 5,000 hospitals in the United States, about 1,200 to 1,800 fall in this category," said Ms. Lautner.

These centers have evidence-based stroke protocols in place, and a stroke code team that arrives within 20 minutes. The center has lab testing and diagnostic capabilities, and mustprovide IV thrombolytic therapy or telemedicine services. An emergency department physician may lead the Stroke Ready center.

These centers also have transfer agreements in place with local EMS personnel and neighboring hospitals to facilitate ease of transition if the patient needs a higher level of care.

Primary Stroke Center: At this level, the center has the ability to stabilize and treat acute stroke patients, providing initial care and other acute therapies, said Kettering's Ms. Robinson. "They have the capacity to provide acute care safely and efficiently for stroke patients," she said. An example of this designation would be an acute-care hospital with a stroke unit, she explained.

Ms. Robinson added that at these centers, a stroke team arrives within 15 minutes, and the center provides IV thrombolytic therapy. Lab testing and diagnostic capabilities include vascular and cardiac imaging, and neurosurgical expertise is either available on-site or transfer to another facility is possible within two hours. The program director for this designation of stroke center is specially qualified, and the hospital has a stroke unit (it may be within the intensive care unit).

These centers provide stroke education to both the community and local EMS personnel, and have working agreements with other stroke centers in the region. Primary Stroke Centers must show performance improvement on at least two predetermined benchmarks annually, and require strong administrative support and clinical leadership.

Comprehensive Stroke Centers: "These centers provide the highest level of care," said Ms. Robinson. Often academic or tertiary care hospitals, they feature advanced treatment options and trained specialists in key areas such as neurology, neurosurgery and neuroradiology.

These centers have all the treatment options of a Primary Stroke Center, plus advanced interventional capabilities and comprehensive rehabilitation assessment and care. A continuous research plan on stroke care is in place, and the center participates in patient-centered research activities. These centers also have working agreements in place with other stroke centers in the area.

Additional requirements of this designation include a specially qualified program director and dedicated ICU beds with specialty trained staff. Lab testing and advanced imaging capabilities, as well as physician specialists are available around-the-clock, and the operating room is available and ready for an operation within two hours.

Additionally, "these centers also provide comprehensive patient education," said Ms. Robinson. Staff works closely with often-overwhelmed patients to help manage medications and risk factors to limit the risk of a second stroke. "There's also a process in place to make it easy for patients to get outpatient testing or therapies to strengthen the diagnosis and try to find out why the stroke happened in the first place," she said.

Know Your Neighbors.

Once a hospital has determined their level of stroke care, the next step is to enhance patient care by partnering with neighboring stroke centers of different designations.

The panelists recommend identifying the level of stroke care available at other hospitals in the region and forming partnerships to allocate patients to best optimize resources and provide the highest level of care possible. Ms. Poland recommends exploring rural and more distant hospitals, along with telemedicine, to extend partnerships further.

"Comprehensive Stroke Centers have a social responsibility to connect and partner with other centers in their region," said Ms. Poland. The panelists recommended a hub and spoke model, with Comprehensive Stroke Centers at the hubs, to overcome regional treatment inequities and provide the best care for all stroke patients.

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More Articles on Stroke Programs:

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Neurologist: Intermountain Healthcare Barred Competition for Stroke Care
Gates Vascular Institute's 3 Secrets for a Successful Multidisciplinary Center

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