The Importance of Primary and Comprehensive Stroke Centers

While effective and rapid stroke treatments exist, access to high-quality stroke care differs significantly across the country. The Joint Commission, a national nonprofit accrediting body for thousands of healthcare organizations, has created certifications to define a hospital's stroke care abilities.

Acute Stroke Ready Certification

For individuals experiencing an ischemic stroke (caused by a blocked brain artery), treatment occurs in stages. Initial care involves identifying the stroke type and onset time, monitoring blood pressure, and ensuring stable breathing. Hospitals with "Acute Stroke Ready" certification can meet these basic needs. Following this initial assessment, a decision is made regarding local treatment or transfer to a more specialized center. Some "Acute Stroke Ready" hospitals can administer the clot-dissolving drug, tissue plasminogen activator (TPA), if the patient arrives within 4.5 hours of symptom onset, often after consulting with a remote stroke specialist via telephone or video "telestroke" evaluation.

Primary Stroke Center Certification

The Primary Stroke Center certification is awarded to hospitals fully capable of acute stroke treatment, including administering TPA, conducting thorough evaluations, and providing individualized care. These centers are staffed by qualified stroke specialists, have dedicated intensive care units, and provide rehabilitation services.

Thrombectomy-Capable Stroke Center

Thrombectomy-Capable Stroke Centers are specialized hospitals equipped and staffed to perform advanced procedures, specifically thrombectomies. A thrombectomy is a life-saving procedure where doctors surgically remove a blood clot from the brain, restoring blood flow and minimizing potential long-term damage from the stroke. These centers have neurologists, neurosurgeons, and specialized equipment available around the clock, ensuring patients receive the fastest and most effective treatment possible to improve their chances of recovery after a stroke.

Comprehensive Stroke Centers

However, some patients with severe or complex strokes require more than TPA. For instance, those with hemorrhagic strokes (bleeding in the brain) need specialized neurointerventionalists and neurosurgeons to control the bleeding and require intensive monitoring. To identify hospitals best prepared for these challenging cases, The Joint Commission established the Comprehensive Stroke Center certification in 2012. Achieving this requires meeting all Primary Stroke Center criteria plus several others:

• Dedicated neurointensive care unit beds providing 24/7 neurocritical care for complex stroke patients.

• Immediate, in-house access to advanced imaging, including catheter, CT, and MR angiography, among others.

• Complication rates that outperform national benchmarks.

• Meeting minimum patient volume requirements for advanced medical and surgical stroke care.

• Coordinated post-hospital recovery care, including three-month follow-up.

• Active involvement in stroke research.

Recognizing the different levels of a hospital's stroke care certification is essential for directing patients to the most appropriate care and identifying when the highest level of expertise is necessary.

It's important to know where to seek emergency care. Locate your nearest Dignity Health Emergency Room today.