Ideal Foundational Requirements for Stroke Program Development and Growth: A Scientific Statement From the American Heart Association

Abstract

Stroke center certification has evolved at a rapid pace and is now available at 4 different levels of service in the United States. Although certification standards provide guidance on stroke center process elements, lack of guidance on structural components such as workforce, staffing, and unit operations has resulted in heterogeneous services among hospitals credentialed at the same stroke center level. Such heterogeneity challenges public expectations and transparency about actual service capabilities within American stroke centers and in some cases may foster leniency in credentialing agency certification methods. Standards for other time-dependent diagnoses, including trauma, provide detailed guidance on structural elements that has improved patient triage and resuscitative care while enabling practitioners and administrators to more accurately gauge and plan service development to better support their communities. This scientific statement aims to provide similar structural guidance defined by each level of hospital stroke center services to reduce operational inconsistencies, to foster planning for service development, and to improve the interprofessional care of patients with acute stroke.

Nursing and Institutional Responsibilities for In-Hospital Stroke

“…IHS response team positions filled by nurses should be staffed 24/7 as recommended by the AHA and as required by external certifying bodies. [36][37][38] Specialty certification in stroke nursing as a Stroke Certified Registered Nurse is also recommended as certified nurses have been found to provide more timely and accurate care for those experiencing acute stroke when compared with noncertified nurses. 42…”

“…Nurse practitioners responding to IHS events should preferably have certification as an Advanced Neurovascular Practitioner, or be enrolled in an accredited neurovascular fellowship program. 38 When choosing the most appropriate team members for a code stroke response team, hospitals may prefer to recruit certified adult-geriatric acute care nurse practitioners given their clinical training in managing…”

“…Nurse practitioners responding to IHS events should preferably have certification as an Advanced Neurovascular Practitioner, or be enrolled in an accredited neurovascular fellowship program. 38 When choosing the most appropriate team members for a code stroke response team, hospitals may prefer to recruit certified adult-geriatric acute care nurse practitioners given their clinical training in managing acute and critical illness. The use of experienced acute care nurse practitioners with Advanced Neurovascular Practitioner certification during IHS code stroke events (in the absence of vascular neurology coverage) may reduce common practice barriers experienced by other advanced practice providers as most states allow these clinicians to practice to the full extent of their licensure.…”

“…Certified stroke centers are required by their respective certifying bodies to have a SPM to oversee the operations of acute and secondary stroke care to ensure quality care and regulatory requirements are being maintained. [36][37][38] These program managers, often referred to as stroke coordinators, are usually experienced nurses with a background in neurological, emergency, or critical care nursing. The SPM is responsible for not only the day-to-day operation of the stroke program but also systems-level planning and operations.…”

Improving Access to, and Quality of, Stroke Rehabilitation

“…Rehabilitation pathway planning must begin in acute care. Recent statements from the American Heart Association about foundational requirements for stroke program development and growth 9 are, concerningly, largely silent about rehabilitation and onward referral. The rehabilitation development priorities for the Stroke Action Plan for Europe 10 seek to define efficient and cost-effective long-term rehabilitation strategies, determine how to implement evidence-based rehabilitation, provide 20% of patients in all countries with access to early supported discharge, and track documented plans for rehabilitation and self-management support.…”