Stroke team and center support

Coordination of care among EMS, stroke teams, and stroke centers is key to optimizing outcomes

In April 2007, the American Heart Association/American Stroke Association (AHA/ASA) published its updated Guidelines for the Early Management of Adults With Ischemic Stroke.

The guidelines stress that stroke centers are part of a Stroke System of Care—a much larger network that encompasses stroke prevention, education of healthcare practitioners and the public, acute care, rehabilitation, and quality improvement in the delivery of healthcare.1

The 2007 guidelines include new recommendations on prehospital management and field treatment of the patient with acute ischemic stroke.

They recommend activation of the 9-1-1 system by patients or others, because it leads to faster treatment of stroke. As many as 65% of patients with signs or symptoms of acute stroke receive their initial care from EMS.1

The guidelines also state that EMS personnel should transport the patient to the closest facility that has the resources to treat stroke. This means that the ambulance may bypass the nearest hospital if the EMS personnel know that there is a stroke-capable center within a reasonable transport interval.1

Another strong recommendation is the creation of educational programs to increase public awareness of stroke. According to the guidelines, EMS activation appears to be a function primarily of someone other than the patient; 62% to 95% of 9 1-1 calls are made by a family member, coworker, paid caregiver, or other bystander.1

Key corrections made to guidelines in June 2007

  • In Table 11, Characteristics of Patients With Ischemic Stroke Who Could Be Treated With rtPA, "Not taking an oral anticoagulant or, if anticoagulant being taken, INR <1.5" should read "Not taking an oral anticoagulant or, if anticoagulant being taken, INR <1.7."
  • On page 1674, first column, lines 3 and 4, "...systolic blood pressure is >220 mm Hg or the mean blood pressure is >120 mm Hg..." should read "... systolic blood pressure is >220 mm Hg or the diastolic blood pressure is >120 mm Hg...."
  • For the complete list of corrections, please click here

NIH-supported study concluded:

Primary stroke centers (PSCs) greatly enhance efficiency of healthcare providers2

PSCs enhance efficiency of healthcare providers in evaluating patients and administering thrombolytic therapy according to established protocols.

The Suburban Hospital Center Study in Cleveland concluded that2:

  • Substantial benefits would result if community hospitals nationwide set up PSCs
  • With only a 5% increase in Activase (t-PA) use, ~30,000 more patients per year would be treated; 4000 of them would be spared long-term disability at a savings exceeding $100 million annually in medically-related expenses2

Find more information on stroke treatment guidelines, the Stroke System of Care, and Primary Stroke Centers

Genentech supports voluntary certification of Stroke Centers. More information about accreditation can be found at www.JCAHO.org.

Primary Stroke Center Card

  • Elements of a Primary Stroke Center is an informational card that lists the overall treatment functions of a PSC— produced by the Brain Attack Coalition (BAC)
  • Recommended Elements of a Primary Stroke Center is a publication that lists both patient care services and support services—produced by the BAC

Download now

Stroke Resources

  • A one-step source for stroke information with links to:
    • – A Clinical Library of stroke-related articles that discuss the safety and efficacy of Activase, as well as the importance of stroke centers and early treatment
    • – Tools to aid in the assessment, diagnosis, and treatment of stroke for you and your patients
      Read more
    • – Stroke policy statements and guidelines from the American Academy of Neurology (AAN), the American College of Emergency Physicians (ACEP), the American Heart Association/American Stroke Association (AHA/ASA), and the Brain Attack Coalition (BAC)
      Read more
    • – Quality Assessment Tracker – helps you support your institution's commitment to quality stroke care by utilizing the downloadable tracking log for important quality measures for stroke response. You'll also find ideas you may wish to incorporate from the best practices provided by 3 Stroke Centers of Excellence.
      Download now

Indication: Activase is indicated for the management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability. Treatment should only be initiated within 3 hours after the onset of stroke symptoms, and after exclusion of intracranial hemorrhage by a cranial computerized tomography (CT) scan or other diagnostic imaging method sensitive for the presence of hemorrhage (see CONTRAINDICATIONS in the full prescribing information).

Safety Information: All thrombolytic agents increase the risk of bleeding, including intracranial bleeding, and should be used only in appropriate patients. Not all patients with acute ischemic stroke will be eligible for Activase therapy, including patients with evidence of recent or active bleeding; recent (within 3 months) intracranial or intraspinal surgery, serious head trauma, or previous stroke; uncontrolled high blood pressure; or impaired blood clotting.


References:
1.
Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke. Stroke. 2007;38:1655-1711.
2.
Lattimore SU, Chalela J, Davis L, et al. Impact of establishing a primary stroke center at a community hospital on the use of thrombolytic therapy: the NINDS Suburban Hospital stroke center experience. Stroke. 2003;34:e55-e57.
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