Stroke Team Updates 

        We have been hearing “Get With the Guidelines" and relating it to Acute MI, Acute Coronary Syndrome and Congestive Heart Failure. Stroke has now been added as another focus for rapid response, recognition, and intervention to improve quality of life and provide the fastest treatment to patients with stroke symptoms.  Ischemic versus hemorrhagic becomes the question. Interviewing the patient and covering a check list of questions to rule out potential bleeding problems must occur.  Immediate head CT following emergency room physician assessment is imperative to decide if the Stroke is ischemic.  If the CT can provide this information and the patient passes the check list questions then TPA may be indicated.

         Centers of Excellence as recognized by JCAHO have started to take shape. Many representatives from Northern California Hospitals reported that they have already been recognized as Centers of Excellence by JCAHO. Others reported already having applied, while others were in the beginning process of organizing their centers for application.

        Things we know:  The DRG for Medicare patients receiving TPA will double.

Questions were asked:

• Will reimbursement drive this process?

• Will prehospital county Emergency Medical Services enter into designated receiving centers for Stroke, like we are seeing for Cardiac and STEMI?

• The big question posed was, “Can small community hospitals continue to treat stroke patients without being “Stroke Centers”? 

• If we enter into bypassing these hospitals like we do for Acute MI with ST elevation will we compromise the viability of the small community hospital?

• Will EMS step out there and mandate receiving centers for Stroke also?  

• All of these questions were asked. One thing we know for sure is that rapid response to Ischemic stroke within 3 hours may indicate that the use of TPA can improve the outcomes and increase the quality of life for stroke patients. Centers of Excellence certainly will be a good way to provide rapid CT and evaluation to these patients. It was obvious that most people present were either already approved Centers, or were starting. So it looks like we will all be trying to “Get with the Guidelines” and working with American Stroke Association to help deliver the best care possible for these patients.