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A stroke center of excellence

Implementing best practices and improving care

Featured center of excellence

The University of California San Diego Medical Center1

University of California, San Diego Medical Center

UCSD Medical Center became San Diego County's first Joint Commission (JC)–certified stroke center in 2004 and has since continually strived to provide the best stroke care possible to patients. Its commitment to excellence includes publishing a study on streamlined t-PA protocols as well as a study on telemedicine (STRokE DOC), to assess the viability and safety of providing quality stroke care remotely.

UCSD Medical Center focuses on continuous improvement and best practices around protocols, employee training, case assessments, and patient outcomes.

Stroke center and team specifics

Number of
licensed beds		Type of certificationStroke team membersIn-house resources

548

33 beds reserved for acute ischemic stroke (AIS) patients

JC Disease-Specific Certification — 2004

First in San Diego County

Stroke care coordinator

Neurology (4 attendings and 2-3 fellows)

Critical care unit/intensive care unit/surgical intensive care unit-speech

Emergency department/ emergency service disease management

Telemetry

Speech therapy

Stroke team

ICU team

Neurosurgical team

Neuroradiology

CT/CT angiography

Endovascular and revascularization therapies

Neuroimaging

Telestroke program

Best practices

UCSD Medical Center's door-to-needle time is on average 51 minutes (NIH recommends <60 minutes). They consistently achieve this treatment efficiency through the following best practices:

  • 24/7 CT and stroke team on site
  • Acute stroke code protocols
  • Streamlined t-PA protocols
    • – Immediate lab tests
    • – Coagulation run only for selective patients
    UCSD has published a study on streamlined t-PA protocols which can be accessed here.
  • Weekly and monthly interdisciplinary stroke team meetings (including ED and nurses from each unit)
  • Quarterly EMS training seminars & newsletter on acute stroke care
  • New employee training
  • Ongoing educational seminars
  • Stroke Awareness Month activities
  • Outreach activities run by Nursing Stroke Champions

A Performance Improvement & Patient Safety (PI&PS) Plan team meets monthly to review and discuss:

  • Data and metrics
  • Specific stroke patient cases
  • Case outliers
  • Improving processes
  • Outcomes

This consistent communication and constant assessment helps to make UCSD Medical Center a benchmark of excellence in quality stroke care.

Stroke patients treated

# of AIS patients per year
June 2007 – June 2008		% of AIS patients treated with IV t-PA
June 2007 – June 2008
203 33%

UCSD Medical Center credits its success to continued dedication from the entire stroke team, strong administrative support, and a commitment to quality assessment and constant improvement. They also provide leadership in telestroke training, research and patient care to hospitals in California and across the country to enable more stroke patients to receive the best care possible.

Genentech is neither affiliated with nor endorses any of the following organizations.

UCSD Medical Center related links:

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Indication
Activase (Alteplase) 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).

Important Safety Information
Activase therapy in patients with AIS is contraindicated in certain situations (eg, suspicion of subarachnoid hemorrhage on pretreatment evaluation, recent (within 3 months) intracranial or intraspinal surgery, history of intracranial hemorrhage, uncontrolled hypertension at time of treatment, active internal bleeding, known bleeding diathesis (eg, current use of oral anticoagulants, administration of heparin within 48 hours of onset of stroke, platelet count <100,000) (see CONTRAINDICATIONS for full list).

The most common complication during Activase therapy is bleeding. Should serious bleeding in a critical location (intracranial, gastrointestinal, retroperitoneal, pericardial) occur, Activase therapy should be discontinued immediately. Death and permanent disability are not uncommonly reported in patients who have experienced stroke (including intracranial bleeding) and other serious bleeding episodes.

The risks of Activase therapy may be increased and should be weighed against the anticipated benefits in certain conditions. [See WARNINGS in full prescribing information].

  • Patients with severe neurological deficit (eg, NIHSS >22) at presentation. There is an increased risk of intracranial hemorrhage in these patients.
  • Patients with major early infarct signs on a computerized cranial tomography (CT) scan (eg, substantial edema, mass effect, or midline shift).

Treatment of patients with minor neurological deficit or with rapidly improving symptoms is not recommended.

Orolingual angioedema has been observed in postmarketing experience in patients treated with Activase for AIS. Patients should be monitored during and for several hours after infusion for signs of orolingual angioedema.

Please click here for full prescribing information.
Reference:
1.
Data on file. Genentech, Inc.