Acute Care Hospitals, Stroke Care Centers, and Stroke Evaluation

According to the CDC, stroke is the leading cause of serious long-term disability, and every 4 minutes someone dies of a stroke. In an effort to decrease these alarming statistics, many acute care hospitals are taking the important step of becoming certified as Primary Stroke Centers or Acute Stroke Ready Hospitals.

Stroke Centers

A Primary Stroke Center (PSC) certification demonstrates that the hospital has the critical elements in place to achieve long-term success in improving stroke patient outcomes. Key requirements include:

  • Acute stroke team available 24/7

  • Access to a neurologist 24/7

  • Designated stroke beds

  • Ability to provide IV thrombolytic care

Hospitals that are not candidates for primary stroke center certification due to a lack of resources to care for patients after IV thrombolytic therapy are still able to achieve Acute Stroke-Ready Hospital (ASRH) Certification. Since more than 50% of the U.S. population lives more than 60 minutes from a primary stroke center, these acute care centers are critically necessary and allow smaller or more rural hospitals to demonstrate excellence by meeting standards of care for stroke patients that improve outcomes. This includes rapid assessments, head CT scans, and administering IV thrombolytic therapy for transfer to a PSC or more advanced center, such as comprehensive or thrombectomy-capable centers.

Comprehensive Stroke Centers (CSC) and Thrombectomy-Capable Stroke Centers (TSC) offer the highest level of care and are developed in collaboration with the American Heart Association/American Stroke Association (AHA/ASA).

How strokes are assessed in hospital

There are a variety of assessments used for evaluating a patient to determine the possible presence of a stroke. One of the most common is the National Institutes of Health Stroke Scale (NIHSS), which uses an 11-item scale to measure neurological impairment. This assessment is considered the “gold standard” in clinical trials and is a quality metric for certification.

These 11 evaluations include:

  • Level of consciousness, orientation questions, and response to commands

  • Gaze

  • Visual fields

  • Facial movement

  • Motor function of the arms

  • Motor function of the legs

  • Limb ataxia

  • Sensory perception

  • Language

  • Articulation

  • Extinction or inattention

With a zero in any category indicating normal, the scoring range is 0-42. The higher the score, the more serious the stroke.

Collecting data on stroke response

In order to achieve certification, hospitals must be able to collect data on patients and stroke care over the course of up to a year and demonstrate a very high level of care and successful patient outcomes.

When a patient comes into the hospital as a possible stroke patient, the protocols are fairly straight-forward: assess the patient using the NIHSS scale or other appropriate scale, order the tests needed to determine the type of stroke and the extent of damage, and administer life-saving treatments, such as thrombolytics for ischemic strokes or endovascular procedures for hemorrhagic strokes.

When a patient already in the hospital has a stroke, however, things are more complicated. Studies show that up to 17% of all strokes happen to patients in the hospital for another reason. Since the patient is not being monitored for a stroke and is often not seen for an extended period of time between visits by the attending nurse, there is a delay in recognizing that a stroke has occurred. Studies indicate that hospital patients who have strokes are not evaluated for up to four hours before their stroke is diagnosed. This valuable time lost means worse outcomes for the patient.

Diagnosing strokes sooner

To be designated a PSC or ASRH, a hospital must show that their stroke patients, both those who are brought into the hospital and those who develop strokes in-hospital, are receiving the immediate help they need and are experiencing better outcomes than with the average standard of care. Because many patients are sedated or are receiving IV fluids in one arm, even the NIHSS scale has limited functionality, because many of the 11 categories can not be measured.

Neuralert Technologies is committed to ending the devastation caused by in-hospital strokes with its innovative Stroke Detection Monitor, combining a unique, non-invasive wristband technology with a state-of-the-art patented algorithm developed by the University of Pennsylvania to detect asymmetry in arm movement, one of the initial indications of stroke onset.

Because Neuralert’s algorithm is able to rule out other reasons for asymmetry (for instance, an IV in the arm, eating, talking on the phone) the frequency of false alerts is extremely low. Your hospital staff will know, when they get an alert from the Neuralert technology, that the patient needs immediate attention. Quick treatment decreases the severity of the effects of a stroke. And Neuralert has been shown in studies to detect 80% of ischemic strokes in less than one hour.

Partner with Neuralert to provide your patients with the very highest standard of care, cut response times to in-hospital strokes significantly, and improve outcomes.