Systems in Acute Stroke Care: Stroke Centers. Andy Jagoda, MD, FACEP Kevin Baumlin, MD, FACEP

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Systems in Acute Stroke Care: Stroke Centers. Andy Jagoda, MD, FACEP Kevin Baumlin, MD, FACEP"

Transcription

1 Systems in Acute Stroke Care: Stroke Centers, FACEP Kevin Baumlin, MD, FACEP This presentation addresses some of the systems that could be used to optimize the care of patients with acute cerebrovascular accidents. Several areas will be discussed, including: 1. Emergency medical services 2. Emergency Department care 3. Acute stroke teams 4. Stroke protocols 5. Stroke units 6. Neurological services 7. Neuroimaging and laboratory services 8. CQI efforts 9. Educational programs 10. Overall institutional support for stroke care

2 Systems in Acute Stroke Care: Stroke Centers Page 2 of 12 Systems in Acute Stroke Care: Stroke Centers Introduction In 1996, the National Institute of Neurological Disorders and Stroke (NINDS) sponsored a National symposium on the "Rapid Identification and Treatment of Acute Stroke".(1) The symposium brought together a multidisciplinary group of experts representing more than fifty organizations interested in the care of stroke patients. Five panels were assembled that reviewed and made recommendations on how to reduce disability and improve the quality of life for stroke victims, see Table 1. The panel presentations emphasized the pivotal role played by prehospital providers and emergency physicians in acute stroke care. The Executive Summary of the symposium recommended that: "Emergency departments must have specialized protocols in place for identifying candidates for therapy and treating those that require therapy within a narrow therapeutic time window" and "Hospitals must develop comprehensive acute stroke plans that define the specialized roles of nursing staff, diagnostic units, stroke teams, and other treatment services...". Studies on acute stroke management released since the seminal NINDS trial in 1995 have borne out the imperative of organized systems necessary for acute stroke care.(2,3) There is a narrow therapeutic window that mandates rapid identification, transport, diagnosis, and treatment; any weak link in this "chain of survival" undermines the system and the quality of care available to the acute stroke patient. Only 1% to 3% of ischemic stroke patients are being treated with tpa, primarily as the result of delays in disease recognition and arrival to the emergency department (ED).(4,5) In addition to timely arrival to the ED, physician acceptance of tpa and institutional attitudes and capabilities have impeded the widespread use of tpa. In one study, only 10% of eligible patients with an acute ischemic stroke received tpa.(2) Once in the ED, expedient triage, diagnostic testing and interpretation must be accomplished to assess eligibility for thrombolytic therapy. When used properly, tissue plasminogen activator (tpa) has been clearly demonstrated to be beneficial.(4,5) The Brain Attack Coalition (BAC) was formed under the sponsorship of the NINDS to pursue and promote the agenda established by the 1996 Symposium. Members of this multidisciplinary group are listed in Table 2. Recognizing the importance of adhering to the acute stroke management and treatment guidelines as defined by the NINDS, American Stroke Association, and the American Academy of Neurology (4, 6, 7 ), the BAC developed recommendations for the creation of stroke centers.(8) The BAC proposed the creation of two levels of stroke centers; primary stroke centers and comprehensive centers. Eleven elements were identified as necessary to qualify as a primary stroke center, see Table 3. These recommendations were not intended to be guidelines per se, though the release of the recommendations have stimulated a debate on the need to credential services provided by hospitals. Emergency Medical Services EMS is the link between the community and the hospital. EMTs and paramedics interface with the community at multiple levels, providing services that range from onsite education in the community, to triage decisions regarding whether to transport a patient, to transport decision

3 Systems in Acute Stroke Care: Stroke Centers Page 3 of 12 regarding level of transport, speed of transport, and destination of transport. Consequently, a stroke center cannot exist without full integration with EMS. In the 1995 NINDS symposium, it was emphasized that EMS training curricula were significantly deficient in the areas of cerebrovascular disease. Dispatchers and prehospital care providers had limited instruction on stroke diagnosis and management which contributed to the small numbers of acute stroke patients arriving in the ED within the therapeutic window. Since that time there has been significant effort in upgrading training though there is limited data to demonstrate impact at this time. EMS is the vital link and a successful stroke center must be involved in the EMS quality assurance program, EMS training, and EMS continuing education. Emergency Department Those EDs receiving acute stroke patients must have systems in place to expeditiously triage them and to initiate diagnostic and therapeutic management. Issues in acute stroke care have taken on an important role in emergency resident education, while the recent emergency medicine literature has actively published on topics related to stroke.(13, 14) Emergency physicians are ideal coordinators of acute stroke response since they are the medical directors for EMS, are experts in stabilization and resuscitation, and intimately familiar with resource utilization and system operations at their respective hospitals.(11) Acute Stroke Teams The concept of an acute stroke team is modeled after that of the trauma team, ie, designated personnel experienced in the diagnosis and management of a specific problem type. In the case of stroke, effective management depends on a comprehensive neurologic examination, proper laboratory testing and neuroimaging with proper result interpretation, familiarity with thrombolytic administration, and ability to recognize and manage the complications of the stroke or the thrombolytic therapy. There are many potential scenarios that vary depending on the institution that demonstrate the advantages of a stroke team: these scenarios range from the busy ED that does not have the resources to support the continuous care required by the acute stroke patient, to the low volume ED that does not see acute stroke frequently enough to be familiar with the stroke guidelines. A stroke team is composed of at least one physician and one other health care provider, i.e., a nurse or physician extender. The physician can be a neurologist, emergency physician, or other specialist, but must have interest and expertise in acute stroke care. The stroke team must be able to respond within 15 minutes and available 24 hours a day. There must be a system in place for rapid mobilization of the team, communication between various services, ideally including communication with EMS prior to patient arrival. The stroke team must document its activities and have in place a mechanism to evaluate its performance and patient outcomes.

4 Systems in Acute Stroke Care: Stroke Centers Page 4 of 12 Written Care Protocols Thrombolytic use in acute stroke has been shown to be an effective treatment when guidelines are carefully followed. (4, 5, 9) Failure to adhere to time limits and to exclusion criteria has been associated with unacceptable morbidity.(2) In one study, tpa was associated with a 15.7% intracranial hemorrhage rate which was almost three times that reported in the NINDS trial; this unacceptably high rate of hemorrhage was linked to failure to closely adhere to accepted guidelines in thrombolytic use.(2) One study from North Carolina documented that 66% of hospitals surveyed did not have an acute stroke protocol and that 88% did not have an established mechanism for rapid triage of the acute stroke patient.(10) Written protocols are a valuable tool in the provision of quality care. Protocols for the acute stroke patient must include both prehospital and ED management and be comprehensive in their scope. Protocol deviations can be minimized with an ongoing education process.(11, 12) Stroke Unit Studies have shown that morbidity and mortality from acute stroke can be decreased when patients are cared for by providers familiar with issues related to the post-stroke period. These issues include care strategies to prevent aspiration, deep vein thrombosis, pneumonia; and strategies to promote mental and physical rehabilitation.(15 ) Not all hospitals can provide these services, therefore, it is reasonable that once a patient is stabilized that they are transferred to a facility that can. Neurosurgical Services Neurosurgical intervention is rare in acute stroke yet a distinct possibility. (4) In the NINDS trial, only one of 22 patients with an intracranial hemorrhage required a neurosurgical intervention. Hospitals caring for the acute stroke patient must have mechanisms in place to access neurosurgical support. This can entail either having a neurosurgeon on call and available for emergencies within 2 hours, or protocols to facilitate the transport of a patient to a hospital with neurosurgical capabilities. Commitment and Support of the Medical Organization Hospitals choosing to accept acute stroke patients must have an administration that is committed to ensuring the services necessary for quality care are in place. Such a commitment entails allocated funding toward maintaining the infrastructure necessary for ongoing acute stroke care. This infrastructure includes 24 hours a day / 7 days a week services, continuing education, and a medical director for the stroke team who understands the requirements for maintaining a stroke center.

