Criteria for Stroke Center Certification
1a. Door-to-needle time (median)______ min
% of patients with door-to-needle time < 60 min _______ (target > 50%)
% of patients with door-to-needle time < 45 min _______
1b. Door-to-puncture time (median) _____ min
% of patients with door-to-puncture < 120 min _____ (target > 50%)
% of patients with door-to-puncture < 90 min ______
2. Elegibility for reperfusion
Total elegibility _____% (number of patients reperfused / total number of ischemic stroke patients)
Elegibility within the window for IV thrombolysis ____% (number of thrombolyzed patients / number of ischemic stroke patients arriving ≤ 4.5h of symptom onset)
3a. % Final TICI 2b-3 _____ (for Advanced Centers only)
3b. Puncture-to-recanalization time ___ (Advanced Centers)
4. Dysphagia assessment _________ %
5. Patients with suspected stroke who performed NCCT/MRI______%
6. Discharge with prescription of antiplatelets in ischemic stroke patients _____% (target 100%)
7. Discharge with prescription of oral anticoagulants in patients with AF ________ % (target 90%)
8. Stroke patients attended in a stroke unit _______ (number of patients with “U-AVC = sim” / total number of patients with ischemic stroke, hemorrhagic stroke or TIA (target 90%)
9. Median length of stay _____days (IQR 25-75)
10. Inhospital mortality _______%
Deaths by ischemic stroke/TIA_____%
Deaths by hemorrhagic stroke _____%
11. Mean of the Modified Rankin Score in 90 days _____
Modified Rankin Score 0 to 1 in 90 days ______%
Modified Rankin Score 0 to 2 in 90 days ______%
Modified Rankin Score 6 in 90 days _____%
Criteria | Essential Stroke Center | Advanced Stroke Center |
---|---|---|
Access to hyperacute stroke care | ||
Protocols for rapid evaluation and diagnosis of stroke patients in Hospital/ Emergency department 24hours/day, 7days/week, with time metrics assessment | Mandatory | Mandatory |
Access to basic diagnostic services | ||
Laboratory blood test 24/7 (CBC, electrolytes, urea, glucose, INR, PT) | Mandatory | Mandatory |
Electrocardiogram (12 lead) 24/7 | Mandatory | Mandatory |
Computed Tomography (CT) scan brain 24h/7 days | Mandatory | Mandatory |
Capability to do CT Angiography (CTA) 24/7 | Recommended | Mandatory |
Transthoracic Echocardiogram | Mandatory | Mandatory |
Vascular Doppler ultrasound | Mandatory | Mandatory |
Holter monitors | Recommended | Recommended |
Access to advanced diagnostic services | ||
Magnetic Resonance Imaging (MRI) | Mandatory | |
Capability to do MR Angiography | Mandatory | |
CT or MR Perfusion scans | Recommended | |
Prolonged ECG monitoring devices | Recommended | |
Transcranial Doppler | Recommended | |
Transesophageal Echocardiogram | Recommended | |
Access to emergency medical services –EMS– (ambulance)? ( ) Yes ( ) No | Recommended | Recommended |
If yes: | ||
Training of ambulance crews to identify stroke signs using FAST mnemonic or similar | Recommended | Recommended |
Work with ambulance systems to have stroke identified as a high priority transport emergency | Recommended | Recommended |
Access to nurses and nursing assessment with stroke training | ||
Acute care settings (the training should be documented, at least 4 hours/year - the documentation can be uploaded in the platform or should be presented during the onsite visit) | Mandatory | Mandatory |
Stroke unit settings (the training should be documented, at least 4 hours/year - the documentation can be uploaded in the platform or should be presented during the onsite visit, including stroke unit protocols, neurological assessment and swallow screen) | Mandatory | Mandatory |
Access to physicians with stroke expertise in acute stroke care available 24h/7 days | Mandatory | Mandatory |
Check below the specialist responsible for thrombolysis treatment in your hospital (check all available) | ||
Neurologist | ( ) | ( ) |
Neurosurgeon | ( ) | ( ) |
Emergency physician | ||
Intensivist | ( ) | ( ) |
Other speciality | ( ) | ( ) |
Access to stroke specialists through telestroke modalities, and teleradiology | ( ) | ( ) |
Access to physicians with expertise in stroke prevention and stroke rehabilitation | Recommended | |
Program to develop and maintain core competencies and stroke care | Recommended | Recommended |
