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Recommendations for the Establishment of Primary Stroke Centers

August 25, 2011 - The Brain Attack Coalition's recommendations for a Primary Stroke Center address the following 10 major aspects of acute stroke care:

  • Acute Stroke Teams: Members include, at a minimum, a physician and another health care practitioner that are available 24 hours a day and able to be at the bedside of a possible stroke patient within 15 minutes of arrival. Ideally, a neurologist or neurosurgeon will be a member of the team because these physicians have stroke expertise.
  • Written Care Protocols: Adherence to stroke protocols improves the care that patients receive. Written protocols should be available in the ED and other areas where stroke patients are likely to receive care. They should be reviewed and updated by the stroke team at least once a year.
  • Emergency Medical Services: Emergency medical services (EMS) have a vital role in the rapid transportation and survival of stroke patients. Improved coordination between hospitals and EMS is a cornerstone of a Primary Stroke Center. One element of a well integrated system would be effective communications between EMS personnel and the stroke center during rapid transport of a patient experiencing a stroke.
  • Emergency Department Commitment: The ED is normally the first point of contact between the patient and the medical facility. ED personnel should be trained to diagnose and treat all types of acute stroke.
  • Stroke Unit: Patients who receive care in stroke units have better outcomes than those that receive care in general medical wards.
  • Neurosurgical Services: Although not all hospitals can have a neurosurgeon on staff, neurological care should be available to patients within 2 hours, even if that requires patient transport.
  • Support of Medical Organization: A hospital’s administration and staff drive the quality of stroke care, so it is important that a facility’s leadership is committed to high quality, efficient stroke care.
  • Neuroimaging and Laboratory Services: Access to brain imaging and laboratory services, either in the hospital or through teleradiology, is critical to a hospital’s ability to rapidly diagnose a patient.
  • Outcomes and Quality Improvement Activities: Studies show that improvement programs improve the quality of care received by stroke patients.
  • Continuing Medical Education: The science surrounding the diagnosis and treatment of cerebrovascular disease is constantly changing, and staff should continually be updating their knowledge.
The National Institute of Neurological Disorders and Stroke is a component of the National Institutes of Health, U.S. Department of Health and Human Services.