MDNews - Minnesota

Certification means your entire hospital needs to eat, breathe and sleep stroke," Dr. Haake says. "That was the 'aha' factor for us. For example, during the certification process, the stroke education requirement surprised us — all of our staff had been educated in stroke at some point in their training — we thought that was a shoe-in. But then we learned the stroke education had to have occurred within the last two years. We had to provide eight hours of stroke training to each of 382 staff within 60 days. And our people stepped up to the plate, completing that training in their free time within that 60-day window. It was a stunning response and exemplifies Regions' level of dedication to stroke care." Expertise in Ischemic and Hemorrhagic Stroke Strokes can be divided into two groups. Approximately 87 percent are ischemic, in which a blood clot blocks the flow of blood to the brain. These strokes are treated with tPA and, in some cases, with delicate neurological procedures to remove the clot. The second category is hemorrhagic stroke, in which blood bleeds into the brain. Treatment for hemorrhagic strokes is more limited and very neurologically specialized. The expertise required to deliver a full range of treatment options for both types of stroke is what distinguishes a Comprehensive Stroke Center from a Primary Stroke Center. Primary Stroke Center Certification requires a hospital to have the infrastructure to deliver tPA for ischemic strokes in a timely fashion. Comprehensive Stroke Center Certification requires a multidisciplinary staff — including neurointensivists, neurohospitalists, and neurosurgeons — with the capability to treat ischemic stroke and provide the highly specialized proce- dures needed to treat the most complex and rare type of hemorrhagic stroke. Treatment for Intraparenchymal and Subarachnoid Hemorrhage C ompre hen si v e St rok e C ent er Certification requires demonstrated proficiency in both interventional and surgical approaches as well as pre- and postprocedural care. "A Comprehensive Stroke Center has proven that it can take care of all strokes, including the most complicated," says Ellie Choi, DO, a HealthPartners physician and stroke neurologist at Regions Hospital. "It must have the capability and neurosurgical skills to handle the entire continuum of a complex stroke patient." Hemorrhagic stroke affects only 10–15 percent of stroke patients. Some of these patients have a subarachnoid hemor- rhage. Treatment options for subarachnoid hemorrhages include both surgical clipping of the bleeding aneurysm and endovascular coiling, a procedure that fills the aneurysm with a fine platinum wire. "Nowadays, the majority of aneurysms are being coiled," explains HealthPartners physician Tenbit Emiru, MD-PhD, a neurointensivist with Regions Hospital's Stroke Center. James Goddard, MD, St. Paul Radiology Medical Director and neurointerventional radiologist at Regions Hospital, adds, "The publication of the ISAT [International Subarachnoid Aneurysm Trial], revealed that for patients who can undergo either type of treatment, endovascular coiling is more likely to result in a better outcome at one year compared to clipping. In addition, for patients who are surgically high-risk, coiling is the less-invasive and safer option. We can safely coil a patient soon after his or her arrival at the hospital, and coiling has become the national trend in aneurysm treatment." Gold-Standard Imaging Resources and Subspecialty Radiology Support Another critical factor distinguishing Regions' Stroke Center is the availability of advanced neuro imaging 24 hours a day, seven days a week. Hospitals with only one CT scanner cannot be considered for Comprehensive Stroke Center Certification. Regions Hospital has three CT scanners, including one of only 10 Toshiba Aquilion ONE ViSION scanners in the world, as well as two MRI scanners. "These resources provide gold-standard imaging for stroke patients," Dr. Goddard explains. "The Toshiba CT scanner's wide band enables clinicians to capture an image of the entire brain in a single rotation, unlike 2007 2008 2009 2010 2011 2012 2013 2014 Regions receives PSC designation. Regions receives CARF Stroke Specialty Certification, Inpatient Rehabilitation. GWTG awards Silver Performance Achievement. APN stroke program coordinator is hired. Stroke neurologist and neurointensivist are hired; new CT scanner is installed. Regions designated first TJC Comprehensive Stroke Center in Minnesota, 64th in nation. Minnesota joins Paul Coverdell National Stroke Registry. • January — Criteria is released for Comprehensive Stroke Center (CSC). • September — TJC conducts first on-site surveys for CSC. • November - Stanford Hospital and Clinics is first CSC in nation. Minnesota enacts legislation establishing statewide stroke system. Slightly more than 1,000 PSCs and 68 CSCs exist in United States. The wide band of the CT scanner enables clinicians to capture an image of the entire brain in a single rotation. • Regions Hospital receives Silver Performance Achievement from GWTG. • Hospital also receives Gold Plus Performance Achievement from GWTG (first and only in Minnesota). M D N E W S . CO M ■ MD NEWS Minnesota | 7

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