Thomas Jefferson University Hospital
 
DEPARTMENT OF NEUROLOGY

About Us

Quality Statements: Stroke

 1. Brain Imaging Media Availability

According to the American Stroke Association’s “Guidelines for the Early Management of Patients With Ischemic Stroke,” a brain imaging study is mandatory in order to distinguish ischemic stroke from hemorrhagic stroke or from other brain conditions that may mimic stroke. “Brain imaging is required to guide acute intervention. For most cases and at most institutions, computerized tomography (CT) remains the most important brain imaging test.”

According to the guidelines, “because time is of the essence in acute stroke care, institutions should have these diagnostic studies available on a 24-h/day and 7-d/week basis.” ( Stroke, April 2003: 34(4); 1056-1083)

Thomas Jefferson University Hospital has 24-h/day 7-d/week radiology services available for brain imaging, including computerized tomography (CT). and Magnetic Resonance Imaging (MRI)

2. Physician Availability for Interpretation of Brain Imaging Studies

For most cases and at most institutions, computerized tomography (CT) remains the most important brain imaging test. A physician skilled in assessing CT studies should be available to interpret the scan. ( Stroke, April 2003: 34(4); 1056-1083)

Thomas Jefferson University Hospital offers 24-h/day 7-d/week coverage by radiologists skilled in the interpretation of brain computerized tomography (CT) scans and other brain imaging tests.

3. Stroke Disease Management Program

Disease management programs are increasingly being examined and introduced to help treat chronic illnesses such as cardiovascular diseases and stroke. “The term ‘disease management programs’ typically refers to multidisciplinary efforts to improve the quality and cost-effectiveness of care for select patients with chronic illness.” ( Circulation, June 1, 2004: 109(21); 2651-2654)

Thomas Jefferson University Hospital offers a comprehensive disease management program for stroke patients that works to improve the quality of care and patient outcomes by using evidence-based interventions and a multi-disciplinary approach, and by encompassing all aspects of care required to obtain optimal levels of health and functionality.

4. tPA

Stroke occurs when blood flow to the brain is disrupted. Disruption in blood flow is caused when either a blood clot or piece of plaque blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

Intravenous tissue plasminogen activator, or tPA (also known as a “clot-buster” medication) is currently the only agent approved by the US Food and Drug Administration (FDA) for treating acute ischemic stroke. tPA should be administered within three hours of onset of acute ischemic stroke in patients who meet certain eligibility requirements. New England Journal of Medicine, September 7, 2000: 343(10); 712-722)

Nationwide, less than 5 percent of eligible ischemic stroke patients receive tPA. ( Neurology, May 13, 2003: 60(9); 1452-1456; Stroke , June 2003: 34(6); e55-e57)

Thomas Jefferson University Hospital uses tPA to treat ischemic stroke patients when appropriate, according to national guidelines.

In 2004, Thomas Jefferson University Hospital treated twice as many eligible acute ischemic stroke patients with tPA than other hospitals participating in the Get With the Guidelines stroke program.

5. Neurologist on Staff

Studies have shown that stroke patients who are treated primarily by a neurologist have better outcomes, both short-term and long-term. ( Neurology, September 23, 2003: 61(6); 792-796; Stroke, November 1996: 27(11); 1937-1943)

Thomas Jefferson University Hospital has 24 neurologists on staff.

6. Neurologist Board Certification

A board-certified physician has completed an approved educational training program and an evaluation process including an examination designed to assess the knowledge, skills, and experience necessary to provide quality patient care in that specialty. A specialty certificate is issued by a medical specialty certifying board, which is valid nationwide. Although certification is not required for an individual physician to practice medicine, most hospitals and managed care organizations require that at least a certain percentage of their staff be “board certified." ( American Board of Medical Specialties)

All of Thomas Jefferson University Hospital’s neurologists are board certified in Neurology by the American Board of Psychiatry and Neurology.

7. Patient and Community Education

According to the latest statistics from the American Stroke Association:

  • Someone in the US has a stroke every 45 seconds.

  • Someone dies of a stroke every three minutes.

  • Stroke killed approximately 163,538 people in 2001, and is the US’ third leading cause of death.


