During the Initial Application for Designation Process – Level 2 Stroke Centers

During the Initial Application for Designation Process – Level 2 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 and surgical care. The team consists of a diagnostic radiologist, neurologist, and neurosurgeon ii. Fully equipped Emergency Department for rapid diagnosis and treatment using standard CT imaging as defined in the AHA/ASA CPGs iii. Departments/Sections 1. Emergency Department 2. Laboratory 3. Radiology 4. Stroke unit or designated beds 5. 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 5. Evaluation protocol to assess for large vessel occlusion that may benefit from intervention 6. Transfer protocol to Level 1 Stroke Center for large vessel occlusion a. Consider rapid transfer to Level 1 Stroke Center for the following: i. Patients, who were previously functionally independent, with signs of large vessel occlusion (examples include aphasia, neglect, eye deviation, hemiplegia, intubated, NIHSS ˃6); consider transfer at the discretion of the accepting physician ii. Patients with large strokes with cerebral edema for consideration of surgical decompression 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 c. Consultant availability (on-call in accordance with hospital Stroke Plan): i. Neurologist ii. Neurosurgeon iii. Pulmonary/Critical Care iv. 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. Thrombolytic medications 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 a. Appropriate cardiac monitoring and respiratory support equipment iii. Rehabilitation 1. Protocol for stroke patients 2. Complete rehabilitation services including OT, PT, and SLP available for all stroke patients within 24-48 hours iv. Laboratory Services 1. Glucose 2. Blood cell count with platelet count 3. Coagulation studies 4. Blood chemistries 5. Troponin v. 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