Acute Stroke Ready Service Written Care Protocols

(A) Each facility shall develop and implement written care protocols for acute stroke. Such protocols shall include the emergency care of acute stroke patients by a multidisciplinary team and plans for transfer, as clinically appropriate. The hospital shall treat eligible patients according to its written care protocols consistent with time targets acceptable to the Department. These protocols shall address issues such as stabilization of vital functions, initial diagnostic tests, and use of medications (including but not limited to intravenous tissue-type plasminogen activator (t-PA) treatment), as applicable. These protocols shall be based on nationally accepted evidence based guidelines and adapted for each facility by a multidisciplinary team. (B) Acute Stroke Ready Service Protocols. The facility shall develop and implement written protocols, including, but not limited to: (1) triage and treatment of patients presenting with symptoms of acute stroke (e.g., use of thrombolytic therapy, management of increased intracranial pressure and blood pressure and post-thrombolysis management plan, as applicable). (2) communicating effectively with Emergency Medical Service (EMS) personnel in the pre-hospital setting during transportation of a patient with symptoms of acute stroke. The facility must be able to efficiently prepare for the arrival, to receive, and to triage patients with symptoms of acute stroke arriving via EMS transportation and to be able to efficiently communicate about the need for any transfers. (3) a specific, well-organized system for promptly notifying and activating the Acute Stroke Team to evaluate patients presenting with symptoms of acute stroke. (C) Coordinating Stroke Care Agreement. The facility must have a coordinating stroke care agreement with a hospital with primary stroke service or endovascular capable stroke service within their service area to provide appropriate care for acute stroke patients. The coordinating stroke care agreement may include the provision of telestroke services. The coordinating stroke care agreement must be in writing and include, at a minimum, the following: 1. Transfer protocols for the transport and acceptance of stroke patients for stroke treatment therapies which the facility is not capable of providing; and 2. Communication criteria and protocols with one or more facilities, or hospitals with primary stroke service or endovascular capable stroke service, as needed.