Role of Primary Stroke Centers in Arizona

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Role of Primary Stroke Centers in Arizona

• Dr. Timothy Ingall
• Mayo Clinic Arizona
• Chair, Steering Committee
• AZ Cardiovascular Disease State Plan

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STROKE CARE ISSUES IN ARIZONA

• Prevention primary secondary
• Acute Care
• EMS/Dispatch
• Acute hospital care PSCs Telemedicine
• Subacute hospital care initiation of secondary
  prevention
• Rehabilitation

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STROKE CARE ISSUES IN PHOENIX

• Prevention primary secondary
• Acute Care
• EMS/Dispatch
• PSC Matrix
• Acute hospital care PSCs Telemedicine
• Subacute hospital care initiation of secondary
  prevention
• Rehabilitation

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Operation Stroke The Phoenix Experience
Establishing a Comprehensive Stroke Program,
Implementing a Primary Stroke Center Matrix, and
Developing a Quality Assurance Program
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Operation Stroke

• A nationwide American Stroke Association
  initiative implemented in 1999.
• Two major goals
• Reorganize stroke services to provide better
  acute stroke care across the USA.
• Implement OS in the top 125 MSAs by 2003.

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The Stroke Chain of Survival
All links will be strong...
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OS Organizational Structure
Operation Stroke Executive Committee
Co-Chair Dr. John Raife
Co-Chair Dr. Timothy Ingall
Communications
Provider Education
Community Ed.
EMS
Survivor Support
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Operation Stroke and Primary Stroke Center
Classification in Phoenix
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Primary Stroke Centers

• PSCs provide appropriate acute stroke
  management
• Rapid distinction between ischemic stroke and
  ICH
• IV tPA for appropriately selected patients
• Identify, and manage, arrhythmia's, hypotension,
  fever, and hyper hypoglycemia

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Primary Stroke Centers

• PSCs provide appropriate acute stroke
  management
• Dedicated care in geographically identified
  Stroke Units.
• Stroke Unit care has been shown to reduce by 20
  both one-year stroke mortality and morbidity.

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Phoenix Primary Stroke Center Initiative

• A collaborative effort between Operation Stroke
  and Arizona Emergency Medicine Systems (AEMS )
• Regular meetings between members of the OS
  Executive Committee and the AEMS Categorization
  Committee

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Phoenix Primary Stroke Center Initiative Timeline

• 2001-2002
• Stroke center surveys conducted by both OS and
  AEMS based on modified PSC criteria
• Help provided to hospitals that needed
  assistance to meet PSC criteria
• Results of surveys presented to Phoenix
  hospitals 3-02

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Phoenix Primary Stroke Center Initiative

• April 2003
• Site visits commence for hospitals requesting to
  be included in the AEMS PSC Matrix
• Site visit teams consisted of two members of the
  OS Executive Committee (MD, Allied Health) and a
  member of the AEMS Categorization Committee

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Phoenix Primary Stroke Center Initiative

• April July 2003
• Five hospitals classified as PSCs
• August 2003
• Proposal presented to, and accepted by, the AEMS
  Board to implement a limited PSC Matrix in early
  September 2003

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Phoenix Primary Stroke Center Initiative

• May 2006
• Eight hospitals classified as Primary Stroke
  Centers based on the local certification process.

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Phoenix Primary Stroke Center Matrix
Mayo Hospital
Arrowhead
Del Webb
BNI -- St. Josephs
Boswell
SMH Osborn
Banner Thunderbird
Banner Good Samaritan
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Phoenix Stroke Initiative August 2007

• PSC certification and recertification in order to
  be considered for PSC Matrix membership converted
  from local process to Joint Commission process
• Hospitals with local PSC designation given until
  7/09 to initiate JC PSC certification application

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Phoenix Primary Stroke Center InitiativeApril
2009

• Arizona Joint Commission certified PSCs
• Four in Phoenix
• Phoenix PSC Matrix
• Six of the eight hospitals are locally
  designated PSCs.
• Two of the eight hospitals are Joint Commission
  certified PSCs.

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Role of PSCs in Arizona

• Function as a best practices forum.
• Promote collection and review stroke specific
  quality measures data
• GWTG Stroke is the program most commonly utilized
  to collect stroke related quality measures data.
• Currently there are 18 GWTG Stroke hospitals in
  AZ, of which 13 are in Phoenix
• Review ASPIRE data.
• Help non-PSC hospitals with their JC PSC site
  visit preparation.

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Role of PSCs in Arizona

• Develop protocols for stroke care at non-PSC
  hospitals.
• Oversight of the PSC Matrix.
• Participate actively in the Arizona
  Cardiovascular Disease Plan.
• Participate in STARR (Stroke Telemedicine for
  Arizona Rural Residents) i.e. Phoenix PSCs
  Hubs and Non-PSCs - Spokes