So what is a Comprehensive Stroke Center anyway?

Wayne Clark, M.D.
Director, Oregon Stroke Center

This week the Oregon Stroke Center at the OHSU Brain Institute was very pleased to receive the following notification from our hospital accreditation organization: “Effective Immediately The Joint Commission has officially certified OHSU as a Comprehensive Stroke Program!”

OHSU is the first hospital in the Pacific Northwest and one of only 27 hospitals in the U.S. to receive this certification.

Well, this all does sound exciting — but what does it mean for a patient who is having a stroke? Taking a step back, there are several different levels of treatment for someone who is having a stroke that is being caused by a blocked artery in the brain. The first is to make sure basic care is provided for the patient. Are they breathing safely? Is their blood pressure too high or low? What kind of stroke is happening and when did it occur?

These needs can be met at excellent, local “stroke ready” hospitals around the state. Here the patient is first examined and decisions are made on whether the patient should be treated locally or whether he or she needs to be transferred to facilities for more advanced care. Some of these local hospitals can give the specific stroke treatment “clot buster” therapy — “tissue plasminogen activator,” or TPA —  in an attempt to open up the artery causing the stroke. The decision to give TPA often involves discussing the case with a remote stroke specialist by phone or more recently by using video “telestroke” evaluations. OSHU currently has a nine-hospital “telestroke” network where we can evaluate the patient and assist local hospitals around the state. After the TPA is started, the patient is frequently transferred to a larger hospital for further care and and management.

The next level of stroke care capability is a “primary stroke center.” These hospitals have been certified by The Joint Commission — a non-profit that accredits more 20,000 health care organizations across the country — to be fully capable of delivering acute stroke treatment, including TPA, and providing extensive evaluation and detailed management of the patient. This includes having intensive care beds and being able to provide rehabilitation services. Currently, 14 hospitals in Oregon are primary stroke center certified. OHSU has been a primary stroke center since 2007.

However, for many patients, TPA alone may not be sufficient. In these cases, more advanced “interventional” techniques are required to try to pull out the clot that is causing the stroke. In addition there are other types of stroke that can be caused by an artery breaking inside the brain (a cerebral hemorrhage) or an artery popping on the surface of the brain (a subarachnoid hemorrhage). For these very critical patients, specialized “neurointerventionalists” and cerebrovascular neurosurgeons are required to stop the bleeding, using special clips or coils. In addition, the patients need to be managed very closely in a specialized neurosciences intensive care unit. This is where a “comprehensive stroke center” is required.

To meet the Joint Commission criteria, the Oregon Stroke Center had to prove that we had all of these capabilities — 24 hours a day, 365 days a year. In addition, we had to demonstrate that our complication rates for all these procedures were better than the national guidelines. Another big part of the comprehensive stroke center criteria is that we monitor the care and outcome of our patients not only in the hospital but during outpatient follow-up for three months!

Having this hierarchical hospital approach to stroke care — stroke ready, primary stroke center, comprehensive stroke center — allows patient throughout the state to start receiving immediate appropriate treatment locally while providing a tertiary referral center for advanced stroke care for Oregon.

Wayne Clark, M.D.
Director, Oregon Stroke Center
OHSU Brain Institute