5 Systems in Acute Stroke Care: Stroke Centers Page 5 of 12 Neuroimaging and laboratory services Acute stroke protocols require that a neuroimaging study be performed within 25 minutes of being ordered and read within 20 minutes of study completion. The study must be read by someone experienced in interpreting the images in the context of acute stroke since risk stratification can be performed based on findings. (5) It has been recommended that laboratory study results be available within 45 minutes of being ordered. In general, the acute stroke patient needs a complete blood cell count, blood chemistries, and coagulation studies. In addition, cardiac enzymes may be necessary in select patients. The BAC recommends that, due to the importance of these studies, that the Director of Laboratory Services provide a written letter of support towards ensuring the timely availability of testing results. Outcome and quality improvement Tracking of the care provided to all acute patients is essential to any continuous quality improvement (CQI) program. Studies have demonstrated the value of CQI in stroke care.(16, 17). The BAC recommends that hospitals providing acute stroke care have systems in place for tracking patients treated including the timing of therapies, complications, short-term and longterm outcomes. Education Programs Stroke diagnosis and management is continually evolving, mandating the need for ongoing continuing education. Neuroimaging technologies are rapidly changing and new therapies are on the horizon. The BAC identifies the importance of education not only for the health care provider but also for the community at large since effective stroke care and activations of the stroke care system must begin with recognition of the problem by the patient.(18) Conclusions In conclusion, effective management of the acute stroke patient requires intact systems that facilitate diagnostic and therapeutic decision making. At the present time, tpa is the only drug readily available for treating an acute stroke and its therapeutic window is small. Those hospitals accepting these patients must be prepared to mobilize the appropriate resources to ensure a timely diagnosis, and must be prepared to manage consequent complications. When treatment protocols are carefully followed, symptomatic intracranial hemorrhage can be reduced to levels even below that reported in the NINDS trial.(5) Conversely, when systems are not in place, an unacceptably high complication rate results not only from thrombolytics but from the complications of the stroke itself.

6 Systems in Acute Stroke Care: Stroke Centers Page 6 of 12 Table 1: Panels at the NINDS symposium on stroke Prehospital Emergency Medical Care Systems Panel Emergency Department Panel Acute Hospital Care Panel Health Care Systems Panel Public Education Panel Table 2: Members of the Brain Attack Coalition American Academy of Neurology American Association of Neurological Surgeons American Association of Neurosciences Nurses American College of Emergency Physicians American Heart Association American Society of Neuroradiology National Institute of Neurologic Disorders and Stroke National Stroke Association Stroke Belt consortium

7 Systems in Acute Stroke Care: Stroke Centers Page 7 of 12 Table 3: The 11 elements necessary for a hospital to provide acute stroke care Acute stroke team available 24 hours a day Written care protocols to ensure rapid recognition, diagnosis, and treatment Emergency medical services integrated into the acute stroke team operations Emergency department integrated into the acute stroke team Stroke unit Neurosurgical services available within 2 hours Commitment from the institution Neuroimaging performed and interpreted within 45 minutes of patient arrival Laboratory services with rapid turn around of tests Quality improvement program including a database or registry Continuing education program

8 Systems in Acute Stroke Care: Stroke Centers Page 8 of 12 Systems in Acute Stroke Care: Stroke Centers Reference List 1. Marler J, Jones P, Emr M. (Eds). Proceeding of a National Symposium on Rapid Identification and Treatment of Acute Stroke. [NIH publication No ] 1996, Bethesda, MD Katzan I, Furlan A, Lloyd L, et al. Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. JAMA 2000; 282: Tanne D, Bates V, Verro P, et al. Initial clinical experience with IV tissue plasminogen activator for acute ischemic stroke: A multicenter survey. The t-pa Stroke Survey Group. Neurology 1999; 53: The National Institute of Neurological Disorders and Stroke rt-pa Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: Albers G, Bates V, Clark W, et al. Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Alteplase to Reverse Stroke (STARS) study. JAMA 2000; 283: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Practice advisory: thrombolytic therapy for acute ischemic stroke - summary statement. Neurology. 1996; 47: Adams H, Brott T, Furlan A, et al. Guidelines for thrombolytic therapy for acute stroke: A supplement to the guidelines for the management of patients with acute ischemic stroke. Circulation. 1996; 94: Alberts M, Hademenos G, Latchaw R, et al. Recommendations for the establishment of primary stroke centers. JAMA 2000; 283: Chiu D, Krieger D, Villar-Cordova C, et al. Intravenous tissue plasminogen activator for acute ischemic stroke: Feasibility, safety, and efficacy in the first year of clinical practice. Stroke 1998; 29: Goldstein L. North Carolina stroke prevention and treatment facilities survey. Stroke 2000; 31: Akins P, Delemos C, Wentworth D, et al. Can emergency department physicians safely and effectively initiate thrombolysis for acute ischemic stroke. Neurology 2000; 55:

9 Systems in Acute Stroke Care: Stroke Centers Page 9 of The NINDS rt-pa Stroke Study Group: A systems approach to immediate evaluation and management of hyperacute stroke: Experience at 8 centers and implications for community practice and patient care. Stroke 1997; 28: Lewandowski C, Barsan W. Treatment of acute ischemic stroke. Ann Emerg Med 2001; 37: Osborn T, LaMonte M, Gaasch W. Intravenous thrombolytic therapy for stroke: A review of recent studies and controversies. Ann Emerg Med 1999; 34: Stroke Unit Trialists' Collaboration. Collaborative systemic review of the randomized trials of organized inpatient (stroke unit) care after stroke. BMJ 1997; 314: Tilley B, Lyden P, Brott T, et al. Total quality improvement methodology reduce delays between emergency department admission and treatment of acute ischemic stroke. Arch Neurol 1997;54: Newell S, Englert J, Box-Taylor A, et al. Clinical efficiency tools improve stroke management in a rural southern health system. Stroke 1998; 29: Pancioli A, Broderick J, Kothari R, et al. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA 1998; 279:

