Quality Indicators: Stroke
May is National Stroke Awareness month. Scroll down, or use the links below, to see how UVa performs on the following quality indicators for Stroke:
Primary Stroke Center Designation (JCAHO)
In a Consensus Statement published in 2003, the Brain Attack Coalition states that the “establishment of primary stroke centers has the potential to improve the care of patients with stroke.” The Coalition recommends that primary stroke centers have the following key elements:
- Acute stroke team: Includes a physician and one or more other healthcare professionals (i.e, nurse, physician’s assistant, nurse practitioner) who are available on an around-the-clock basis.
- Written care protocols
- Emergency medical services (EMS): It is vital that EMS have effective communication with the Emergency Department during transportation of suspected stroke patients.
- Emergency department: ED personnel should be well trained in the diagnosis and treatment of all types of stroke.
- Stroke unit: Studies have shown that stroke patients who receive care in a specialized stroke unit had decreased rates of death, decreased lengths of stay, and increased rates of being able to live at home after the stroke.
- Neurosurgical services: Because some patients with acute stroke will require evaluation and/or intervention by a neurosurgeon, neurosurgical care should be available within two hours of such a requirement being deemed necessary, either onsite or by transfer to another facility.
- Medical organization commitment to and support of the primary stroke center
- Neuroimaging: The primary stroke center should be able to provide either a cranial computerized tomography (CT scan) or brain magnetic resonance imaging (MRI) within 25 minutes of the order being written on an around-the-clock basis. In addition, physicians with experience in interpretation of CT and/or MRI studies should be available to interpret the scans within 20 minutes of their completion.
- Laboratory services: Available 24/7
- Outcomes and quality improvement
- Educational programs: The stroke center’s professional staff should receive a minimum of eight hours/year of continuing education programs to maintain and expand their knowledge of stroke care. (JAMA, 2000: 283(23); 3102-3109)
Is UVa a designated Primary Stroke Center?
Yes: UVa has one of only three JCAHO-designated Primary Stroke Centers in Virginia, and provides all the elements listed by the 2003 Brain Attack Coalition recommendations. Members of UVa’s Stroke Team are specialists in the diagnosis and treatment of patients with stroke. UVa also has facilities--including a complete inpatient unit, surgery services, imaging and lab services—designed for stroke patients. This kind of specialized, team approach means UVa can offer stroke patients more treatment options, at all stages of their care.
Presence of a Stroke Disease Management Team
Disease management programs are increasingly being examined and introduced to help treat chronic illnesses such as cardiovascular diseases and stroke. “The term ‘disease management programs’ typically refers to multidisciplinary efforts to improve the quality and cost-effectiveness of care for select patients with chronic illness.” (Circulation, June 1, 2004: 109(21); 2651-2654)
Does UVa have a stroke disease management team?
Yes: UVa’s accreditation as a Primary Stroke Center was based in large part on UVa’s comprehensive disease management program. This program works to improve the quality of care and patient outcomes by using evidence-based interventions and a multi-disciplinary approach, and by encompassing all aspects of care required to obtain optimal levels of health and functionality. UVa’s designation as Primary Stroke Center also means we serve as a model for other hospitals and physicians.
24/7 Availability of Brain Imaging
According to the American Stroke Association’s “Guidelines for the Early Management of Patients With Ischemic Stroke,” a brain imaging study is mandatory in order to distinguish ischemic stroke from hemorrhagic stroke or from other brain conditions that may mimic stroke. “Brain imaging is required to guide acute intervention. For most cases and at most institutions, computerized tomography (CT) remains the most important brain imaging test. ”According to the guidelines, “because time is of the essence in acute stroke care, institutions should have these diagnostic studies available on a 24-h/day and 7-d/week basis.” (Stroke, 2003: 34(4);1056)
Does UVa have around-the-clock brain imaging availability?
Yes: UVa has 24-hour a day, 7-days a week Radiology services available for brain imaging, including computerized tomography (CT). Even more important, UVa has a dedicated team of neuro-radiologists who are specialists in reading and interpreting scans to quickly identify brain injury. In addition to CT, UVa also has a wide range of other brain imaging technologies including magnetic resonance imaging (MRI) and brain angiography.
24/7 Availability of Radiology Interpretation
For most cases and at most institutions, computerized tomography (CT) remains the most important brain imaging test. A physician skilled in assessing CT studies should be available to interpret the scan. (Stroke, 2003: 34(4);1056)
Does UVa have around-the-clock radiologists available to interpret brain-imaging studies?
Yes: UVa has 24-hour a day, 7-days a week coverage by radiologists skilled in the interpretation of brain computerized tomography (CT) scans and other brain imaging tests.
Availability of on-staff Neurologist
Studies have shown that stroke patients who are treated primarily by a neurologist have better outcomes, both short-term and long-term. (Neurology, 2003: 61(6); 792-796; Stroke, 1996: 27(11); 1937-1943)
Is a Neurologist on staff to treat stroke patients at UVa?
Yes: UVa has 37 neurologists, including four who are dedicated to the care of stroke patients and who are on call 24/7.
Board Certification of Stroke Physicians
A board-certified physician has completed an approved educational training program and an evaluation process including an examination designed to assess the knowledge, skills and experience necessary to provide quality patient care in that specialty. A specialty certificate is issued by a medical specialty certifying board, which is valid nationwide. Although certification is not required for an individual physician to practice medicine, most hospitals and managed care organizations require that at least a certain percentage of their staff be “board certified." ( American Board of Medical Specialties)
Are UVa Neurologists board certified?
Yes: All of UVa’s neurologists are board certified in Neurology by the American Board of Psychiatry and Neurology. In addition, Neurologists on UVa’s dedicated Stroke Team are stroke specialists, with additional training and expertise in the treatment of stroke patients.
Presence of Patient and Community Education Programs
According to the latest statistics from the American Stroke Association, someone dies of a stroke every three minutes. ( American Stroke Association). “Only about one-third of patients who are having a stroke are aware of its symptoms, and most bystanders are not knowledgeable about the signs of stroke.” (New England Journal of Medicine, 2000: 343(10); 710-722). A person experiencing a stroke may be unaware of the stroke symptoms or unable to communicate the problem, and it is often bystanders who initiate communication for stroke care. (Archives of Internal Medicine, 2003: 163(18); 2198-2202)
Does UVa offer patient and community education programs?
Yes: UVa actively participates in local and regional stroke education programs.
Presence of Stroke Rehabilitation Program
Strokes, whether a first stroke or a recurrent stroke, can be prevented. In addition, those who have a stroke are at greatly increased risk for a recurrent stroke. Evidence shows that physical activity and exercise training are considered an important part of a stroke risk-reduction program. (Stroke, 2004: 35(5); 1229-39).
Does UVa have a stroke rehabilitation program?
Yes: At UVa, each stroke patient is automatically evaluated for appropriate rehabilitation care. UVa offers an inpatient rehabilitation team that works with stroke patients beginning during the acute phase of stroke recovery. The team works with patients to ensure their discharge to the most appropriate location, whether to home, a skilled nursing facility, or a rehabilitation facility. In addition, outpatient rehabilitation services are available for stroke patients once they are discharged from the hospital to continue rehabilitation as needed to achieve and maintain optimal functioning after stroke. These are provided at the area’s only rehabilitation hospital, with stroke rehabilitation specialists on staff.