Access to acute inpatient stroke care, where admitted stroke patients are cared for on: | Recommended (1 available, the item is positive) | Recommended (1 available, the item is positive) |
Stroke Unit (a defined group of beds, staff, and protocols that are used for the acute care of patients with a stroke) | ( ) | ( ) |
Clustered model on same ward | ( ) | ( ) |
Access to acute Intravenous thrombolysis | ||
IV thrombolysis | Mandatory | Mandatory |
Members of a interdisciplinary stroke team | ||
Neurologist with stroke expertise (or Stroke physician in some countries) | Mandatory | Mandatory |
Stroke Nurses | Mandatory | Mandatory |
Nursing assistants | Mandatory | Mandatory |
Pharmacist | Recommended | Recommended |
Social worker/case manager | Recommended | Recommended |
Palliative Care team | Recommended | Recommended |
Physiotherapist | Mandatory | Mandatory |
Occupational Therapist | Recommended | Recommended |
Speech-Language Pathologist | Mandatory | Mandatory |
Neurosurgeon | Recommended | Mandatory |
Neurointerventionalist (Interventional Neurologist OR Endovascular Neurosurgeon, OR Interventional Neuroradiologist) | Mandatory | |
Access to stroke unit protocols to guide acute stroke care based on best practice guidelines (Medical and nursing assessments) | ||
Swallowing assessment performed | Mandatory | Mandatory |
Nutrition, hydration | Mandatory | Mandatory |
Functional status, mobility, DVT risk | Mandatory | Mandatory |
Level of dependency | Mandatory | Mandatory |
Skin Integrity | Mandatory | Mandatory |
Bladder and bowel continence | Mandatory | Mandatory |
Temperature management | Mandatory | Mandatory |
Positioning, mobilization | Mandatory | Mandatory |
Access to stroke prevention therapies such as antiplatelet therapy, anticoagulants, lifestyle change recommendations, blood pressure management | Mandatory | Mandatory |
Access to advanced interventions: | ||
Endovascular thrombectomy 24/7 | Mandatory | |
Neurosurgery for hemorrhagic stroke 24/7 (including clipping and intraventricular drain placement) | Recommended | Mandatory |
Hemicraniectomy for ischemic stroke 24/7 | Mandatory | |
Acute inpatient stroke units | Recommended | Recommended |
Intensive care unit on site | Recommended | Mandatory |
Products to reverse coagulopathy | Recommended | Recommended |
Access to stroke rehabilitation services | ||
Early access to rehabilitation therapies – including cross training of skills to nurses, nursing assistants and family members | Recommended | Recommended |
Early functional assessments, goal setting and individualized rehab plans developed | Recommended | Recommended |
Organization of Stroke Care | ||
Stroke Director | Mandatory | Mandatory |
Nurse Coordinator (quality manager) | Mandatory | Mandatory |
Stroke Task Force (meets monthly) discusses data, guides, performance, improvement | Mandatory | Mandatory |
Interdisciplinary meetings weekly to discuss patient progress against treatment goals; update management plans | Recommended | Recommended |
Patient and family education, skills training, and involvement in care planning | Recommended | Recommended |
Discharge planning | Recommended | Recommended |
Stroke training programs for all levels of healthcare providers | Recommended | Recommended |
Participation in quality assessment of services (registry) - 4 months of data collection in the registry and performance measures must be included in the platform before the visit | Mandatory | Mandatory |
Printed stroke patient educational materials | Recommended | Recommended |
Treatment Requirements | ||
Thrombolysis (minimum number recommended per year) | 10 | 20 |
Thrombectomy (minimum number recommended per year) | 10 | |
Coordinated stroke care provided across geographically discrete regions | ||
Stroke pathways that define movement of stroke patients across region to higher and lower levels of services as required | Recommended | Recommended |
Coordinated referral system | Recommended | |
Provide telestroke consultations to smaller and more rural centers | Recommended | |
Education of population | Recommended | Recommended |
Implement research in stroke | Recommended |