10 Systems in Acute Stroke Care: Stroke Centers Page 10 of 12 Systems in Acute Stroke Care: Stroke Centers Annotated Bibliography 1. Proceeding of a National Symposium on Rapid Identification and Treatment of Acute Stroke. [NIH publication No ] 1996, Bethesda, MD The proceeding from this symposium established the need for an organized, systems approach to acute stroke care. The symposium brought together a multidisciplinary group of experts representing more than fifty organizations interested in the care of stroke patients. Five panels were assembled that reviewed and made recommendations on how to reduce disability and improve the quality of life for stroke victims. The panel presentations emphasized the pivotal role played by prehospital providers and emergency physicians in acute stroke care. 2. Alberts M, Hademenos G, Latchaw R, et al. Recommendations for the establishment of primary stroke centers. JAMA 2000; 283: This document reviewed the current literature regarding the need to establish designated centers for acute stroke care. The document recognizes the limited amount of outcome data to support strict guideline development, consequently, the recommendations made are primarily consensus based. The Brain Attack Coalition, which authored this paper, proposed the creation of two levels of stroke centers; primary stroke centers and comprehensive centers. Eleven elements were identified as necessary to qualify as a primary stroke center.

11 Systems in Acute Stroke Care: Stroke Centers Page 11 of 12 Systems in Acute Stroke Care: Stroke Centers Questions 1. Approximately what percent of acute stroke patients are arriving to emergency departments within the therapeutic window for t-pa? a. 1-5% b % c % d % e % 2. Which of the following is not true regarding Stroke Centers? a. Stroke Center designation is regulated by the NINDS b. Stroke Centers should be integrated with EMS systems c. Stroke Centers should have twenty-four hour a day, seven day a week, head CT availability d. Stroke Centers should have written protocols for triaging and treating acute stroke patients e. Stroke Centers should provide ongoing stroke education 3. Which of the following is true of Stroke Teams providing emergent stroke care at Primary Stroke Centers? a. Stroke teams should be led by a neurologist b. Stroke teams should have a neurosurgeon available in-house c. Stroke teams should be available within five hours of patient arrival in the emergency department d. Stroke teams should have a neuroradiologist reading a head CT before giving t-pa e. Stroke teams must be prepared to recognize and manage complications of thrombolytic therapy

12 Systems in Acute Stroke Care: Stroke Centers Page 12 of 12 Systems in Acute Stroke Care: Stroke Centers Answers 1. Answer a. The NINDS t-pa study and most subsequent studies have reported that less than 5% of acute stroke patients are candidates for thrombolytic therapy. Most acute stroke patients arrive in the ED outside of the three hours limits for t-pa eligibility. Reasons for the delay in arrival in the ED include failure of the patient to recognize that an acute stroke has occurred and delay in accessing transport to the ED. 2. Answer a. The concept of a stroke center arose from the success of trauma centers and the recognized need for acute stroke patients to arrive in facilities capable of diagnosing and treating the stroke. Though the components of a stroke center have been delineated in a consensus documents supported by the NINDS, stroke center designation is not regulated at this time. 3. Answer e. Stroke teams should be led by a physician with expertise in acute stroke diagnosis or management; the specialty training of the stroke team leader is not critical. Neurosurgeons should be available within two hours of need and thus a stroke center does not necessarily need an in-house neurosurgeon. Stroke teams must be mobilized upon the arrival of a patient in the emergency department; ideally, it should be mobilized via EMS notification before the patient arrives. Stroke teams must have someone with expertise in reading head CTs, however, this person does not necessarily have to be a neuroradiologist. The stroke team must be prepared to recognize and manage complications of thrombolytic therapy.

Department of Veterans Affairs VHA DIRECTIVE 2011-038 Veterans Health Administration Washington, DC 20420 November 2, 2011

Department of Veterans Affairs VHA DIRECTIVE 2011-038 Veterans Health Administration Washington, DC 20420 November 2, 2011 Department of Veterans Affairs VHA DIRECTIVE 2011-038 Veterans Health Administration Washington, DC 20420 TREATMENT OF ACUTE ISCHEMIC STROKE (AIS) 1. PURPOSE: This Veterans Health Administration (VHA)

More information

Approved: Acute Stroke Ready Hospital Advanced Certification Program

Approved: Acute Stroke Ready Hospital Advanced Certification Program Approved: Acute Stroke Ready Hospital Advanced Certification Program The Joint Commission recently developed a new Disease- Specific Care Advanced Certification program for Acute Stroke Ready Hospitals

More information

TIME LOST IS BRAIN LOST. TARGET: STROKE CAMPAIGN MANUAL

TIME LOST IS BRAIN LOST. TARGET: STROKE CAMPAIGN MANUAL TIME LOST IS BRAIN LOST. TARGET: STROKE CAMPAIGN MANUAL 2010, American Heart Association TARGET: STROKE CAMPAIGN MANUAL 01 INTRODUCTION Welcome to the Target: Stroke. The purpose of this manual is to provide

More information

DNVGL Healthcare. 2nd Annual Stroke Center Certification Workshop November 6, Comprehensive Stroke Center Certification Program

DNVGL Healthcare. 2nd Annual Stroke Center Certification Workshop November 6, Comprehensive Stroke Center Certification Program DNVGL Healthcare Comprehensive Stroke Center Certification Program 2nd Annual Stroke Center Certification Workshop November 6, 2014 Cathie Abrahamsen RN MSN SAFER, SMARTER, GREENER Disclosure Employment

More information

ACUTE STROKE PATHWAY

ACUTE STROKE PATHWAY 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

More information

The Savvy PSC: Review of the 2014 Primary Stroke Certification Standards

The Savvy PSC: Review of the 2014 Primary Stroke Certification Standards The Savvy PSC: Review of the 2014 Primary Stroke Certification Standards Wendi J. Roberts RN, BA, MS, TNS, CLNC Field Director, Surveyor Management and Development Division of Accreditation and Certification

More information

IS EMS A PART OF YOUR STROKE TEAM?

IS EMS A PART OF YOUR STROKE TEAM? IS EMS A PART OF YOUR STROKE TEAM? S. R. Scott, MD Chief of Service Associate EMS Medical Director Department of Emergency Medicine New Jersey Medical School-Newark Presenter Disclosure Information Sandra

More information

EMS Management of Stroke. Deaver Shattuck, M.D. Brian Wiseman, M.D. Keith Woodward, M.D.

