NOV. 19, 2012

Stanford Hospital is first in nation to earn comprehensive stroke center designation

BY SARA WYKES

Stanford Hospital & Clinics is the first hospital in the country to earn the newest level of certification for advanced stroke care, awarded by the Joint Commission, the nation's oldest and largest standards-setting and accrediting body in health care.

"Stroke patients who are treated at Stanford can have confidence that the hospital has put in place the critical elements necessary to meet their unique needs," said commission president Mark Chassin, MD, in announcing the certification on Nov. 16. "The Joint Commission commends Stanford Hospital & Clinics for seeking and achieving certification as part of its commitment to focusing on the care processes that produce the best outcomes for complex stroke patients."

A team of Joint Commission expert surveyors evaluated Stanford Hospital & Clinics and its Stroke Center for two days in October for its compliance with the new comprehensive stroke center standards and requirements, including advanced imaging and treatment capabilities, 24/7 availability of specialized treatments, participation in research, and staff with the unique education and competencies to care for complex stroke patients. The surveyors found the hospital met or exceeded all required standards.

"We are very pleased to have earned the Joint Commission and the American Heart Association/American Stroke Association's recognition. The leading-edge standards of care the Stanford Stroke Center team developed and refined over the last 20 years should be upheld as a national model," said Amir Dan Rubin, president and CEO of Stanford Hospital & Clinics.

Rubin added that the center's founders "knew from the very start that the most effective way to battle complex stroke cases was to create a truly coordinated, multidisciplinary team that united experts from every related field — not just those dedicated to neurology, neurosurgery and interventional neuroradiology, but also experts in nursing, rehabilitation, emergency medicine and pharmacy, amongst others. This approach has improved patient outcomes and pioneered significant advances in stroke diagnosis and treatment."

Nearly 1 million people in the United States were hospitalized by stroke in 2009, according to the Centers for Disease Control and Prevention. An estimated 7 million Americans have had some form of stroke. It was the fourth-leading cause of death in the United States in 2010.

The new comprehensive stroke center certification was developed by the commission in collaboration with the AHA/ASA and derived from a graded evaluation of nearly 40 years of published data on clinical trials, care and scientific guidelines, research reports on diagnostic and therapeutic approaches to stroke care. The group also sought input from professional organizations.

In 2004, Stanford's Stroke Center earned the Joint Commission's first stroke-care certification as a primary stroke center. More than 900 centers have since been awarded that designation. In 2005, the commission began work on a higher level of specialty care and technology standards needed to treat patients with complex strokes, severe deficits and multi-organ disease.

Stanford created its stroke center in 1992. "What we recognized from the start was that the best care would come from going beyond issues about turf," said Michael Marks, MD, the center's director of interventional neuroradiology and one of its three founding physicians. "We have been blessed to work with people who are open-minded and interested in a common goal, taking care of patients by using what is best from their individual areas of expertise."

The multidisciplinary concept expanded quickly beyond physicians and nurses to representatives from social work, case management, pharmacy, rehabilitation, clinical nutrition, radiology, quality and other treatment modalities.

The center also gained strength from the continuity of its leadership and a good portion of its affiliated staff. "Our three original leaders are still together 20 years later," said Gary Steinberg, MD, PhD, co-director of the center and one of those three founding members. "That's unprecedented in stroke centers. What keeps us here is our shared enthusiasm for innovation and our shared passion for discovery — and our shared passion for helping patients."

The Stanford Stroke Center's foundational philosophy was the key to its success, said center director Greg Albers, MD, one of the original founders. "To partner neurosurgery, neurology and interventional neuroradiology seemed sensible," he said, "but it was a unique concept then. We were confident that this approach would be fruitful and the administrators at Stanford Hospital and at the university supported us."

Each year, the stroke center cares for more than 2,000 patients in its ambulatory care clinic, emergency room, in-hospital stroke service, neurological critical care unit and operating rooms. It also acts as a regional resource, expediting care for patients from outside the area; the hospital maintains a Life Flight helicopter on standby for patients who require emergency transfer to its facilities.

Among the center's accomplishments are the development of better methods for treating and preventing stroke, innovative neurosurgical techniques for stroke prevention and groundbreaking interventional neuroradiologic procedures. It has developed a program that has transformed the way that transient ischemic attacks, sometimes referred to as mini-strokes, are diagnosed and managed.

The hospital's Neurocritical Care Program has made key advances in the ability to diagnosis intracerebral hemorrhages (also known as a hemorrhagic stroke) and predicting a stroke patient's likelihood of a coma. Stanford neuroscientists also have helped clarify the basic mechanisms of stroke-induced brain injury and have developed several imaging techniques that allow them to successfully treat selected patients up to 12 hours after symptom onset.

Additionally, the hospital's unique hybrid interventional radiology/operating room allows for faster collaboration between specialists in neurosurgery and neuroradiology, streamlining the treatment process.

Outreach to the community has been part of the center's concept of care, and includes providing information at health fairs and continues through to post-treatment therapy and support groups.

One of the center's essential elements, and one particularly commended by the Joint Commission surveyors, is the monthly meeting of the Stroke Interdisciplinary Team, said neurosurgical nurse Teresa Bell-Stephens. She was the center's original nurse coordinator. Between 30 and 40 people take part, in a collaboration that encourages networking and discussions that are valuable because of their frankness. "We all have an equal voice," she said. "We would never have gotten this far had we not worked together."

"We've always worked cohesively," said JJ Baumann, another long-time center nurse coordinator, "and we've been early adopters who strive for continuing education — as a multidisciplinary team.

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Sara Wykes is a writer for the Stanford Hospital & Clinics communications office.

Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For more information, please visit the Office of Communication & Public Affairs site at https://mednews.stanford.edu/.