Business of Hospital Neurology

Published on 14/05/2017 by admin

Filed under Neurology

Last modified 14/05/2017

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Monico Peter Baňez, MD, MBA, FACP, SFHM


Hospital neurologists are increasingly being asked to treat strokes acutely. Because of this, we are asked to start or participate in Stroke Centers.

There are different levels of stroke center certification, and the key is selecting which is the best fit for each facility. The certifications are designed and granted by The Joint Commission (TJC). Requirements are complex and subject to change, so source documentation from TJC should be consulted (visit https// xThe criteria presented are active at the time of writing.

The types of stroke centers are:

Acute stroke-ready hospital (ASRH)

Primary stroke center (PSC)

Comprehensive stroke center (CSC)

Many hospitals have the personnel and resources to be a PSC. CSC certification is usually the province of academic hospitals and regional referral medical centers. Smaller hospitals may seek certification as ASRHs.


ASRH certification is best suited to hospitals with 24/7 ED service typically without in-house neurology. Basic requirements include:

24/7 provider coverage

Initial evaluation by physician, nurse practitioner, or physician assistant

Neurologic consultation in person or by telemedicine

Imaging including computed tomography (CT) and magnetic resonance imaging (MRI) available 24/7

Ability to administer IV tissue plasminogen (tPA) with subsequent transfer to a stroke center

Transfer agreement with a PSC or CSC

There are other requirements regarding education, timing of response, record-keeping, and requirement of TJC site visit.


PSC certification is best suited for hospitals with 24/7 neurology coverage, although the criteria do allow for telemedicine to fulfill this requirement. In comparison to the ASRH designation, the PSC must have more extensive access to advanced imaging and neurovascular interventions. Some of the requirements are:

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