Virginia Stroke Systems Website - Acute Stroke Treatment

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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 this 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.

Stroke Systems Technical Consultation: The Virginia Stroke Systems Ambassador Panel (VSS AP)

Virginia Stroke Systems (VSS) invites you to access the expertise available to stroke professionals in Virginia and neighboring states by tapping into the Virginia Stroke Systems Ambassador Panel (VSS AP).

Submit your confidential questions to VA.STROKESYSTEMS@HEART.ORG

Purpose of the VSS AP:

In concert with the implementation of Virginia Stroke Systems, there is a recognized need for an increased number of Primary Stroke Centers (PSC) and novel strategies to assist acute care facilities in enhancing stroke care. To aid in the development of PSC's and integrated stoke systems, the Virginia Stroke Systems Leadership Team identified a need for access to stroke program development expertise by all interested healthcare institutions in the state. To address this need, the VSS Leadership Team collaboratively designed and implemented a statewide-accessible Ambassador Program.

The VSS Ambassador Panel (VSS AP) is an 11-member team of recognized and dedicated stroke professionals invested in providing the best stroke care possible. The Panel is comprised of physiatrists, neuro-radiologists, neurologists, emergency physicians, nurses, EMS leadership, hospital administrators, legislative and advocacy personnel, stroke program coordinators and experts in stroke program development and stroke systems of care. VSS AP was developed to meet a need for a single reliable and free resource for questions regarding stroke program design, development, evaluation and performance improvement.

Panel members respond to your questions with answers based on science and and best practice. The VSS AP is prepared to answer questions about EMS operations, ED work-up, stroke center development, hospital infrastructure, administrative management, or any question related to the development of an acute care system for stroke. There is no charge for this service. No query is too small.

The Virginia Stroke Systems Ambassador Panel (VSS AP) members have expertise in the following content areas:
1. Emergency Medical Service (EMS)/pre-hospital programs, training and regulations
2. Emergency Department (ED) stroke program barriers and development, ED stroke diagnosis and treatment
3. Acute and post-acute stroke care, Stroke Unit development, secondary prevention
4. Neurology & ED physician medicolegal issues, reimbursements, professional organization position statements
5. Administrative issues, achieving administrative support, creating a stroke program business case, defining fiscal and market incentives
6. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) certification, national initiatives, state legislation efforts
7. Performance measures, quality (process & outcome) measures, national indicator development, data systems
Access to the VSS AP has been extended to stroke professionals in Virginia’s neighboring states, including:
 Virginia
 Maryland
 District of Columbia
 West Virginia
 Kentucky
 Tennessee
 North Carolina
Take advantage of this unique service now and benefit from the experience of others who have been there and are eager to share their knowledge.! Requests are kept confidential, and responses are evidence- and science-based. In most cases a response is provided within 10 business days. Complex questions may take more time in order to ensure an evidence-based response. If your question is very time-sensitive, please write Urgent in the subject line and the panel will make every effort to respond more quickly.
To submit a question to the Panel, email VA.STROKESYSTEMS@HEART.ORG
Please articulate your question clearly and concisely to help streamline processing of your request.
All questions and information shared with VSS APP will be treated as strictly confidential.
We encourage you to add this address to your FAVORITES or CONTACTS list for easy access in the future.

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

Virginia Stroke Systems Task Force (VSSTF)
Acute Stroke Transport/Triage t-PA Guidance Statement

Acute stroke is a time critical illness with optimal patient outcomes achieved by rapid assessment, management, and intervention. The sooner an acute stroke is treated, the better the potential outcome. We endorse a pre-and inter-hospital triage plan to promote rapid access for stroke victims to appropriate organized stroke care within three hours of symptom onset. In general this would involve transport to a JC Certified Stroke Center, although consideration may be given to transport to a closer facility, given that facility has a protocol in place for administration of IV t-PA. Determinations of transport priority should be made regionally, with consideration given to availability of appropriate facilities, patient transport times, and patient and/or family choice.