EMS Management of Stroke. Deaver Shattuck, M.D. Brian Wiseman, M.D. Keith Woodward, M.D. EMS Management of Stroke Deaver Shattuck, M.D. Brian Wiseman, M.D. Keith Woodward, M.D. Financial Disclosure: No relevant financial relationship exists Working Together to End Stroke Formed in 2013 Identified

More information

A Collaborative Effort to Improve Emergency Stroke Care: Mobile Stroke Unit

A Collaborative Effort to Improve Emergency Stroke Care: Mobile Stroke Unit A Collaborative Effort to Improve Emergency Stroke Care: Mobile Stroke Unit What can we do to cut down the time it takes to give a clot dissolving drug (tpa)? MOBILE STROKE UNIT! Mobile Stroke Unit Mobile

More information

ALBERTA PROVINCIAL STROKE STRATEGY (APSS)

ALBERTA PROVINCIAL STROKE STRATEGY (APSS) ALBERTA PROVINCIAL STROKE STRATEGY (APSS) Stroke Systems of Care Key Components APSS Pillar Recommendations March 28, 2007 1 The following is a summary of the key components and APSS Pillar recommendations

More information

Accreditation and Certification Guidelines

Accreditation and Certification Guidelines Accreditation and Certification Guidelines MARTIN GIZZI, MD, PHD, FAHA CHAIR, NJ NEUROSCIENCE INSTITUTE AT JFK CHAIR, NORTH EAST CEREBROVASCULAR CONSORTIUM (NECC) CHAIR, STROKE ADVISORY PANEL, NJDOH MEMBER,

More information

Prehospital Management of Stroke. Todd J. Crocco, MD

Prehospital Management of Stroke. Todd J. Crocco, MD After returning home from the supermarket, a woman finds her 67-year-old husband in the kitchen with slurred speech and left-sided weakness. He was acting normally when she left the house earlier that

More information

CERTIFICATE OF NEED AND ACUTE CARE LICENSURE PROGRAM. Hospital Licensing Standards: Emergency Department and Trauma Services:

CERTIFICATE OF NEED AND ACUTE CARE LICENSURE PROGRAM. Hospital Licensing Standards: Emergency Department and Trauma Services: HEALTH AND SENIOR SERVICES HEALTH CARE QUALITY AND OVERSIGHT BRANCH HEALTH CARE QUALITY AND OVERSIGHT DIVISION ACUTE CARE FACILITY OVERSIGHT CERTIFICATE OF NEED AND ACUTE CARE LICENSURE PROGRAM Hospital

More information

Primary & Comprehensive Stroke Centers Use of Telemedicine for Stroke Care

Primary & Comprehensive Stroke Centers Use of Telemedicine for Stroke Care Primary & Comprehensive Stroke Centers Use of Telemedicine for Stroke Care 2 nd Annual Stroke Seminar March 29, 2011 Karen Ellmers, RN, MS, CCNS ellmersk@ohsu.edu Lecture Objectives and Outline 1. Discuss

More information

Preparing Your Hospital for Primary Stroke Center Certification

Preparing Your Hospital for Primary Stroke Center Certification Preparing Your Hospital for Primary Stroke Center Certification Christy Franklin, BSN, MS, CNRN Erin Conahan, MSN, RN, ACNS-BC, CNRN, SCRN Disclosures Christy Franklin - I have no actual or potential conflict

More information

Stroke Systems of Care

Stroke Systems of Care Stroke Systems of Care Ashutosh P. Jadhav, MD PhD Assistant Professor, Neurology and Neurological Surgery Center for Neuro-endovascular Therapy UPMC Stroke Institute Pittsburgh, PA Stroke chain of survival

More information

Level III Stroke Center Data Collection Requirements

Level III Stroke Center Data Collection Requirements Who? Level III Stroke Center Data Collection Requirements All LERN Level III Stroke Centers. LERN Level I and II Stroke Centers have reporting requirements to The Joint Commission or other Board approved

More information

4th Annual New York Stroke Conference Maximizing Stroke Quality of Care: Key Ingredients

4th Annual New York Stroke Conference Maximizing Stroke Quality of Care: Key Ingredients 4th Annual New York Stroke Conference Maximizing Stroke Quality of Care: Key Ingredients Thomas Kwiatkowski, MD Medical Director : Center for Emergency Medical Services NSLIJ No relevant financial relationships

More information

Preparing Your Hospital for Primary Stroke Certification Authors: Wendy J. Smith, BS, MA, RES, RCEP, RN Claranne Mathiesen, MSN, RN, CNRN

Preparing Your Hospital for Primary Stroke Certification Authors: Wendy J. Smith, BS, MA, RES, RCEP, RN Claranne Mathiesen, MSN, RN, CNRN Preparing Your Hospital for Primary Stroke Certification Authors: Wendy J. Smith, BS, MA, RES, RCEP, RN Claranne Mathiesen, MSN, RN, CNRN Disclosures Wendy J. Smith-I have no actual or potential conflict

More information

Primary Stroke Certification

Primary Stroke Certification Primary Stroke Certification Clinical Standards A Program of the American Osteopathic Association 142 East Ontario Street Chicago, IL 60611-2864 GOVERNANCE Strategic Direction GOVERNANCE PLAN 01.00.01

More information

What Is a Stroke? From the Cerebrovascular Imaging and Interventions Committee of the American Heart Association Cardiovascular Radiology Council

What Is a Stroke? From the Cerebrovascular Imaging and Interventions Committee of the American Heart Association Cardiovascular Radiology Council What Is a Stroke? From the Cerebrovascular Imaging and Interventions Committee of the American Heart Association Cardiovascular Radiology Council Randall T. Higashida, M.D., Chair 1 What Is a Stroke? From

More information

GP workshop. Maria Fitzpatrick Nurse Consultant Kings College Stroke Centre

GP workshop. Maria Fitzpatrick Nurse Consultant Kings College Stroke Centre GP workshop Maria Fitzpatrick Nurse Consultant Kings College Stroke Centre Stroke: the Facts Stroke: the Facts Every 5 minutes someone in the UK has a stroke 1 in 4 men and 1 in 5 women will have a stroke

More information

Cost Effectiveness of Helicopter Transport of Stroke Patients for Thrombolysis

Cost Effectiveness of Helicopter Transport of Stroke Patients for Thrombolysis 966 Silbergleit et al. d HELICOPTER TRANSPORT IN STROKE Cost Effectiveness of Helicopter Transport of Stroke Patients for Thrombolysis Abstract Objectives: Treatment with intravenous (IV) or intra-arterial

More information

Building an Emergency Response to Acute Stroke

Building an Emergency Response to Acute Stroke Great Lakes Stroke Network August 2006 Building an Emergency Response to Acute Stroke Wende N. Fedder RN, BSN, MBA Director, Stroke & Neurovascular Services Alexian Brothers Hospital Network Elk Grove

More information

CASE SELECTION: EVALUATING THE RECORDS TO DETERMINE WHICH CASES TO REJECT OR TAKE

CASE SELECTION: EVALUATING THE RECORDS TO DETERMINE WHICH CASES TO REJECT OR TAKE CASE SELECTION: EVALUATING THE RECORDS TO DETERMINE WHICH CASES TO REJECT OR TAKE Philip C. Henry, Esquire Henry, Spiegel, Fried & Milling, LLP Suite 2450 950 East Paces Ferry Road Atlanta, Georgia 30326

More information

S9 Administer thrombolytic treatment in acute ischaemic stroke

S9 Administer thrombolytic treatment in acute ischaemic stroke S9 Administer thrombolytic treatment in acute ischaemic Screening and initiating treatment, overseeing competency of treatment About this workforce competence This competence is about the emergency administration

More information

Stroke Telemedicine Services: A Guide to the Commissioning and Provision

Stroke Telemedicine Services: A Guide to the Commissioning and Provision Stroke Telemedicine Services: A Guide to the Commissioning and Provision Author: Professor Tony Rudd, National Clinical Director for Stroke Date: December 2014 First produced in August 2010 by Dr Damian

More information

Your Time on the Island The Role of the Stroke Coordinator

Your Time on the Island The Role of the Stroke Coordinator Your Time on the Island The Role of the Stroke Coordinator Andrea Jaeger, MHA, BSN, CNRN Original Presentation by: Alex Graves, MS, ANP 1 Presenter Disclosure Information Andrea Jaeger, MHA, BSN, CNRN

More information

1 1-1 1-1 All trauma centers must participate in the state and/or regional trauma system planning, development, or operation.

