Building on UCSF Medical Center's recent recertification as a primary stroke center, UCSF neurologists have joined a nationwide effort to define an even higher standard of care that would earn certification as a comprehensive stroke center.

According to Anthony Kim, M.D., medical director of the UCSF Stroke Center, upcoming formal standards for comprehensive stroke centers will likely include:

• Timely delivery of standard stroke care by a specialized neurovascular team with ongoing quality assurance, education and neurointensive care units staffed by personnel with specific expertise in vascular neurology, neurocritical care, vascular neurosurgery, and interventional and endovascular radiology
• Access to state-of-the-art surgical and interventional therapies for stroke 24 hours daily
• Expert, carefully coordinated transitional care

"We believe that formally defining higher standards will help enhance patient care and outcomes," Kim says.

Continual Improvement

The process for continually improving standard stroke care is a key component. For example, when a stroke patient arrives at the UCSF Stroke Center, a specialized team of providers, overseen by a neurologist, immediately mobilizes. Radiologists perform specialized CT scans. Lab staff prioritize stroke patients' samples. Clinical pharmacists and critical care-trained nursing staff mix and administer tissue plasminogen activator (tPA).

The team then carefully tracks this process against evidence-based best practices, and has instituted a feedback loop using an electronic system that is updated in real time for each stroke patient and reviewed within 48 hours. Key personnel review more formal reports every two weeks.

"By providing clear feedback, setting performance goals, and identifying patterns and outliers with each stroke patient, we've achieved door-to-needle times that are significantly faster than the national average," Kim says.

Care Options, Coordination

When tPA fails or is not an option, Kim emphasizes that comprehensive stroke centers have alternatives. One example: As a pioneer in the use of intra-arterial therapies, the UCSF Stroke Center has a team of neurointerventional radiologists experienced with the Merci (mechanical embolus removal in cerebral ischemia) Retriever.

In addition, transitional and follow-up care should incorporate the latest insights about these processes. UCSF has instituted a new, proactive program, based on a successful heart failure program, which includes a follow-up telephone call to each stroke patient within a few days of discharge and again at 30 days after discharge to answer outstanding questions, manage medication changes, coordinate care and capture outcome data.

“The goal is to ease the transition between hospital and rehab or between hospital and home,” Kim says.

For more information, contact Dr. Anthony Kim at (415) 353-8897.