What Makes a Comprehensive Stroke Center?

uva-stroke-team-1At a Glance

  • UVA Stroke Center achieved the highest level of recognition
  • Cutting response rates was a primary focus for the stroke team
  • UVA is one of the few centers in Central Virginia offering comprehensive cerebrovascular care
  • UVA has invested in the latest technology, which means patients receive the most current diagnostics and treatments available today

The University of Virginia Stroke Center has been a pioneer in advancing stroke care for decades. In its quest to achieve Comprehensive Stroke Center designation — the highest level of recognition awarded by the Joint Commission to the top 2 percent of stroke centers nationally — UVA was required to take a broad look at its services and define its role as a leader in the field. It took the help of many individuals from across the organization to tell the story of what excellent stroke care looks like from every angle.

UVA Stroke Center successfully demonstrated that it had in place those key attributes necessary to achieve this highest-level designation. To not only uphold these standards, but to improve upon them will be the next challenge. “Certification is the end of the beginning,” says Stroke Program Director Beth Hundt, PhD(c), MS, NP-C, ACNS-BC. “There’s always something we can do to get better.”

To get a sense of where UVA will go from here, take a look at some of the attributes that earned UVA the Comprehensive Stroke Center designation:

Rapid Response
As you know, when it comes to stroke, timing is everything. That’s why response rates — the time from stroke recognition to stroke treatment — are a clear measure of success. This year, UVA was awarded the American Heart Association’s top award: the Target: Stroke Honor Roll Elite Plus, for providing clot-busting medications 7+ minutes faster than the national average. (UVA provides tPA within 45 minutes of arrival to more than 50 percent of eligible stroke patients and within 60 minutes of arrival for more than 75 percent of eligible stroke patients.)

“We know that minutes matter and that 1.9 million neurons die every minute when brain cells don’t get blood flow. Our whole team moves as fast as they can for this very reason,” says Stroke Center medical director Karen C. Johnston, MD, MSc.

Response times were one of the areas the stroke team reviewed closely during the application process, according to Hundt. “Our times were good, but they continued to get better, and in the end we were recognized for exemplary work by the Joint Commission,” she says.

Improving response times means shaving minutes off the evaluation process, which begins with a rapid assessment by EMS field providers and the Emergency Department staff. “We continue to innovate to reduce our time to treatment,” says Emergency Department chair Robert O’Connor, MD.

The duration of the evaluation process may also be impacted by the way the stroke team and patient first meet. “We developed protocols to allow the stroke team to meet the patient in CT so that the team can make the call as soon as possible as to the type of treatment that’s best, whether that’s thrombectomy or tPA,” says Hundt.

Another time saver is educating frontline staff. Everyone from the parking valet to emergency operators and ED admissions team learn about the signs of stroke so that they can set the stroke response in motion sooner. They are all part of the team that works together to provide the best care for stroke patients.

UVA stroke neurologists are on call 24/7 to respond at the bedside or to alerts from outside hospitals. An extensive telemedicine network connects UVA stroke neurologists to patients in various hospitals across the state that depend upon UVA for emergency stroke care. “We’re working to bring our expertise to the patient,” says Hundt. “We’re moving more assessments into the field with telemedicine and we’re giving our pre-hospital colleagues the tools they need to give a more detailed assessment.”

Comprehensive Care
With a team of neurosurgeons and interventional neuroradiologists, UVA is now one of the few centers in Central Virginia offering comprehensive cerebrovascular care. This team is highly skilled in treating both hemorrhagic and ischemic stroke, with multiple physicians trained in endovascular thrombectomy, as well as advanced surgical procedures, such as coiling and clipping, to treat aneurysms that cause hemorrhagic stroke.

While these skilled neurosurgeons and interventional neuroradiologists are key to ensuring a successful outcome, so too are the support staff and environment of care available to patients before and after a procedure. Neuro-critical care and the appropriate environment are key to ensuring patients continue to benefit from the treatment.

UVA has a dedicated neuro-intensive care unit that is staffed around the clock, a requirement for Comprehensive Stroke Center status. “The knowledgeable neuro-critical care team monitors patients after treatment and gives them the time and the tools necessary for the brain to heal,” says Hundt. “Our occupational therapists, physical therapists, speech language pathologists — there are hundreds of people involved in stroke care, and their commitment to helping patients recover and get back to their communities is important and impacts our outcomes, which are very good.”

Tools for Progress
To provide advanced stroke care requires advanced technology, and UVA has the tools necessary to provide patients with the most current diagnostics and treatments available today. They’re not only investing in the latest technology – UVA stroke team members are on the forefront of developing new devices and training other providers how to use them. For example, UVA researchers were involved in some of the earliest studies investigating the benefits of clot removal and have continued to push for further device development over the past decade.

Telemedicine is another area making gains thanks to the efforts of UVA researchers. Expanding on its vast telehealth network, which connects hundreds of community hospitals throughout the region to UVA specialists via broadband technology, UVA is currently evaluating the feasibility of mobile neurological assessments during ambulance transport through its iTreat study. “Giving first responders access to the expertise of UVA stroke neurologists and screening technology during pre-hospital assessment — at the patient’s home and en route to the hospital – are key to further improving the timely diagnosis and treatment of acute stroke,” says UVA stroke neurologist Andrew Southerland, MD.

As part of its Comprehensive Stroke Center designation, UVA will continue to assess stroke procedures; the team is required to submit quality data quarterly, participate in a regulatory review at the one-year mark and apply for recertification in two years. “The expectations will be higher each time,” says Hundt. That UVA achieved this highest level of recognition is a testament to their commitment to quality across the continuum of care. And it’s an assurance for patients and referring providers that patients will continue to receive the very best stroke treatment available at the UVA Stroke Center.