1 1-1 1-1 All trauma centers must participate in the state and/or regional trauma system planning, development, or operation. American College of Surgeons Consultation/Verification Program Reference Guide of Suggested Classification Level II Chapter CD Requirement by Chapter http://www.facs.org/trauma/verifivisitoutcomes.html

More information

Stroke/VTE Quality Measure Build for Meaningful Use Stage 1

Stroke/VTE Quality Measure Build for Meaningful Use Stage 1 Stroke/VTE Quality Measure Build for Meaningful Use Stage 1 Presented by Susan Haviland, BSN RN Senior Consult, Santa Rosa Consulting Meaningful Use Quality Measures Centers for Medicare and Medicaid Services

More information

Module Two: EMS Systems. Wisconsin EMS Medical Director s Course

Module Two: EMS Systems. Wisconsin EMS Medical Director s Course : EMS Systems Wisconsin EMS Medical Director s Course Objectives List the components of EMS systems Outline organizational and design options for EMS systems Outline system staffing and response configurations

More information

Developing a Dynamic Team Approach to Stroke Care. Emergency Medical Services 2015

Developing a Dynamic Team Approach to Stroke Care. Emergency Medical Services 2015 Developing a Dynamic Team Approach to Stroke Care Emergency Medical Services 2015 Why Stroke, Why now? A recent study showed that 80 percent of people in the United States live within an hour s drive of

More information

What You Should Know About Cerebral Aneurysms

What You Should Know About Cerebral Aneurysms What You Should Know About Cerebral Aneurysms From the Cerebrovascular Imaging and Interventions Committee of the American Heart Association Cardiovascular Radiology Council Randall T. Higashida, M.D.,

More information

Appendix L: HQO Year 1 Implementation Priorities

Appendix L: HQO Year 1 Implementation Priorities Appendix L: HQO Year 1 Implementation Priorities Chronic Obstructive Pulmonary Disease (Source: COPD Chairs) Non-Invasive Positive Pressure Ventilation Early Ambulation If possible, seek patient preferences

More information

AMERICAN BURN ASSOCIATION BURN CENTER VERIFICATION REVIEW PROGRAM Verificatoin Criterea EFFECTIVE JANUARY 1, 2015. Criterion. Level (1 or 2) Number

AMERICAN BURN ASSOCIATION BURN CENTER VERIFICATION REVIEW PROGRAM Verificatoin Criterea EFFECTIVE JANUARY 1, 2015. Criterion. Level (1 or 2) Number Criterion AMERICAN BURN ASSOCIATION BURN CENTER VERIFICATION REVIEW PROGRAM Criterion Level (1 or 2) Number Criterion BURN CENTER ADMINISTRATION 1. The burn center hospital is currently accredited by The

More information

Houston Paramedic and Emergency Stroke Treatment and Outcomes Study (HoPSTO)

Houston Paramedic and Emergency Stroke Treatment and Outcomes Study (HoPSTO) Houston Paramedic and Emergency Stroke Treatment and Outcomes Study (HoPSTO) Anne W. Wojner-Alexandrov, PhD; Andrei V. Alexandrov, MD; Diana Rodriguez; David Persse, MD; James C. Grotta, MD Background

More information

CDA Position on Provincial Funding of Hospital Based Dental Services and Post-Graduate Dental Education

CDA Position on Provincial Funding of Hospital Based Dental Services and Post-Graduate Dental Education CDA Position on Provincial Funding of Hospital Based Dental Services and Post-Graduate Dental Education Preamble Hospital dental programs exist to meet the needs of special patient population who face

More information

American Stroke Association Highlights Carla D. English, MHS, MHSA

American Stroke Association Highlights Carla D. English, MHS, MHSA AMERICAN STROKE ASSOCIATION HIGHLIGHTS 1 CARLA D. ENGLISH, MHS, MHSA QUALITY & SYSTEMS IMPROVEMENT GREATER SOUTHEAST AFFILIATE ASA VISION: Empower people to live longer, healthier lives free of stroke

More information

Ischemic stroke affects over 400,000 people in the

Ischemic stroke affects over 400,000 people in the Utilization and Outcome of Thrombolytic Therapy for Acute Ischemic Stroke: The St. John Hospital Code Stroke Experience Sule Salami, MD, Anuradha Kolluru, MD, Saif Al-Najafi, MD, Carrie Stover, MSN, NP,

More information

Providence Telemedicine Network

Providence Telemedicine Network Providence Telemedicine Network Around the clock, around the region, our specialists are with you when every minute counts. Telemedicine brings our specialists to your hospital It is exciting to report

More information

doi: 10.1016/j.jocn.2010.10.005

doi: 10.1016/j.jocn.2010.10.005 doi: 10.1016/j.jocn.2010.10.005 A remote desktop-based telemedicine system Yasushi Shibata, MD, PhD Department of Neurosurgery, Mito Medical Center, University of Tsukuba Mito, Ibaraki, 310-0015, Japan

More information

Stroke Transfers. Downstate Receiving Hospital Perspective

Stroke Transfers. Downstate Receiving Hospital Perspective Stroke Transfers Downstate Receiving Hospital Perspective Jeffrey M. Katz, MD Director, North Shore University Hospital Stroke Center Assistant Professor of Neurology, Hofstra North Shore-LIJ School of

More information

Top Ten Priorities for Stroke Services Research A summary of an analysis of Research for the National Stroke Strategy

Top Ten Priorities for Stroke Services Research A summary of an analysis of Research for the National Stroke Strategy The Stroke Strategy confirmed that the Department would commission a short analysis of research evidence in relation to the strategy and the top ten research areas identified in it. We said that we would

More information

Stroke is the No. 3 Killer in the United States and in New Mexico Two people in New Mexico die every day from stroke Eight people in NM become stroke

Stroke is the No. 3 Killer in the United States and in New Mexico Two people in New Mexico die every day from stroke Eight people in NM become stroke UNM Stroke Program and Telehealth Marc Malkoff MD Professor of Neurosurgery and Neurology ogy Medical Director Stroke Program and NSI UNMH 2 What Is The Impact Of Stroke? Stroke is the No. 3 Killer in

