Formation and function of acute stroke-ready hospitals within a stroke system of care recommendations from the brain attack coalition.
OBJECTIVE
Many patients with an acute stroke live in areas without ready access to a Primary or Comprehensive Stroke Center. The formation of care facilities that meet the needs of these patients might improve their care and outcomes and guide them and emergency responders to such centers within a stroke system of care.


METHODS
The Brain Attack Coalition conducted an electronic search of the English medical literature from January 2000 to December 2012 to identify care elements and processes shown to be beneficial for acute stroke care. We used evidence grading and consensus paradigms to synthesize recommendations for Acute Stroke-Ready Hospitals (ASRHs).


RESULTS
Several key elements for an ASRH were identified, including acute stroke teams, written care protocols, involvement of emergency medical services and emergency department, and rapid laboratory and neuroimaging testing. Unique aspects include the use of telemedicine, hospital transfer protocols, and drip and ship therapies. Emergent therapies include the use of intravenous tissue-type plasminogen activator and the reversal of coagulopathies. Although many of the care elements are similar to those of a Primary Stroke Center, compliance rates of ≥67% are suggested in recognition of the staffing, logistical, and financial challenges faced by rural facilities.


CONCLUSIONS
ASRHs will form the foundation for acute stroke care in many settings. Recommended elements of an ASRH build on those proven to improve care and outcomes at Primary Stroke Centers. The ASRH will be a key component for patient care within an evolving stroke system of care.
From the Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas (M.J.A.); Department of Neurology, University of Pittsburgh, PA (L.R.W.); Department of Radiology and Medical Imaging (M.E.L.J.), Department of Neurology (D.G.), University of Virginia, Charlottesville; Department of Radiology, UC Davis Medical Center (R.E.L.); Department of Emergency Medicine, West Virginia University, Morgantown (T.J.C.); Centers for Disease Control and Prevention, Atlanta, GA (M.G.G.); National Stroke Association, Englewood, CO (J.B.); National Association of EMS Officials, Falls Church, VA (R.R.B.); Department of Neurology, VA Medical Center, Cleveland, OH (R.L.R.); Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD (J.H.); Inova, Inc, San Diego, CA (B.M.); American Heart Association, Dallas, TX (T.G.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.E., M.W., M.D.W.).
Mark J
MJ
Alberts
Lawrence R
LR
Wechsler
Mary E Lee
ME
Jensen
Richard E
RE
Latchaw
Todd J
TJ
Crocco
Mary G
MG
George
James
J
Baranski
Robert R
RR
Bass
Robert L
RL
Ruff
Judy
J
Huang
Barbara
B
Mancini
Tammy
T
Gregory
Daryl
D
Gress
Marian
M
Emr
Margo
M
Warren
Michael D
MD
Walker
D003952:Diagnostic Imaging; D004632:Emergency Medical Services; D006301:Health Services Needs and Demand; D006761:Hospitals; D006801:Humans; D010360:Patient Transfer; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*
acute stroke; cerebrovascular disease; stroke