Certified Primary Stroke Centers

Primary stroke centers are hospitals that have been certified by the Joint Commission, which is an organization that accredits health care programs in the United States. The Joint Commission began certifying primary stroke care centers in December 2003.

Primary stroke centers must fulfill certain criteria in order to become formally approved and certified by that designation. Some of these requirements include:

• Having a designated stroke unit for continuous patient monitoring.
• Demonstrating compliance with the established clinical practice guidelines for stroke.
• Ensuring proper staff emergency department knowledge of stroke protocols.
• Establishing a procedure for receiving and transferring stroke patients.
• Collecting and reporting standardized data regarding stroke outcomes.

A common goal of each stroke center is to transport, assess, diagnose, and medically treat each stroke patient within three hours of the onset of their symptoms. Administration of appropriate stroke treatment  requires a skilled and experienced medical team.

Stroke treatments include administration of powerful blood thinners such as IV TPA and intra-arterial thrombolysis. These medications must be administered within a short window of time after stroke symptoms begin, or else they cause severe ,and possibly fatal complications. Some of the major tasks a primary stroke center must be able to accomplish during this three-hour time window include:

• Transport the patient to the hospital
• Perform a full evaluation by a physician -- often a neurologist
• Obtain and read, a CT scan of the brain
• Draw blood, analyzing it, and reporting the results
• Deliver appropriate treatment

Most stroke centers with a functional stroke unit have neurologists, or vascular neurologists (neurologists who specialize in stroke) on staff, and very often they are available in-house, around the clock. These physicians function under the motto "time is brain." Therefore, they are very speedy, but very accurate, at recognizing unusually dangerous strokes. When this happens, these physicians are trained to coordinate emergent surgeries, and to arrange rapid transfers to the intensive care unit, or to a more specialized hospital.

Physicians and nurses who are a part of a stroke center are trained to recognize medical complications that can arise in someone who has suffered a stroke. This is extremely important, as stroke patients often worsen quickly within the first few hours or days after a stroke. In fact, even the mildest of strokes run a 10% risk of converting to larger ones in the first 48 hours.

Some of the complications that are common after a stroke include:

• A new, or an expanding stroke
• Bleeding, especially when treated with t-PA
• Seizures
• Brain swelling
• Medical complications such as pneumonia and other infections

An important advantage of stroke centers is their connection with social workers and other ancillary staff members who are familiar with the short- and long-term needs of stroke patients. These trained professionals often provide major assistance in solving problems related to health insurance, in obtaining outpatient appointments with stroke physicians, psychologists, or occupational therapists, and in choosing the best stroke rehabilitation programs to maximize recovery and convenience after a stroke.

According to a data analysis published by the Journal of the American Heart Association, patients who receive stroke treatment at primary stroke centers are more likely to receive treatment with T-PA than patients who are not treated at Primary Stroke Centers.

Another patient sample which studied over 120,000 patients who were admitted and treated for stroke was published in the Journal of Stroke and Cerebrovascular Disease. Patients included stroke patients who were admitted to primary stroke centers and patients who were admitted to hospitals that were not designated as primary stroke centers.

The study authors noted that stroke patients who were treated in primary stroke centers were less likely to have in-hospital complications and more likely to have better outcomes on discharge from the hospital.

An even newer way to get stroke patients treated faster lies in a stroke treatment center called the Mobile Stroke Unit. With only a few in the world and two in the United States, Mobile Stroke Units function just as the name implies, starting stroke evaluation, and sometimes even treatment, on the way to the hospital, saving precious time.

Edited by Heidi Moawad MD