NINDS: Stroke Proceedings: Acute Care

Proceedings of a National Symposium on
Rapid Identification and Treatment of Acute Stroke
December 12-13, 1996

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RECOMMENDATIONS:
Acute Hospital Care Panel

The Acute Hospital Care Panel identified three major issues that are most important for designing acute stroke treatment programs on a national level. These are (a) the proper design and use of stroke critical pathways, (b) the appropriate distribution of medical resources, and (c) the development of medical expertise needed in acute stroke management. Each of these topics is discussed fully in the Acute Hospital Care section of this monograph.

Panel Recommendations

1. Every hospital that cares for patients with acute stroke needs a Stroke Plan.

2. The Stroke Plan should cover stroke care from prehospital recognition through discharge and should address secondary prevention issues.

3. Hospital Stroke Plans should use evidence-based guidelines to develop algorithms and critical pathways appropriate for each institution.

4. Hospital Stroke Plans should include outcomes assessment and be linked with quality improvement.

5. Assuming the patient meets the treatment criteria, the following acute stroke management goals are endorsed:

• Time from door to doctor: 10 minutes

• Time from door to CT scan: 25 minutes

• Time from door to CT reading: 45 minutes

• Time from door to drug: 60 minutes (80% success target)

• Time from door to monitored bed: 3 hours

6. There should be access to stroke expertise within 15 minutes of patient arrival at the hospital and neurosurgical expertise within 2 hours of patient arrival at the hospital.

7. The feasibility of establishing a national stroke outcomes database should be explored.

8. Criteria for distinguishing primary, intermediate, and comprehensive stroke centers should be established.

9. A voluntary system for recognizing primary, intermediate, and comprehensive stroke centers is endorsed.

10. The creation of local and regional stroke networks encompassing all levels of stroke care is endorsed.

11. Residency and other health professional training programs should develop educational standards related to acute stroke.

12. Specialty-specific continuing medical education related to acute stroke is endorsed.

13. A Stroke Toolbox containing evidence-based guidelines, algorithms, critical pathways, NIH Stroke Scale training tapes, and other stroke templates should be created, updated, and made easily available through the National Institute of Neurological Disorders and Stroke.

14. The implementation of recommendations regarding stroke centers, stroke expertise, stroke education, and stroke outcomes analysis will require a substantial continuing commitment from the National Institutes of Health and other national organizations.

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Last Edited: July 01, 1999

National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892