More information

Rehabilitation Where You Recover. Inpatient Rehabilitation Services at Albany Medical Center

Rehabilitation Where You Recover. Inpatient Rehabilitation Services at Albany Medical Center Rehabilitation Where You Recover Inpatient Rehabilitation Services at Albany Medical Center You're Here and So Are We As the region s only academic medical center, Albany Medical Center offers a number

More information

Emergency Medical Services Agency. Report to the Local Agency Formation Commission

Emergency Medical Services Agency. Report to the Local Agency Formation Commission Emergency Medical Services Agency August 8, 2012 Report to the Local Agency Formation Commission The Relationship of Fire First Response to Emergency Medical Services On September 26, 2011, the Contra

More information

Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium

Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium October 30, 2008 Barry Libman, RHIA, CCS, CCS-P President, Barry Libman Inc. Stroke Coding Issues Outline Medical record documentation

More information

REFERRAL HOSPITAL. The Importance of Door In Door Out Time DIDO

REFERRAL HOSPITAL. The Importance of Door In Door Out Time DIDO REFERRAL HOSPITAL The Importance of Door In Door Out Time DIDO Time to Treatment is critical for STEMI patients For patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary

More information

Telestroke Area Overview/Statement of Problem

Telestroke Area Overview/Statement of Problem Telestroke Area Overview/Statement of Problem The burden of stroke in North Carolina is one of the highest in the nation. From 2003-2007, there were 27,927 stroke hospitalizations in the state (Huston,

More information

STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE

STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE CASE REPORT: ACUTE STROKE MANAGEMENT 90 YEAR OLD WOMAN, PREVIOUSLY ACTIVE AND INDEPENDENT, CHRONIC ATRIAL FIBRILLATION,

More information

The Brain and Spine CenTer

The Brain and Spine CenTer The Br ain and Spine Center Choosing the right treatment partner is important for patients facing tumors involving the brain, spine or skull base. The Brain and Spine Center at The University of Texas

More information

DO YOU LIVE IN A CARDIAC READY COMMUNITY?

DO YOU LIVE IN A CARDIAC READY COMMUNITY? DO YOU LIVE IN A CARDIAC READY COMMUNITY? If someone in your community suffers a sudden cardiac arrest tomorrow, how likely is he or she to survive due to rapid access to life-saving treatment? Cities

More information

Chapter 23. New Criteria Quick Reference Guide Changes are noted in Orange

Chapter 23. New Criteria Quick Reference Guide Changes are noted in Orange Chapter 23 New Criteria Quick Reference Guide Changes are noted in Orange The preceding chapters of Resources for Optimal Care of the Injured Patient are designed to clearly define the criteria to verify

More information

Today s Final Jeopardy Question: What is 77 mg? IV tpa: To treat or Not to Treat?

Today s Final Jeopardy Question: What is 77 mg? IV tpa: To treat or Not to Treat? IV tpa: To treat or Not to Treat? Gregory W. Albers, MD Professor of Neurology and Neurological Sciences Director, Stanford Stroke Center Today s Final Jeopardy Question: What is 77 mg? 1 Key Points tpa

More information

EMERGENCY MEDICAL DISPATCH PROGRAM REQUIREMENTS PURPOSE:

EMERGENCY MEDICAL DISPATCH PROGRAM REQUIREMENTS PURPOSE: EMERGENCY MEDICAL DISPATCH PROGRAM REQUIREMENTS PURPOSE: To establish operational guidelines for existing and new providers of emergency medical dispatch (EMD) services, which are located and/or authorized

More information

Comprehensive Stroke Center Certification

Comprehensive Stroke Center Certification Comprehensive Stroke Center Certification July 17, 2012 Today s Agenda Welcome and Introductory Comments Standards and Eligibility Questions and Answers Performance Measurement Questions and Answers On-Site

More information

Helen Fry Manager, Publications and Education Resources Joint Commission Resources

Helen Fry Manager, Publications and Education Resources Joint Commission Resources July 2012 Dear Valued Customer: The Joint Commission developed a new Disease-Specific Care Advanced Certification Program for Comprehensive Stroke Centers (CSC) in collaboration with the American Heart

More information

TRAUMA SYSTEM UPDATE FEBRUARY 2015

TRAUMA SYSTEM UPDATE FEBRUARY 2015 TRAUMA SYSTEM UPDATE FEBRUARY 2015 The Problem: In 2009, injury was the number one killer of Arkansans between the ages of one and 44. Arkansas overall injury fatality rate was 33% higher than the national

More information

Guidelines for the Operation of Burn Centers

Guidelines for the Operation of Burn Centers C h a p t e r 1 4 Guidelines for the Operation of Burn Centers............................................................. Each year in the United States, burn injuries result in more than 500,000 hospital

More information

Prepublication Requirements

Prepublication Requirements Issued Prepublication Requirements The Joint ommission has approved the following revisions for prepublication. While revised requirements are published in the semiannual updates to the print manuals (as

More information

Advances in Stroke Care

Advances in Stroke Care Advances in Stroke Care 2015 Friday October 2 7 a.m. to 4:30 p.m. Hyatt Regency New Brunswick Two Albany Street New Brunswick, NJ 08901 Jointly sponsored by the Comprehensive Stroke Center Robert Wood

More information

Strategic Planning for Stroke Center Accreditation/Certification. Suzanne Borgos, MBA/MHA VP, Planning

Strategic Planning for Stroke Center Accreditation/Certification. Suzanne Borgos, MBA/MHA VP, Planning Strategic Planning for Stroke Center Accreditation/Certification Suzanne Borgos, MBA/MHA VP, Planning Disclosures I have no pertinent relationships to disclose. 2 Stroke Care at Capital Health Regional

More information

Emergency Department Planning and Resource Guidelines

Emergency Department Planning and Resource Guidelines Emergency Department Planning and Resource Guidelines [Ann Emerg Med. 2014;64:564-572.] The purpose of this policy is to provide an outline of, as well as references concerning, the resources and planning

More information

There are 2 types of clinical trials that are of interest to the. The Clinical Trials Network of the Society of Nuclear Medicine

There are 2 types of clinical trials that are of interest to the. The Clinical Trials Network of the Society of Nuclear Medicine The Clinical Trials Network of the Society of Nuclear Medicine Michael M. Graham, PhD, MD The Clinical Trials Network of the Society of Nuclear Medicine was formed to provide quality assurance of both

More information

Pennsylvania Trauma Nursing Core Curriculum. Posted to PTSF Website: 10/30/2014

Pennsylvania Trauma Nursing Core Curriculum. Posted to PTSF Website: 10/30/2014 Pennsylvania Trauma Nursing Core Curriculum Posted to PTSF Website: 10/30/2014 PREFACE Care of the trauma patient has evolved since 1985, when the Pennsylvania Trauma Systems Foundation (PTSF) Board of

More information

Draft Document 2/27/09. American Association of Neuroscience Nurses Scope of Practice for Neuroscience Advanced Practice Nurses

