ACUTE STROKE PATHWAY

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1 ACUTE STROKE PATHWAY THERE IS A NEED FOR STATEWIDE STROKE SYSTEM OF CARE ALL MISSISSIPPIANS SHOULD BE ABLE TO ACCESS NEW PROTOCOLS FOR STROKE TREATMENT JOINT EFFORT WITH EMS, PHYSICIANS, HOSPITALS AND SPECIALISTS

2 North Central South

3 Stroke Center-Levels of Care Definition: The Brain Attack Coalition has published recent recommendations for the establishment of a primary stroke center & stroke systems of care. The hospital directors, administrators, medical and nursing staff should demonstrate a commitment to quality stroke care. The governing body of the hospital should establish policy and procedures to ensure the maintenance of quality stroke care. The participating hospitals shall agree to accept all stroke patients appropriate for their established level of care. The hospital shall establish a stroke program which will be available on a 24/7 basis in which to evaluate for stroke appropriately, treat and transfer when appropriate. 3

4 Stroke Center-Levels of Care Definition: The Brain Attack Coalition has published recent recommendations for the establishment of a primary stroke center & stroke systems of care. The hospital directors, administrators, medical and nursing staff should demonstrate a commitment to quality stroke care. The governing body of the hospital should establish policy and procedures to ensure the maintenance of quality stroke care. The participating hospitals shall agree to accept all stroke patients appropriate for their established level of care. The hospital shall establish a stroke program which will be available on a 24/7 basis in which to evaluate for stroke appropriately, treat and transfer when appropriate. 4

5 Level 1- Comprehensive Referral Stroke Center Consists of a core team of personnel, infrastructure & expertise to diagnose & treat stroke patients who require intensive medical, surgical, & interventional vascular care. The team consists of a neurologist, neurosurgeon & endovascular specialists Fully equipped ED for rapid diagnosis and treatment using standard CT imaging within 25 minutes and ability to have results reported within 25 minutes of test completion Lab services available 24/7 with appropriate result reporting Neurology, Neurosurgery and Endovascular specialists are available 24/7 Intensive Care capability available with critical care specialist available 24/7 Has complete rehab services (physical therapy, occupational therapy & speech therapy) staffed by trained professionals and available for all patients within 24 to 48hrs of admission Will be readily available for transfer of patient from field or lower care facility Maintenance of adequate helicopter landing site on campus Operating room and appropriate support staff should be made available 24/7 for emergency surgery when necessary Radiologic and diagnostic imaging with expedited reporting available 24/7. This should include angiography with endovascular capabilities, CT, CTA, MRI, MRA, MRV, US, TTE, TEE, etc. Must participate in the AHA GWTG Stroke Registry. A multi-disciplinary quality improvement team including EMS should meet to review data and lead quality improvement initiatives at least quarterly. Stroke team members must document at least 8 CME hours annually. Community and professional educational projects should be ongoing. 5

6 Level 2- Referral Stroke Center (MUST HAVE ALL REQUIREMENTS OF LEVEL 1 EXCLUDING ENDOVASCULAR CAPABILITIES) Consists of a core team of personnel, infrastructure & expertise to diagnose & treat stroke patients who require intensive medical & surgical care. The team consists of a diagnostic radiologist, neurologist & neurosurgeon. Fully equipped ED for rapid diagnosis and treatment using standard CT imaging within 25 minutes and ability to have results reported within 25 minutes of test completion Lab services available 24/7 with appropriate result reporting Radiology, Neurology & Neurosurgery specialists are available 24/7 Intensive Care capability available with critical care specialist available 24/7 Has complete rehab services (physical therapy, occupational therapy & speech therapy) staffed by trained professionals and available for all patients within 24 to 48hrs of admission Will be readily available for transfer of patient from field or lower care facility Maintenance of adequate helicopter landing site on campus Operating room and appropriate support staff should be made available 24/7 for emergency surgery when necessary Radiologic and diagnostic imaging with expedited reporting available 24/7. This should include angiography with endovascular capabilities, CT, CTA, MRI, MRA, MRV, US, TTE, TEE, etc. Must participate in the AHA GWTG Stroke Registry. A multi-disciplinary quality improvement team including EMS should meet to review data and lead quality improvement initiatives at least quarterly. Stroke team members must document at least 8 CME hours annually. Community and professional educational projects should be ongoing. 6

7 Level 3- Transferring Stroke Capable (MUST HAVE THE ABILITY TO DIAGNOSE AND STABILIZE PATIENT FOR TRANSFER TO LEVEL 1 OR 2 REFERRING CENTER) ED physician, other qualified physician or physician extender available 24/7 to diagnose and initiate appropriate treatment Rapid diagnosis and treatment using standard CT imaging within 25 minutes and ability to have results reported within 25 minutes of test completion Lab services available 24/7 with appropriate result reporting Neurology specialists should be available 24/7 to direct IV TPA administration. TPA must be stocked and readily available. Transition plans must be established for rapid transfer of patient to Level 1 or 2 Stroke Center Must participate in the AHA GWTG Stroke Registry. A multidisciplinary quality improvement team including EMS should meet to review data and lead quality improvement initiatives at least quarterly. Community and professional educational projects are present 7

8 Level 4- Non Stroke Hospital Facility is able to assess and evaluate for possible stroke but cannot treat Rapid transfer of patient to Level 1 or 2 Stroke Center should be facilitated May be bypassed in EMS Plan of Care 8

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