Texas Stroke Institute – Saving Lives, One Stroke at a Time
Clinical Impact of Stroke Center Certification
Alexander Venizelos, MD Stroke Center Certification Workshop
SVIN Meeting, Westin Diplomat Thursday, November 6 2014
Primary Prevention
Public Awareness
Emergency Medical Services
Acute Treatment
Subacute Treatment
Rehabilitation, Recovery, Secondary Prevention
Systems of Care Save Lives
Primary Prevention
Public Awareness
Emergency Medical Services
Acute Treatment
Subacute Treatment
Rehabilitation, Recovery, Secondary Prevention
• Screening for cardiovascular risk factors
• Smoking cessation counseling • Primary Care Physician
• Community Outreach • Symptom Recognition • 911 activation
• Activation • 911 - EMD • EMS provider recognition • Prehospital triage and activatio
• TPA • Mechanical Thrombolysis • Critical Care Unit
• Cardiovascular risk factor reduction
• Counseling
• Acute Rehabilitation • Post-acute Care
4 3 2 1
Stroke Systems of Care
Stroke Center Certification
Designation of stroke centers is a fundamental building block of stroke systems
– Public policy – Public health – Committed investment
Certification is about more than designation
• Quality and performance improvement • Research/Scholarship/Teaching • Integration along the continuum of care
Quality and performance improvement
• Increased rate of thrombolysis
Quality and performance improvement
• Increased rate of thrombolysis
SVIN, 2013
Quality and performance improvement
• Increased stroke volume
SVIN, 2013
Quality and performance improvement
• Decreased Morbidity
SNIS, 2014
Research/Scholarship/Teaching
• Community outreach • Residency and Fellowship • Continuing education for professionals • Society membership and participation • Clinical Trials
Integration across continuum of care
SVIN, 2014
Integration across continuum of care
Integration across continuum of care
Integration across continuum of care
• Decreased Mortality
Primary Prevention
Public Awareness
Emergency Medical Services
Acute Treatment
Subacute Treatment
Rehabilitation, Recovery, Secondary Prevention
4 3 2 1
Stroke System of Care
Stroke Center Certification
Selected References • Gladstone DJ, Rodan LH, Sahlas DJ, Lee L, Murray BJ, Ween JE,
Perry JR, Chenkin J, Morrison LJ, Beck S, Black SE. A citywide prehospital protocol increases access to stroke thrombolysis in Toronto. Stroke. 2009 Dec;40(12):3841-4.
• Mullen MT, Kasner SE, Kallan MJ, Kleindorfer DO, Albright KC, Carr BG. Joint commission primary stroke centers utilize more rt-PT in the nationwide inpatient sample. J Am Heart Assoc. 2013 Mar 26;2(2).
• Prabhakaran S, O’Neill K, Stein-Spencer L, Walter J, Alberts MJ. Prehospital triage to primary stroke centers and rate of stroke thrombolysis. JAMA Neurol. 2013 Sep 1;70(9):1126-32
• Soares-Oliveira M. Implementation of a regional system for the emergency care of acute ischemic stroke. Rev Port Cardiol. 2014 Jun;33(6):329-35.
Thank you
