Recommendations for the
Establishment of Primary Stroke Centers
June 20, 2000 – The Brain Attack Coalition’s recommendations for a Primary Stroke Center address the following 11 major aspects of acute stroke care:
- Acute Stroke Teams: The Acute Stroke Team should include a physician with experience in diagnosing and treating cerebrovascular disease, and one other healthcare provider as a minimum. Hospital-based stroke teams should be available around-the-clock, seven days a week in order to evaluate within 15 minutes any patient who may have suffered a stroke.
- Written Care Protocols: Hospitals should have written procedures to streamline and accelerate the diagnosis and treatment of stroke patients. The availability of such protocols is a key step in reducing time to treatment as well as complications from treatment.
- Emergency Medical Services: Emergency medical services (EMS) have a vital role in the rapid transportation and survival of stroke patients. Improved coordination between hospitals and EMS is a cornerstone of a Primary Stroke Center. One element of a well integrated system would be effective communications between EMS personnel and the stroke center during rapid transport of a patient experiencing a stroke.
- Emergency Department: The emergency department staff should have training in diagnosing and treating stroke and have good lines of communications with both EMS and the acute stroke team.
- Stroke Unit: A Primary Stroke Center wishing to provide care beyond the initial life-threatening period should have access to a Stroke Unit where patients can receive specialized monitoring and care. Some hospitals may choose to stabilize patients and transfer them to another facility.
- Neurosurgical Services: Primary Stroke Centers should be able to provide neurosurgical services to stroke patients within two hours of when the services are deemed necessary.
- Support of Medical Organization: The facility and its staff, including administration, should be committed to the Primary Stroke Center. This comprehensive commitment ensures the delivery of high quality and efficient care to acute stroke patients.
- Neuroimaging: The ability to perform brain imaging studies on acute stroke patients is vital for physicians to make a fast, accurate diagnosis of stroke patients. Brain imaging studies include CT scans. A Primary Stroke Center must be capable of performing an imaging study within 25 minutes of the physician’s order. The image should be evaluated by a physician within 20 minutes of completion.
- Laboratory Services: Standard laboratory services should be available around-the-clock, seven days per week at a Primary Stroke Center. Standard laboratory services include rapidly performing and reporting blood counts, blood chemistries and coagulation studies. A Primary Stroke Center also should be able to rapidly obtain ECG and chest x-rays.
- Outcomes/Quality Improvement: Primary Stroke Centers should have a database or registry for tracking the number and type of stroke patients seen, their treatments, timeline for treatments and some measurement of patient outcome.
- Education Programs: The professional staff of a Primary Stroke Center should receive at least eight hours per year of continuing medical education credit. In addition to professional education, the Primary Stroke Center should plan and implement at least two annual programs to educate the public about stroke prevention, diagnosis and availability for emergency treatment.
The National Institute of Neurological Disorders and Stroke is a component of the National Institutes of Health, U.S. Department of Health and Human Services.
Prepared By: Margo Warren and Marian Emr