Virginia Stroke Systems Website - Acute Stroke Treatment

To download a high resolution version of this map, click here.

Virginia's Acute Stroke Hospital Roles Map

The American Stroke association white paper Recommendations for Development of Stroke Systems of Care (2005) recommends that states identify the role each hospital plays in treating acute stroke, and lays out parameters for considering those roles. Virginia hospitals participate voluntarily in a biennial survey process to help draw a picture that is important for strategic planning across the state. Mapping services are graciously provided by the UVA Department of Planning and Research.

All stratifications presented on this map were derived from information reported by the hospitals during the 2008 survey process. The stratifications do not in any way reflect the quality of care provided at each facility and are not approved for hospital use in marketing or public relations. Revisions to reflect new Joint Commission-certified Primary Stroke Centers are planned for approximately every six months. Definitions of the stratifications levels are provided on Page 2 of the map.

Acute Stroke Treatment

A hospital-based acute stroke team improves stroke care through established protocols that facilitate rapid evaluation and appropriate use of stroke therapies. The availability of providers capable of diagnosing and treating all aspects of acute stroke is critical.

A systems approach that provides timely multidisciplinary care helps prevent stroke progression, recurrent stroke and common complications during the acute care phase. It is also key to appropriately treating patients with various forms of hemorrhagic stroke.

The Task Force has made the following recommendations in the context of the acute treatment of stroke:

A stroke system should determine the acute stroke treatment capabilities and limitations of all hospitals and make this information available to primary care providers, EMS, and the public.
A stroke system must develop strategies that incorporate hospitals that do not intend to seek stroke center status. All hospitals and facilities that could be involved in the care of acute stroke patients should develop action plans for the triage and treatment (or transport) of stroke patients.
A stroke system should ensure that hospitals identified as “acute stroke capable” possess the appropriate resources and deliver primary stroke care, in accordance with national recommendations and local or national certifying bodies.
A stroke system should make certain that clinical pathways are used consistently to ensure the organized application of interventions to prevent or limit stroke progression or secondary complications.
A stroke system should identify the roles played by each type of hospital in the system and define the responsibilities inherent in those roles.

Telehealth -Telemedicine and the REACH SYSTEM

Telemedicine dramatically expands the capability for optimum diagnosis and treatment that rural hospitals can offer to their stroke patients. The following providers have graciously lent their expertise and knowledge to the VSSTF. To download a presentation explaining telestroke operations of a variety of differing models which have been provided by Specialists on Call, Massachusetts General Hospital, and Reach Call click on the following links:
Specialists on Call
MGH Telestroke Presentation
REACH Call

CMS to Focus on Stroke Care in U. S. Hospitals

A new rule from the U.S. Centers for Medicare and Medicaid Services unveiled an upcoming addition to the structural measures for payment determination: participation in a database registry for stroke care, such as Get With The Guidelines®-Stroke from the American Heart and American Stroke Association.

Beginning in 2010, hospitals must note whether they participate in such a registry when submitting Medicare claims for stroke. The rule also identifies stroke care quality measures hospitals may be required to report for reimbursement beginning in 2012. All of the measures listed in the rule have been included in Get With The Guideline-Stroke since 2001.

For the thousand-plus acute care hospitals already participating in Get With The Guidelines-Stroke, the rule indicates that their stroke quality improvement efforts are being recognized and rewarded at the highest levels.

For hospitals that do not currently participate in Get With The Guidelines-Stroke, it means the new CMS requirement can be met by implementing an award-winning program demonstrated to improve patient outcomes. This presents an ideal opportunity for hospitals not currently participating in Get With The Guidelines-Stroke to join. Those hospitals that begin participating in the initiative by January 1, 2010, will be able to report to CMS that they are participating in a qualifying registry for stroke care.

More information on Get With The Guidelines-Stroke can be found at www.americanheart.org/getwiththeguidelines

National Public Radio Story: Drug Can Stop Strokes, But Most Patients Don't Get It

On December 14, 2009 NPR's Morning Edition ran a story detailing the experience of Beverly Sylvia, of North Dartmouth, Massachusetts, who was fortunate to be one of the 5% of eligible stroke victims to receive the clot-busting drug t-PA which doctors credit with her full recovery. The drug must be given within the first three hours of the onset of stroke symptoms and can only be given when the stroke is caused by a clot and is not appropriate in all stroke situations. However, when used appropriately t-PA can be an important and effective tool for neurologists to use to help their patients. Ms. Sylvia's experience illustrates the importance of seeking medical attention at the first symptom of stroke. Click here for the complete story at NPR

Stroke Education: Introducing NIHSS Mobile

The AHA’s Professional Education Center now offers a mobile version of the NIH Stroke Scale (NIHSS). This free, CME/CE-certified program for healthcare professionals provides training on how to administer the NIHSS, a critical component of acute stroke assessment. Learn more on how to complete this certification on the iPhone! (1st time users only).
Click here

Stroke education: Introducing NIHSS Mobile

Sample Stroke Orders, Sets and Pathways from Virginia Hospitals

sample ED Observation TIA

sample Subarachnoid Hemorrhage Admission

sample ED NIP Stroke

sample ED Stroke Alteplase Infusion 1210

sample ED Suspected Stroke

sample Intracerebral Hemorrhage Admission

sample Ischemic Stroke TIA Admission

sample Stroke Altplase Infusion 1053

sample Stroke POST Alteplase Infusion 1020

For other credible online sources for sample STROKE orders, sets, and pathways check out these sites:

Click here for Stroke-site Guidelines
Click here for Massachusetts General Acute Stroke Program
Click here for the Internet Stroke Center
Click here for The Stroke Association: Target Stroke

VSS Website Disclaimer

The following disclaimer will apply to all materials listed:

VSS Website Disclaimer:

The information, opinions, and content contained on this Web Site are not necessarily
always those of VSS or endorsed by VSS. VSS provides links to other third-party
websites, which are provided for convenience only, and VSS does not endorse the
information contained on or warrant any third-party website.

Medical Information

[i]The medical information contained in this web site is designed to be used only as a
medical and educational reference tool. It is not intended to be used as a diagnostic
decision-making system and must not be used to replace or overrule a physician's
judgment or diagnosis. The responsibility for decisions regarding actual patient care
rests solely with the physician treating a patient. While we try to keep the information as
accurate as possible, we disclaim any implied warranty or representation about its
accuracy, completeness, or appropriateness for a particular purpose. Please note that the
stroke protocols are subject to change without notice. Scientists and healthcare providers
continue to refine the current treatments for stroke and develop other treatments. Users
are reminded to be aware of the effective date of a guideline and to consider whether
more current information may be available from other sources. The approach to each
patient should be individualized to fit the particular needs of the patient and the available
resources of the stroke team.[/i]

Your Responsibility

You assume full responsibility for using the information at this site, and you understand
and agree that VSS and those institutions listing materials and their affiliates are not
responsible or liable for any claim, loss, or damage resulting from its use.
If you would like assistance developing acute stroke guidelines for your own institution,
please contact the VSS Ambassador Panel email: [url=http://www.va.strokesystems@heart.org]