Monico Peter Baňez, MD, MBA, FACP, SFHM
CHAPTER CONTENTS
STROKE CENTER
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//www.jointcommission.org/facts_about_joint_commission_certification). xThe criteria presented are active at the time of writing.
The types of stroke centers are:
•Acute stroke-ready hospital (ASRH)
•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.
ACUTE STROKE-READY HOSPITAL
ASRH certification is best suited to hospitals with 24/7 ED service typically without in-house neurology. Basic requirements include:
•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.
PRIMARY STROKE CENTER
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:
