At a glance
State laws with “promising” evidence could have positive impacts, but the quantity and quality of the evidence for public health impact is limited at this time.
Pre-hospital
Includes all emergency medical care provided to the stroke patient prior to the handoff of the patient from Emergency Medical Services (EMS) providers to staff at the acute care facility.
Pre-hospital Stroke Screening Tool Use by EMS Providers
The identification of stroke patients by EMS responders allows for initiation of appropriate treatment in the field along with rapid transport and triage of acute stroke patients. EMS responders can identify stroke patients with a high degree of accuracy when using validated stroke screening algorithms for the pre-hospital setting. As such, policy encourages EMS responders to use validated and standardized pre-hospital screening and neurological assessment tools to identify stroke patients.
State law example: The Nebraska Stroke System of Care Act requires the Nebraska Department of Health and Human Services to adopt and distribute to EMS a nationally recognized, standardized stroke triage assessment tool. All EMS providers must use the assessment (or substantially similar) tool and establish pre-hospital stroke-care and transport protocols.
In-hospital/post-hospital
Includes the treatment of an acute stroke patient at the appropriate stroke hospital(s) and all the long-term, rehabilitative care received by the patient after discharge from the hospital.
State Standards for Comprehensive Stroke Centers (CSCs)
A state can designate a facility as a CSC or the equivalent when the facility meets specific standards set by the state.
State law example: Since 2004, hospitals in New Jersey must apply to the Commissioner of Health and Senior Services for designation as a primary or CSC. Designated CSCs are required to meet the minimum Primary Stroke Center (PSC) criteria set forth in statute and regulation as well as additional statutory and regulatory CSC criteria and standards.
Nationally Certified Comprehensive Stroke Centers
Nationally certified CSCs provide highly specialized stroke care for patients who require more complex medical and surgical interventions. They also serve as a top-tier resource center for other facilities within the stroke system of care.
State law example: As of August 30, 2016, the Delaware Department of Health and Social Services is required to designate an in-state acute health-care facility, as well as out-of-state facilities upon request as a CSC if the facility is certified by either the Joint Commission or by another nationally recognized accrediting organization with an equivalent certification.
Nationally Certified Acute Stroke Ready Hospitals (ASRH)
ASRH is a relatively new certification for facilities from nationally recognized accrediting bodies. ASRHs are intended to expand evidence-based stroke care to patients who are otherwise unable to access a PSC, for example, patients who live in rural areas.
State law example: The North Carolina Department of Health and Human Services is required to designate a hospital as a certified “Designated Stroke Center” if the hospital is certified by a nationally accrediting body “that requires conformance to best practices for stroke care” as a PSC, CSC, or ASRH.