It is important to note that the continuing evolution of scientific evidence indicates successful management of stroke outside the three-hour time window using various modalities. System strategies should be implemented that facilitate expeditious patient evaluation, transport directly to stroke centers, and transfer from non-stroke centers to stroke centers for selected patients with stroke symptoms beyond three hours. The VSSTF endorses currently published national guidelines regarding the treatment of acute stroke patients, including recommendations for the administration of t-PA.

References:
Adams HP, del Zoppo G, Alberts MJ et al. Guidelines for the early Management of Adults with Ischemic Stroke: A Guidline from the American Heart Association / American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovscular Radiology and Intervention Council, and the Athersclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke 2007;38:1655-1711.

Del Zoppo GJ, Saver JL, Jauch EC et al. Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator : A Scientific Advisory From the American Heart Association. Stroke;40:2945-2948.

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

Collaborative Effort Across Virginia for Stroke Coordinators!

The beginning of the 4th quarter of 2009 was the initiation of the Virginia Stroke Systems Coordinators Consortium (VSSCC), a sub-group of the Acute Care Team of the Virginia Stroke Systems Task Force (VSSTF). The purpose of the VSSCC is to:

 Promote evidenced based stroke care in all hospitals in the Commonwealth
 To share best practices and latest research
 To improve collaborative partnerships with EMS
 To share resources, tools, innovative ideas and technology
 To provide a forum for stroke coordinators to ask questions and receive timely researched expert answers via the Virginia Stroke Ambassadors Panel
 To communicate work done in VSSTF
 To inform the community about stroke signs and symptoms and prevention

Objectives for the VSSCC are accomplished via a regional lead structure.

The VSSCC is chaired by Pat Lane, RN Neuroscience Coordinator of Bon Secours St. Francis Medical Center.
1. The VSSCC is divided into six (6) regions correlating with EMS Virginia Hospital regions.
a) Region 1 is led by Larisa Golding, RN Patient Care Director from Inova Alexandria Hospital. Region 1 covers the Northern Virginia area
b) Region 2 spearheaded by Sue Fibish, RN Stroke Program Coordinator from Sentara Leigh Hospital covers the Eastern area
c) Region 3 facilitated by Debra Massie, RN Stroke Program Coordinator from Winchester Memorial Hospital covers the North Western area
d) Region 4 organized by Mary Marshman, RN Stroke Program Coordinator from Centra Lynchburg General Hospital and Stacie Stevens, RN Stroke Program Coordinator from Virginia Commonwealth University Medical Center serves the Central Virginia region
e) Region 5 led by Kathy Robertson, RN Stroke Program Coordinator of Carillion Roanoke Memorial hospital serves the Near South West region
f) Region 6’s liaison is Janie Walker, RN Stroke Program Coordinator from Johnson City Medical Center serves the Far South West region
2. The region leads will serve as mentors, coaches, and resources for the hospitals in the regions. Specifically they may assist you with clinical practice guidelines, maneuvering the internet for resources and learning the Primary Stroke Center verbiage and sharing their pearls of wisdom.
3. Pat meets monthly with the region leaders to discuss regional issues, best practices, updates from VSSTF and plan future agenda items.
4. The VSSCC meets every other month either via conference call or webinars and has at least one face to face meeting per year coinciding with an educational seminar.

The next meeting will be in person following the GWTG Stroke Workshop, March 4, 2010 from 8:30 A.M. - 3:30 P.M held at Lynchburg General Hospital (Centra Health), 1901 Tate Springs Rd., Lynchburg, VA.

For information about future meetings contact Tiffany McGhee 804-965-6570(Phone)
804-965-6421 (Fax) 434-228-0265 (Mobile)Tiffany.McGhee@heart.org
This group is supported and funded by the Virginia Department of Health Heart Disease and Stroke Prevention Project and the American Heart Association.

Virginia Stroke Systems