Draft Document 2/27/09. American Association of Neuroscience Nurses Scope of Practice for Neuroscience Advanced Practice Nurses American Association of Neuroscience Nurses Scope of Practice for Neuroscience Advanced Practice Nurses Background Specialization in nursing arose as a way to enhance quality of care and improve access

More information

Crittenton Hospital Medical Center Primary Stroke Center. Cesar D.Hidalgo, MD. Stroke Program Medical Director

Crittenton Hospital Medical Center Primary Stroke Center. Cesar D.Hidalgo, MD. Stroke Program Medical Director Crittenton Hospital Medical Center Primary Stroke Center Cesar D.Hidalgo, MD Stroke Program Medical Director 290 bed all-inclusive medical center 500 physicians 54 medical specialties full scope of inpatient,

More information

The Independent Order Of Foresters ( Foresters ) Critical Illness Rider (Accelerated Death Benefit) Disclosure at the Time of Application

The Independent Order Of Foresters ( Foresters ) Critical Illness Rider (Accelerated Death Benefit) Disclosure at the Time of Application The Independent Order of Foresters ( Foresters ) - A Fraternal Benefit Society. 789 Don Mills Road, Toronto, Canada M3C 1T9 U.S. Mailing Address: P.O. Box 179 Buffalo, NY 14201-0179 T. 800 828 1540 foresters.com

More information

Access to Intra-Arterial Therapies for Acute Ischemic Stroke: An Analysis of the US Population

Access to Intra-Arterial Therapies for Acute Ischemic Stroke: An Analysis of the US Population AJNR Am J Neuroradiol 25:1802 1806, November/December 2004 Access to Intra-Arterial Therapies for Acute Ischemic Stroke: An Analysis of the US Population Shuichi Suzuki, Jeffrey L. Saver, Phillip Scott,

More information

King County EMS Stroke Quality Improvement Program

King County EMS Stroke Quality Improvement Program King County EMS Stroke Quality Improvement Program A Report from the King County EMS Medical QI Section March 2012 Prepared by Sofia Husain, Jim Duren, and Norm Nedell OBJECTIVE The goal of the King County

More information

Penn State Hershey Medical Center s Journey to State-of-the-Art Telemedicine

Penn State Hershey Medical Center s Journey to State-of-the-Art Telemedicine Telemedicine Case Study Penn State Hershey Medical Center s Journey to State-of-the-Art Telemedicine Based in South Central Pennsylvania, Penn State Hershey Medical Center (PSHMC) is a 563-bed academic

More information

BriefingPaper. Towards faster treatment: reducing attendance and waits at emergency departments ACCESS TO HEALTH CARE OCTOBER 2005

BriefingPaper. Towards faster treatment: reducing attendance and waits at emergency departments ACCESS TO HEALTH CARE OCTOBER 2005 ACCESS TO HEALTH CARE OCTOBER 2005 BriefingPaper Towards faster treatment: reducing attendance and waits at emergency departments Key messages based on a literature review which investigated the organisational

More information

Global Objectives. Use of the NIH Stroke Scale (NIHSS) in Emergency Department Patients with Acute Stroke. Why Do This Exercise? Session Objectives

Global Objectives. Use of the NIH Stroke Scale (NIHSS) in Emergency Department Patients with Acute Stroke. Why Do This Exercise? Session Objectives 1 Use of the NIH Scale (NIHSS) in Emergency Department Patients with Acute Professor Department of Emergency Medicine University of Illinois College of Medicine Chicago, IL Global Objectives Improve pt

More information

NAME OF HOSPITAL LOCATION DATE

NAME OF HOSPITAL LOCATION DATE MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES BUREAU OF EMERGENCY MEDICAL SERVICES TRAUMA CENTER SITE REVIEW CRITERIA CHECK SHEET LEVEL I 19CSR 30-40.430 NAME OF HOSPITAL LOCATION DATE (1) GENERAL

More information

May 20, 2016. May 21, 2016. The 5th Annual Comprehensive Stroke and Neurocritical Care Symposium. Comprehensive Stroke Symposium

May 20, 2016. May 21, 2016. The 5th Annual Comprehensive Stroke and Neurocritical Care Symposium. Comprehensive Stroke Symposium The 5th Annual Comprehensive Stroke and Neurocritical Care Symposium May 20, 2016 Comprehensive Stroke Symposium May 21, 2016 Emergency Neurological Life Support Course and Certification The Richmond Marriott

More information

Critical Illness Supplemental Insurance

Critical Illness Supplemental Insurance You ve protected your family s financial future by purchasing life and health insurance. Critical Illness Supplemental Insurance It s cash when you need it. You choose how to spend it. So you can focus

More information

Sample Position Description Nurse Practitioner GS-12. Introduction

Sample Position Description Nurse Practitioner GS-12. Introduction Sample Position Description Nurse Practitioner GS-12 Introduction The Nurse Practitioner Position is located within the National Institutes of Health, (Institute, Branch). The nurse practitioner is a Masters

More information

Health Science Career Field Allied Health and Nursing Pathway (JM)

Health Science Career Field Allied Health and Nursing Pathway (JM) Health Science Career Field Allied Health and Nursing Pathway (JM) ODE Courses Possible Sinclair Courses CTAG Courses for approved programs Health Science and Technology 1 st course in the Career Field

More information

Brain Tumor Center. A Team Approach to Treating Brain Tumors

Brain Tumor Center. A Team Approach to Treating Brain Tumors Brain Tumor Center A Team Approach to Treating Brain Tumors Introducing Our Brain Tumor Center Making an appointment with the Brain Tumor Center at the Center for Advanced Medicine is the important first

More information

Defining The State of Emergency Care Research. Robert W. Neumar MD, PhD Chair, Research Committee American College of Emergency Physicians

Defining The State of Emergency Care Research. Robert W. Neumar MD, PhD Chair, Research Committee American College of Emergency Physicians Defining The State of Emergency Care Research Robert W. Neumar MD, PhD Chair, Research Committee American College of Emergency Physicians Future of Emergency Care Series Hospital-Based Emergency Care At

More information

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological

More information

Prehospital and Disaster Medicine, Vol. 4, No. 2, October-December 1989 Jeff J. Clawson, MD. Position Paper: Emergency Medical Dispatching

Prehospital and Disaster Medicine, Vol. 4, No. 2, October-December 1989 Jeff J. Clawson, MD. Position Paper: Emergency Medical Dispatching Search Terms: Position paper, emergency medical dispatching, National Association of Emergency Medical Services Physicians (NAEMSP), prehospital emergency medical services, essential part, prearrival instructions,

More information

Advanced Heart Failure & Transplantation Fellowship Program

Advanced Heart Failure & Transplantation Fellowship Program Advanced Heart Failure & Transplantation Fellowship Program Curriculum I. Patient Care When on the inpatient Heart Failure and Transplant Cardiology service, the cardiology fellow will hold primary responsibility

