Documents Required to be submitted to start Process
Center Structure: Infrastructure, number of beds, ICU, number of CT scanners, number of MRI scanners, number ofbeds in the stroke unit, and list of stroke team professionals and specialties.
Stroke Team Documents:
Minimum conformation: All Neurologists, one representative from Emergency Nursing, one representative from the Stroke Unit Nursing, one representative from the ICU nursing and one representative from Physiotherapy.
- Neurologists: All must attach training certificate (diploma), NIHSS certificate and mRankin obtained within thelast 2
- Head of Emergency Nurse, Stroke Unit, and ICU: Must include certificate (diploma) of training and NIHSS
- Physiotherapy: Must attach training certificate (diploma).
- Professional in charge of assessment of outcomes: Certificate (diploma) of training and mRankin certificateobtained within the last 2
Nursing staff training:
Nurses and Nursing Technicians – Certificate 4 hours / year.
Topics: Swallowing assessment, Temperature Control, Glucose Control, Mobilization, Secondary Prevention,Anticoagulation, among others.
Nurses: A representative of the Emergency Nursing team, a representative of the Stroke Unit Nursing team and a representative of the ICU Nursing team must present one of the following certifications:
- Angels program nursing training course
- Training Course on the Stroke Protocol for Nursing (Global Stroke Alliance – ABENEURO)
- Local training course given by a competent and certified
Nursing Technicians: Attendance list of training given by a competent and certified professional.
Stroke nursing staff training: Acute Management
Certificate 2 hours / year.
Nursing: Nurse representing the Emergency team must present one of the following certifications:
- Angels program nursing training course
- Training Course on the LCA Protocol for Nursing (Global Stroke Alliance – ABENEURO)
- Local training course given by a competent and certified
Emergency nursing technicians: List of presence of training given by a competent and certified professional.
Training for Emergency Service physicians: 4 hours / year.
A Local Training Attendance List given by a competent and certified professional will be accepted. The trainingcontent table must be presented and inform the learning assessment method.
Training for physicians at the stroke unit, Angiosuite and neurological ICU: 8 hours/year. The followingcertifications will be accepted:
- Angels Stroke Academy Course Certificate
- Local training provided by a competent and certified The training content table must bepresented and inform the learning assessment method.
Training for Physiotherapists and Occupational Therapy: 4 hours / year.
- Local Training may be presented by a competent and certified The training content table mustbe presented and inform the learning assessment method.
Service protocol implemented:
Description of the protocol used in the care of patients with stroke and references.
Stroke patient care pathway.
Record of performance measures:
Indicators evaluated, what type of registry is used (local, national, or international), frequency of registry evaluation, what actions are generated based on these indicators (action plans).
Responsible for the center’s quality indicators
The responsible person must present their certificate (diploma) of training.
Strategic plan used to improve the quality of care.
Attendance list at the Stroke Center meetings:
List of attendances in training, case discussion, scientific meeting, discussion of quality indicators, etc.
Stroke network and pre-hospital care (description, if any)
Quality Indicators
- % of patients with door-to-needle time < 60 min _______ (target > 50%)
% of - patients with door-to-needle time < 45 min _______
- % of patients with door-to-puncture < 120 min _____ (target > 50%)
- % of patients with door-to-puncture < 90 min ______
- Total elegibility _____% (number of patients reperfused / total number of ischemic stroke patients)
- Elegibility within the window for IV thrombolysis ____% (number of thrombolyzed patients / number of ischemic stroke patients arriving ≤ 4.5h of symptom onset)
(for Comprehensive Stroke Centers only)
As originally described, TICI categories span from no perfusion (grade 0) to complete perfusion (grade 3). The “partial perfusion” category (grade 2) is defined as cases in which contrast passes the obstruction but with rates of entry and washout slower than normal and is subdivided into 2 subcategories, 2a and 2b.
(Comprehensive Stroke Centers)
Dysphagia Tests
Dysphagia is a term that means difficulty swallowing. Normally when you swallow, food moves easily from your mouth, down your throat, and into your stomach. The food travels through a long tube called the esophagus. If you have dysphagia, it can take more time and effort to move food from your mouth to your stomach. It can be painful and may even prevent you from swallowing at all.
Dysphagia can happen at any age but is more common in older adults and people who have certain neurologic diseases. There are many conditions that can cause dysphagia. Some are very serious. Dysphagia tests can help screen for or diagnose these conditions.
Other names: bedside swallow, clinical swallow, dysphagia screening tool, fiberoptic endoscopic evaluation of swallow (FEES), barium swallow, esophagram, videofluoroscopic swallow study (VFSS), upper endoscopy
Any type of Anti-platelets
(number of patients with “U-AVC = sim” / total number of patients with ischemic stroke, hemorrhagic stroke or TIA (target 90%)
(IQR 25-75)
interquartile range ( · (IQR) is a measure of statistical dispersion, which is the spread of the data.
- Deaths by ischemic stroke/TIA_____%
- Deaths by hemorrhagic stroke _____%
- Modified Rankin Score 0 to 1 in 90 days ______%
- Modified Rankin Score 0 to 2 in 90 days ______%
- Modified Rankin Score 6 in 90 days _____%