( American Stroke Association)

“Only about one-third of patients who are having a stroke are aware of its symptoms, and most bystanders are not knowledgeable about the signs of stroke.” ( New England Journal of Medicine, September 7, 2000: 343(10); 710-722)

A person experiencing a stroke may be unaware of the stroke symptoms or unable to communicate the problem, and it is often bystanders who initiate communication for stroke care. ( Archives of Internal Medicine, October 13, 2003: 163(18); 2198-2202)

Studies have shown an increase in public awareness of stroke symptoms and the need for emergent stroke treatment, as well as improvement in stroke care delivery after certain types of community educational interventions. ( Archives of Internal Medicine, October 13, 2003: 163(18); 2198-2202; Stroke, August 2003: 34(8); 1968-1969; Critical Care Nursing Quarterly, October/November/December 2003: 26(4); 316-322)

The pooled results of three major tPA trials confirmed that early stroke treatment is strongly associated with favorable stroke outcomes. (NOTE: tPA is a “clot-buster” medication used to treat ischemic stroke in certain situations.) ( The Lancet, March 6, 2004: 363(1941); 768-74)

Thomas Jefferson University Hospital actively participates in stroke education programs by doing the following:

  1. Stroke month screening programs
  2. Community education lectures
  3. Community stroke screenings in a wide variety of settings

10. Stroke Center

In a Consensus Statement published in 2003, the Brain Attack Coalition states that the “establishment of primary stroke centers has the potential to improve the care of patients with stroke.” The Coalition recommends that primary stroke centers have the following key elements:

Acute stroke team: Includes a physician and one or more other healthcare professionals (i.e, nurse, physician’s assistant, nurse practitioner) who are available on an around-the-clock basis.

  • Written care protocols
  • Emergency medical services (EMS): It is vital that EMS have effective communication with the Emergency Department during transportation of suspected stroke patients.
  • Emergency department: ED personnel should be well trained in the diagnosis and treatment of all types of stroke.
  • Stroke unit: Studies have shown that stroke patients who receive care in a specialized stroke unit had decreased rates of death, decreased lengths of stay, and increased rates of being able to live at home after the stroke.
  • Neurosurgical services:Because some patients with acute stroke will require evaluation and/or intervention by a neurosurgeon, neurosurgical care should be available within two hours of such a requirement being deemed necessary, either onsite or by transfer to another facility.
  • Medical organization commitment to and support of the primary stroke center
  • Neuroimaging: The primary stroke center should be able to provide either a cranial computerized tomography (CT scan) or brain magnetic resonance imaging (MRI) within 25 minutes of the order being written on an around-the-clock basis. In addition, physicians with experience in interpretation of CT and/or MRI studies should be available to interpret the scans within 20 minutes of their completion.
  • Laboratory services: Available 24/7
  • Outcomes and quality improvement
  • Educational programs: The stroke center’s professional staff should receive a minimum of eight hours/year of continuing education programs to maintain and expand their knowledge of stroke care. ( JAMA, June 21, 2000: 283(23); 3102-3109)

  • Thomas Jefferson University Hospital offers a primary stroke center for the diagnosis and treatment of acute stroke patients, including a stroke unit.

11. Stroke Rehabilitation Program

Strokes, whether a first stroke or a recurrent stroke, can be prevented. In addition, those who have a stroke are at greatly increased risk for a recurrent stroke. Evidence shows that physical activity and exercise training are considered an important part of a stroke risk-reduction program. ( Stroke, May 2004: 35(5); 1229-39)

Thomas Jefferson University Hospital offers an inpatient rehabilitation team that works with stroke patients beginning during the acute phase of stroke recovery. The team works with patients to ensure their early discharge to the most appropriate location, whether to home, a skilled nursing facility, or a rehabilitation facility. In addition, outpatient rehabilitation services are available for stroke patients once they are discharged from the hospital to continue rehabilitation as needed to achieve and maintain optimal functioning after stroke.

12. Aspirin Given Within 48 Hours of Admission for Stroke

Patients who are admitted to a hospital for acute ischemic stroke should receive aspirin within 48 hours of admission, unless contraindications for receiving aspirin, including, but not limited to, allergy to aspirin or gastrointestinal bleeding, are present. Patients who meet the criteria should continue to receive aspirin on a daily basis. ( Stroke, July 2002: 33(7); 1934-1942)

Unless otherwise contraindicated, the protocol at TJUH includes the administration of aspirin or other antithrombotic medication to ischemic stroke patients within 48 hours of hospitalization.

13. Antithrombotic Medication Prescribed at Discharge

Because of the risk for recurrence of stroke after an ischemic stroke has occurred, antiplatelet medication is recommended to reduce this risk. Antiplatelet therapy reduces the risk of a recurrent stroke by more than 20 percent. ( Journal of Vascular and Interventional Radiology, January 2004: 15(1, Part 2); S87-S101)

Unless otherwise contraindicated, the protocol at Thomas Jefferson University Hospital includes prescribing antithrombotic medication for ischemic stroke patients when they are discharged from the hospital.