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Barnes-Jewish & Washington University
Stroke Center

Comprehensive Stroke Center

The Barnes-Jewish and Washington University Stroke & Cerebrovascular Center is the first certified Comprehensive Stroke Center in Missouri, and one of the first in the country.

The Joint Commission and the American Heart Association / American Stroke Association established the advanced certification of Comprehensive Stroke Centers to recognize hospitals that achieve higher standards and meet specific criteria for resources, staff, and training that are essential to treat the most complex stroke cases.

Being designated a Comprehensive Stroke Center distinguishes the Barnes-Jewish and Washington University Stroke & Cerebrovascular Center’s achievements in numerous aspects, from training all levels of employees to an efficient hospital infrastructure. The Joint Commission highlighted our team-based approach to complex stroke care as well as patient safety and understanding of stroke rehabilitation.

What makes a Stroke Center Comprehensive?

Our Stroke & Cerebrovascular Center offers services to stroke victims beyond the scope of other hospitals in Missouri. The table below outlines the criteria for Comprehensive Stroke Centers and Primary Stroke Centers.

 

Stroke Center Requirements

Primary

Compre-
hensive


TREATMENT

80% of acute stroke patients have diagnostic brain image completed within 45 minutes of it being ordered. Imaging is available on site 24/7.

Stroke performance is measured and reviewed to evaluate processes and outcomes and to improve quality of care.

Provide guidelines to Emergency Medical Services that address transferring stroke patients to the comprehensive stroke center.

 

Has dedicated neuro-intensive care unit (ICU) beds for complex stroke patients, which includes physician and nursing staff with expertise and experience on site to provide neuro-critical care 24/7.

 

Advanced imaging technology and capabilities include:

  • Carotid duplex ultrasound
  • Catheter angiography of the brain
  • Transcranial doppler
  • Transesophageal echocardiography
  • Transthoracic echocardiography
  • CT angiography available 24/7
  • MRI, including diffusion weighted MRI, available 24/7
  • MR angiography- MRA available 24/7
 

Treatment protocol for Ischemic stroke (stroke from a blood clot)

Administer IV tPA (clot busting drug) to 25 or more patients each year.

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Treatment protocols for:

  • Stroke from subarachnoid hemorrhage (burst brain aneurysm)
  • Stroke from intracerebral hemorrhage
  • Protocol for endovascular interventions and intra-arterial clot busting medication
 

80% of emergency department practitioners must provide evidence of review of all stroke protocols

Provide care to 20 or more patients with diagnosed subarachnoid hemorrhage (stroke from burst brain aneurysm) each year.

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Cares for complex stroke patients and monitors the percent of complex stroke patients that receive follow-up phone calls within 7 days of discharge.

 

Performs microsurgical clipping of aneurysms and neuro-endovascular coiling of aneurysms of 25 or more procedures per year.

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Procedure safety: For diagnostic catheter angiography, risk of stroke and death from procedure must be 1% or less, and serious complications must be 2% or less.

 

Procedure safety: For carotid endarterectomy and carotid artery stenting, complication rate must be 6% or less.

 

In depth peer review process to review and monitor the care provided to patients with stroke.

 

Patients are assessed to identify post hospitalization care needs such as: 

  • Acute rehabilitation
  • Long term acute care
  • Skilled nursing/sub-acute care
  • Outpatient services and physician appointments
  • Home care with required services
  • Palliative care services

The patient is assessed to identify cognitive decline, depression and other social issues prior to discharge using evidence based screening tools.

 

A comprehensive assessment of the family members’ skills, capacity, and resources to supply post-hospital care is completed on all stroke patients.

 

STAFFING

A medical director is appointed, but not required to be a board-certified neurologist.

The stroke center medical director is a physician with extensive experience in neurology and cerebrovascular disease.

 

A Medical Director of Neurorehabilitation is also appointed, who is either a Physiatrist or Neurorehabilitation trained physician.

 

Stroke neurologists, critical care physicians, neurosurgeons, diagnostic and interventional neuro radiologists, and imaging staff are available 24/7. Center has a process to treat simultaneous emergent needs of 2 or more complex stroke patients.

 

Data related to processes and/or outcomes of care at the patient level is collected.

Patient education needs are addressed, related to lifestyle changes that support self-management regimens.

Coordinates post hospital care for patients.

 

Program must have 1 or more Nurse Practitioners with focused expertise in comprehensive stroke care and intensive care unit advanced nursing management.

 

Physical Therapy, Occupational Therapy and Speech Therapy must be provided 6 days per week and on-call the 7th day. The physical therapy, occupational therapy and speech therapy staff in leadership positions have masters degrees in their field.

 

The stroke center maintains a stroke registry or uses a similar data collection tool to monitor this information and publicly reports outcomes.

 

RESEARCH

Active participation in patient-centered stroke research.

EDUCATION

At least one stroke public education activity is conducted annually.

Conduct at least two public educational events per year that raise awareness of stroke prevention and care.

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Members of the core stroke team receive at least 8 hours annually of continuing education.

Specific training and education for all nurses providing care in the emergency department, acute stroke unit, intensive care unit, and neuro-endovascular laboratory.

  • Nurses providing acute stroke care are required to attend 3+ training sessions per year including 10+ hours.
  • Stroke center staff prepares and presents 2+ educational courses per year for hospital staff.
  • Neuro-critical care unit director attends 8+ hours of education per year on cerebrovascular disease and/or acute stroke care.

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