Stroke is the fourth highest cause of death and carries lifetime care costs ranging from about $140,000 for an ischemic stroke to $225,000 for a subarachnoid hemorrhage, with annual costs exceeding $73 billion across the nation, according to a report from the American Heart Association.
The guidelines hospital leaders should implement include:
- Form an acute stroke team (AST) with at least two members – a physician and one other healthcare provider – who could be at the bedside of a stroke patient within 15 minutes at any time of the day or week. These teams are "a key element in the screening and delivery of acute therapies (such as clot busting drug, intravenous tissue plasminogen activator, or tPA)." While the previous stroke guidelines included the formation of an AST, the update is more specific about elements and operations. Emergency department personnel should have a well-organized system for activating the AST through pagers, cell phones, or overhead calling.
- Develop written protocols for patients with ischemic or hemorrhagic stroke, "including stabilization of vital functions, initial diagnostic tests, and the use of various medications," the authors write.
- Establish a protocol for 911 systems to send stroke patients to a designated PSC. "This should be the case unless there is another concomitant imminent life-threatening condition," such as cardiac arrest that would require transport to the nearest emergency department.
- Because 911 response systems are not nationally regulated, the authors write, it's difficult to design and mandate educational programs and care protocols, which leads to variability in training and stroke care across the country. For this reason, the authors recommend that hospitals train each EMS system in basic stroke emergency care so that they recognize strokes and can establish time of onset, can assess severity, can stabilize and treat onsite and during transport, bring all medications, and communicate well with the hospital.
- Mandate that physician assessment for patients suspected of strokes should take place within 15 minutes of entering an emergency room.