During the Initial Application for Designation Process – Level 3 Stroke Ready

During the Initial Application for Designation Process – Level 3 Stroke Ready Hospital shall verify the following resources a. Hospital Organization i. ED Physician, other qualified physician, or physician extender available 24/7 to diagnose and initiate appropriate treatment including patient transfer to a Level 1 or Level 2 facility ii. 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 iv. Stroke Treatment Protocols 1. Protocols and care plans are available in the Emergency Department 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 (on-call, tele-medicine, or transfer agreement to Level 1 or 2 Stroke Center) ii. Critical Care Specialist iii. Internal Medicine/Hospital Care Services d. Facilities and Resources i. Emergency Department 1. Personnel a. Emergency Physicians, other qualified physicians or physician extender 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. Laboratory Services 1. Glucose 2. Blood cell count with platelet count 3. Coagulation studies 4. Blood chemistries 5. Troponin iii. 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