During the Initial Application for Designation Process – Level 1 Stroke Centers

During the Initial Application for Designation Process – Level 1 Stroke Centers shall verify the following resources: a. Hospital Organization i. Core team of personnel, infrastructure, and expertise to diagnose and treat stroke patients who require intensive medical, surgical, and interventional vascular care. The team consists of a neurologist, neurosurgeon, and endovascular specialists ii. Fully equipped Emergency Department (ED) for rapid diagnosis and treatment using standard CT imaging within 20 minutes and the ability to have results reported within 45 minutes of arrival iii. Departments/Sections 1. Emergency Department 2. Interventional/Vascular Suite 3. Laboratory 4. Radiology 5. Stroke Unit or Designated Beds 6. Operating Room iv. Stroke Treatment Protocols 1. Protocols and care plans are available in the Emergency Department, acute care areas and stroke units for the acute assessment and treatment of patients with ischemic or hemorrhagic stroke 2. Utilizes an evidenced based bedside dysphagia screen protocol approved by the organization 3. Protocol for IV thrombolytics 4. A single activation should alert the stroke team b. Clinical Capabilities i. Specialty availability (contact made with patient and care plan determined): 1. Door to Physician as defined in the AHA/ASA CPGs 2. At least one designated stroke team practitioner is able to respond to the bedside as defined in the AHA/ASA CPGs 3. NIHSS completed as defined in the AHA/ASA CPGs 4. Door to CT initiated as defined in the AHA/ASA CPGs 5. Door to CT interpreted as defined in the AHA/ASA CPGs 6. Door to Lab completed as defined in the AHA/ASA CPGs 7. Door to EKG completed as defined in the AHA/ASA CPGs 8. Door to CXR completed as defined in the AHA/ASA CPGs 9. Door to Needle as defined in the AHA/ASA CPGs 10. Door to Groin as defined in the AHA/ASA CPGs 11. Door to Revascularization as defined in the AHA/ASA CPGs c. Consultant availability (on-call in accordance with hospital Stroke Plan): i. Neurologist ii. Neurosurgeon iii. Endovascular Specialist iv. Pulmonary/Critical Care v. Internal Medicine/Hospital Care Services d. Facilities and Resources i. Emergency Department 1. Personnel a. Emergency Physicians privileged in the diagnosis and treatment of ischemic and hemorrhagic stroke b. Nursing personnel with expertise in Alteplase administration and care of the acute stroke patient until admission to a hospital unit or transfer 2. Equipment a. Airway control and ventilation equipment Oxygen/Pulse oximetry b. Suction devices c. 12-lead ECG capability d. Intravenous fluid administration equipment e. Approved thrombolytic medications for stroke treatment f. Cardiac rhythm monitoring capability g. Intubation/emergency airway management equipment h. Two-way communication capability with EMS ii. Intensive Care Unit/Stroke Areas 1. Personnel a. Designated Stroke Medical Director 2. Equipment i. Appropriate cardiac monitoring and respiratory support equipment iii. Interventional/Vascular Suite 1. Personnel a. Radiologic staff with experience in interventional suite operations and all aspects of diagnostic and interventional stroke care b. Nursing staff experienced in interventional suite operations, conscious sedation, cardiac monitoring, and cardiac and neurological emergencies 2. Equipment a. A variety of guiding, diagnostic, intermediate, aspiration and microcatheters b. Cerebral guidewires and microwires c. Stents, balloons and clot retrieval devices d. Advanced hemodynamic and ECG monitoring e. Intravenous antihypertensives, vasoactive/vasopressor medications f. Thrombolytic and antiplatelet medications g. Distal protection devices h. Intubation/emergency airway management equipment iv. Rehabilitation 1. Protocol for stroke patients 2. Complete rehabilitation services including OT, PT, and SLP available for all stroke patients within 24-48 hours v. Laboratory Services 1. Glucose 2. Blood cell count with platelet count 3. Coagulation studies 4. Blood chemistries 5. Troponin vi. Continuing Education: 1. Core Stroke Team – At least 8 hours of stroke education annually 2. Emergency Department Staff – Minimal of two educational activities per year or as defined by the nationally accrediting organization 3. EMS Personnel – Stroke program will provide educational activities to EMS personnel 4. Public Educational Activities – Stroke program will provide at least two public educational activities per year or as defined by the nationally accrediting organization