12
Stroke Systems of Care
and Prehospital Management
2.9. Organization and Integration of Components
COR LOE
Recommendations
1 C-EO
1. Hospitals should participate in an accountable SSOC that
consists of an integrated network of certified hospitals (ie,
ASRH, PSC, TSC, CSC) and prehospital EMS systems
designed so patients in need of acute stroke care receive
appropriate and timely evaluation, diagnosis, treatment, and
interhospital transfer (when appropriate) that optimizes their
long-term outcomes.
1 C-EO
2. Hospitals caring for patients with acute stroke that do not
provide 24/7 thrombectomy treatment (eg, ASRH, PSC
hospitals) should develop interhospital transfer protocols
and procedures to ensure fast, safe, and efficient transfer of
patients who are potentially eligible for EVT.
1 B-NR
3. PSC hospitals caring for patients with acute stroke that do
not provide 24/7 thrombectomy treatment and therefore rely
on interhospital patient transfers should have the capability
to rapidly perform and interpret intracranial vascular imaging
(CTA or magnetic resonance angiography [MRA]) to
identify patients with LVO eligible for EVT.
1 B-NR
4. Hospitals caring for patients with acute stroke should develop
and adopt care protocols that reflect current clinical guidelines
as established by national and international professional
organizations or state or federal agencies and laws.
1 B-R
5. (New and of High Impact) Hospitals caring for patients with
acute stroke that provide EVT (ie, TSC, CSC hospitals)
should develop a system to comprehensively track key time
metrics and other care processes relevant to thrombectomy
(eg, door-to-puncture time, successful reperfusion), as well as
long-term patient outcomes.
1 C-EO
6. (New and of High Impact) Hospitals caring for patients with
acute stroke that provide EVT (ie, TSC, CSC hospitals)
should credential neurointerventionalists using established
and agreed upon training and certification standards.
2a B-NR
7. ASRH caring for patients with acute stroke that rely on
interhospital patient transfers can consider having the
capability to rapidly perform and interpret intracranial
vascular imaging (CTA or MRA) to identify patients with
LVO eligible for EVT.
2b B-NR
8. Depending on the characteristics of the local and regional
systems of care, individual SSOC may consider developing
mobile intervention teams to improve timely delivery of EVT.
