SHC Receives Comprehensive Stroke Center Designation from JC

In 1992, a team of Stanford physicians and nurses led by Greg Albers, MD, Michael Marks, MD, and Gary Steinberg, MD, PhD, set out to create a stroke program that was innovative, collaborative and comprehensive. At the time, interventional neuroradiology was a new field and previously established stroke programs did not involve active collaborations between neurosurgery and neurology.

"Dr. Steinberg had the idea that the Stanford Stroke Center could partner all three areas and the hospital agreed that this was a promising concept," says Gregory W. Albers, MD, director of the Stanford Stroke Center. "The concept in the beginning was really unique." To further develop the program, the Stroke Center added a specialized neurocritical care group about 10 years ago.

"We have been practicing three of the four pillars of a comprehensive stroke center since our inception more than 20 years ago," adds Albers, the Coyote Foundation Professor of Neurology and Neurological Sciences. "You could say that we pioneered this approach. It's fitting that we were recognized first for this highest designation."

The original three founding physicians remain at the helm of the Stanford Stroke Center. They lead a multidisciplinary group of specialists in the fields of neurology, neurosurgery, interventional neuroradiology, nursing, rehabilitation, emergency medicine, social work, pharmacy and nutrition, all using a coordinated approach to caring for complex stroke patients.

"What has contributed to our success is that the three original leaders are still together 20 years later," says Steinberg, co-director of the Stroke Center, chair of the Department of Neurosurgery, director of the Institute for Neuro-Innovation and Translational Neurosciences and the Bernard and Ronni Lacroute-William Randolph Hearst professor of Neurosurgery and the Neurosciences. "That is unprecedented in stroke centers around the world. That kind of collaboration and multidisciplinary cooperation has really turned out to be a huge benefit. We don't have to necessarily treat the patient with the only modality we are most familiar with. Most places are more competitive between specialties."

Perfect score

When the team of Joint Commission surveyors came to Stanford in October, they found that the hospital met or exceeded all required standards, including advanced imaging and treatment capabilities, 24/7 availability of specialized treatments, participation in research and staff and physicians who have the unique education and competencies to care for complex stroke patients.

Hospitals that achieve the Comprehensive Stroke Center status must prove that in addition to handling any stroke patient, they are equipped to deal with the toughest, most complex patients—those requiring expertise in neurosurgery and interventional neuroradiology. These newly designated centers must maintain higher standards for brain imaging capability as well as physician and stroke team expertise. Of the more than 900 Joint Commission certified Primary Stroke Centers, only five thus far have received this comprehensive status.

Every member of the stroke team interviewed for this story attributed the Stroke Center's success to one thing: the shared collegiality that exists among the multidisciplinary team.

"I am blessed to be working with people who are open minded and interested in one common goal—taking care of patients and using whatever is best from their individual fields to do just that," says Michael P. Marks, MD, chief of Interventional Neuroradiology and professor of Radiology. "This group of people is really committed to multidisciplinary care of patients with complex vascular disease in the brain."

The Stanford approach to stroke care

One of the hallmarks of the Stanford program is its system for urgent transfers and immediate access to treatment. For patients experiencing an acute ischemic stroke, Stanford offers ultra RAPID transport coordinated by the Transfer Center, immediate access to CT or MRI upon arrival and guaranteed ICU and Cath Lab access 24/7. Over the past 20 years, the Stanford Stroke Center has provided care for more than 22,000 inpatients with cerebrovascular disorders. Nine physicians are on call for stroke emergencies at all times.

In addition to providing patient care, the Stanford team has pioneered major advances in medical therapies, neurosurgical techniques and interventional neuroradiologic procedures, participated in more than 170 Clinical Stroke Trials and published more than 1,000 articles in scientific journals. The program receives extensive NIH grant support and contributes extensive research findings to the AHA's International Stroke Meeting each year.

The Stanford Stroke Center has also been instrumental in developing national guidelines on stroke care beginning in 1993 with its guidelines on management of TIAs. Since then, it has developed or modified national guidelines for Stroke Treatment and Prevention, TIA Definition, Diagnosis and Evaluation and Stroke Prevention in Atrial Fibrillation.

The Stanford team, known for continuously advancing the care it provides, is not resting on its laurels. They are currently looking to incorporate a novel approach to telemedicine into the Stroke Center Program. "We want to get patients here who can benefit from the advanced care we have available that other hospitals don't have," says Albers. "One of the best ways to do that is through advanced image processing to identify salvageable brain tissue. Our next goal is to develop a way to transfer key neuro-imaging studies directly to Stanford to help evaluate which patients are the best candidates to be urgently transferred to the Stroke Center from outside hospitals."

By Grace Hammerstrom