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New Rules on Stroke
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"Many people assume that stroke can be and is treated by anyone," he said, which simply isn't true.
Massachusetts was the first state to create a stroke care system, in 2004, partly because of the problem of getting on-call specialists. Under the plan, designated hospitals agree to have the appropriate diagnostics and staff (including neurologists on duty or available through telemedicine) and the ability to give TPA within three hours. They also agree to report on the quality of care.
In mid-2005, the state began requiring ambulances to take patients to stroke centers. Within a year, the number of stroke patients receiving TPA increased by 20 percent, Schwamm said. Now the goal is to increase the number of patients who get to the hospital in time, he added. Sixty-eight of the state's 72 hospitals have been designated as stroke centers by the Massachusetts health department.
Several states have followed Massachusetts's lead, including Maryland (in 2007), New York, New Jersey and Florida.
Maryland hospitals that apply for the stroke center designation are evaluated by a state inspection team. Hospitals can also be certified by the Joint Commission.
The nonprofit commission began certifying stroke centers in 2003. So far, 455 hospitals nationwide have received that designation.
Twenty-eight hospitals have received Maryland's five-year stroke center certification. These hospitals can evaluate stroke patients, give the initial treatment and, in most cases, admit patients directly to a special stroke unit in the hospital, Bass said. Since the program's establishment, the number of patients receiving clot-busting therapy has increased 20-fold, said John Young, stroke system coordinator for MIEMSS.
Like the District, Virginia does not have its own stroke center certification process.
Certification isn't a guarantee of superior care, said Ralph Sacco, chairman of the American Stroke Association's Stroke Advisory Committee and chairman of neurology at the Miller School of Medicine at the University of Miami. But it's an indicator that the hospital has the infrastructure in place -- and the commitment -- to deliver high-quality treatment, he and Schwamm agreed.
What should you do if you think you or a loved one are having a stroke?
The keys to a good outcome, Schwamm said, are knowing the warning signs, calling 911 immediately and getting to a primary stroke center.
He and others say they hope that every state adopts a system to require transport to those centers. It could be a lifesaving trip. ¿
Alicia Ault writes frequently for the Health section. Comments:health@washpost.com.