More information

TRAUMA IN SANTA CRUZ COUNTY 2009. Kent Benedict, MD, FACEP EMS Medical Director, Santa Cruz County EMS. November 1, 2010

TRAUMA IN SANTA CRUZ COUNTY 2009. Kent Benedict, MD, FACEP EMS Medical Director, Santa Cruz County EMS. November 1, 2010 TRAUMA IN SANTA CRUZ COUNTY 2009 Kent Benedict, MD, FACEP EMS Medical Director, Santa Cruz County EMS November 1, 2010 The Santa Cruz County Emergency Medical Services (EMS) 2009 annual comprehensive review

More information

Cerebral Hemorrhage Following Thrombolysis in Stroke

Cerebral Hemorrhage Following Thrombolysis in Stroke Von Kummer Cerebral Hemorrhage Following Thrombolysis in Stroke Rüdiger von Kummer SUMMARY Hemorrhagic transformation (HT) of ischemic brain tissue occurs in treated and non-treated stroke patients with

More information

Critical Illness Insurance

Critical Illness Insurance You ve protected your family s financial future by purchasing life and health insurance. Critical Illness Insurance It s cash when you need it. You choose how to spend it. So you can focus on getting well.

More information

Traditional and Emerging Roles of the Stroke Coordinator. Kathy Morrison, MSN, RN, CNRN, SCRN Jean Luciano, MSN, RN, CNRN, CRNP

Traditional and Emerging Roles of the Stroke Coordinator. Kathy Morrison, MSN, RN, CNRN, SCRN Jean Luciano, MSN, RN, CNRN, CRNP Traditional and Emerging Roles of the Stroke Coordinator Kathy Morrison, MSN, RN, CNRN, SCRN Jean Luciano, MSN, RN, CNRN, CRNP Disclosures: Kathy Morrison - I have no actual or potential conflict of interest

More information

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN Janice K. Brewer Governor Arizona State Board of Nursing 4747 North 7 th Street, Suite 200 Phoenix, AZ 85014-3655 Phone (602) 889-5150 Fax - (602) 889-5155 E-Mail: arizona@azbn.gov Home Page: http://www.azbn.gov

More information

Description of the OECD Health Care Quality Indicators as well as indicator-specific information

Description of the OECD Health Care Quality Indicators as well as indicator-specific information Appendix 1. Description of the OECD Health Care Quality Indicators as well as indicator-specific information The numbers after the indicator name refer to the report(s) by OECD and/or THL where the data

More information

SAN FRANCISCO EMERGENCY MEDICAL SERVICES AGENCY LEVEL I TRAUMA CARE STANDARDS

SAN FRANCISCO EMERGENCY MEDICAL SERVICES AGENCY LEVEL I TRAUMA CARE STANDARDS SAN FRANCISCO EMERGENCY MEDICAL SERVICES AGENCY LEVEL I TRAUMA CARE STANDARDS Policy Reference No.: 5014 Review Date: January 1, 2011 Supersedes: New I. Purpose To define standards for Level I Trauma Care

More information

Therapeutic Management Options for. Acute Ischemic Stroke Anna Rosenbaum, MD

Therapeutic Management Options for. Acute Ischemic Stroke Anna Rosenbaum, MD Therapeutic Management Options for Acute Ischemic Stroke Anna Rosenbaum, MD Epidemiology Epidemiology 4 th leading cause of death in the United States 1 Leading cause of disability Increase in projected

More information

TPA, STROKE, & TELEMEDICINE. Improving utilization and improving outcomes in a constantly evolving field

TPA, STROKE, & TELEMEDICINE. Improving utilization and improving outcomes in a constantly evolving field TPA, STROKE, & TELEMEDICINE Improving utilization and improving outcomes in a constantly evolving field OVERVIEW tpa inclusion and exclusion evolution Challenges to tpa administration Target:Stroke Telemedicine

More information

The New Complex Patient: The Shifting Locus of Care and Cost. Does Technology Keep Patients Out of Hospitals?

The New Complex Patient: The Shifting Locus of Care and Cost. Does Technology Keep Patients Out of Hospitals? The New Complex Patient: The Shifting Locus of Care and Cost Does Technology Keep Patients Out of Hospitals? Lee H. Schwamm, MD Executive Vice Chairman, Department of Neurology, Director of Stroke Services

More information

IV tpa labeling. Disclosures

IV tpa labeling. Disclosures Understanding the new IV tpa labeling Michael Wilder, MD Assistant Professor Vascular Neurology, Neurointervention University of Louisville Disclosures No disclosures relevant to this talk 1 Outline Why

More information

GENERAL ADMISSION CRITERIA INPATIENT REHABILITATION PROGRAMS

GENERAL ADMISSION CRITERIA INPATIENT REHABILITATION PROGRAMS Originator: Case Management Original Date: 9/94 Review/Revision: 6/96, 2/98, 1/01, 4/02, 8/04, 3/06, 03/10, 3/11, 3/13 Stakeholders: Case Management, Medical Staff, Nursing, Inpatient Therapy GENERAL ADMISSION

More information

NATIONAL AMBULANCE SERVICE ONE LIFE PROJECT

NATIONAL AMBULANCE SERVICE ONE LIFE PROJECT February 2015 NATIONAL AMBULANCE SERVICE ONE LIFE PROJECT Improving patient outcomes from Out Of Hospital Cardiac Arrest David Hennelly AP MSc Jan 2015 THE ONE LIFE PROJECT IS BEING LED BY THE NATIONAL

More information

Clinical Audit in Hospital Authority. Dr Betty Young Convenor for Clinical Audit, Hospital Authority

Clinical Audit in Hospital Authority. Dr Betty Young Convenor for Clinical Audit, Hospital Authority Clinical Audit in Hospital Authority Dr Betty Young Convenor for Clinical Audit, Hospital Authority Background 1990 1992 1996 1998 2005 Establishment of the Hospital Authority Quality Assurance Subcommittee

More information

A Career in Pediatric Hematology-Oncology? Think About It...

A Career in Pediatric Hematology-Oncology? Think About It... A Career in Pediatric Hematology-Oncology? Think About It... What does a pediatric hematologist-oncologist do? What kind of training is necessary? Is there a future need for specialists in this area? T

More information

Lung Cancer Consultant Outcomes Publication

Lung Cancer Consultant Outcomes Publication Lung Cancer Consultant Outcomes Publication Introduction This report describes the outcomes of individual consultant thoracic and cardiothoracic surgeons who carry out surgery for lung cancer. It has been

More information

Texas Heart Attack and Stroke Data Collection Initiative: Data Update. Nimisha Bhakta, MPH Texas Heart Attack and Stroke Summit July 24, 2015

Texas Heart Attack and Stroke Data Collection Initiative: Data Update. Nimisha Bhakta, MPH Texas Heart Attack and Stroke Summit July 24, 2015 Texas Heart Attack and Stroke Data Collection Initiative: Data Update Nimisha Bhakta, MPH Texas Heart Attack and Stroke Summit July 24, 2015 Presenter Disclosure Information FINANCIAL DISCLOSURE: I have

More information