7
Designation of Stroke Centers and Stroke Care
Quality Improvement Process
Î Regional systems of stroke care should be developed. These should
consist of:
• Health care facilities that provide initial emergency care including administration
of IV rtPA, including PSCs, CSCs and other facilities
• Centers capable of performing endovascular stroke treatment with comprehensive
peri-procedural care, including CSC and other health care facilities, to which rapid
transport can be arranged when appropriate (I-A). (Revised from 2013 guideline)
Î It may be useful for PSCs and other health care facilities that provide
initial emergency care including administration of IV rtPA to develop
the capability of performing emergency noninvasive intracranial
vascular imaging to most appropriately select patients for transfer for
endovascular intervention and reduce time to endovascular treatment
(IIb-C). (Revised from 2013 guideline)
Î Endovascular therapy requires the patient to be at an experienced
stroke center with rapid access to cerebral angiography and qualified
neuro-interventionalists. Systems should be designed, executed and
monitored to emphasize expeditious assessment and treatment.
Outcomes on all patients should be tracked. Facilities are encouraged
to define criteria that can be used to credential individuals who can
perform safe and timely IA revascularization procedures (I-E).
(Revised from 2013 guideline)
Î The creation of primary stroke centers is recommended (I-B).
Note: The organization of such resources will depend on local resources.
The stroke system design of regional acute stroke-ready hospitals and primary stroke centers
that provide emergency care and that are closely associated with a comprehensive stroke
center, which provides more extensive care, has considerable appeal.
Î Certification of stroke centers by an independent external body, such as
The Joint Commission or state health department, is recommended (I-B).
Note: Additional medical centers should seek such certification.
Î Healthcare institutions should organize a multidisciplinary quality
improvement committee to review and monitor stroke care quality
benchmarks, indicators, evidence-based practices, and outcomes (I-B).
Note: The formation of a clinical process improvement team and the establishment
of a stroke care data bank are helpful for such quality of care assurances. The data
repository can be used to identify the gaps or disparities in quality stroke care.
Once the gaps have been identified, specific interventions can be initiated to address
these gaps or disparities.
Î For patients with suspected stroke, EMS should bypass hospitals that
do not have resources to treat stroke and go to the closest facility
most capable of treating acute stroke (I-B).
