California Code of Regulations › Title 22 - Social Security › Division 9 - Prehospital Emergency Medical Services › Chapter 7.2 - Stroke Critical Care System › Article 4 - Hospital Stroke Care Requirements and Evaluations › Section 100270.225 - Primary Stroke Centers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Hospitals
				  designated by the local EMS agency as a primary stroke center shall meet all the
				  following minimum criteria:
(1) Adequate staff,
				  equipment, and training to perform rapid evaluation, triage, and treatment for the
				  stroke patient in the emergency department.
(2) Standardized stroke care protocol/order
				  set.
(3) Stroke diagnosis and treatment
				  capacity twenty-four (24) hours a day, seven (7) days a week, three hundred and
				  sixty-five (365) days per year.
(4)
				  Data-driven, continuous quality improvement process including collection and
				  monitoring of standardized performance measures.
(5) Continuing education in stroke care provided
				  for staff physicians, staff nurses, staff allied health personnel, and EMS
				  personnel.
(6) Public education on
				  stroke and illness prevention.
(7) A
				  clinical stroke team, available to see in person or via telehealth, a patient
				  identified as a potential acute stroke patient within 15 minutes following the
				  patient's arrival at the hospital's emergency department or within 15 minutes
				  following a diagnosis of a patient's potential acute stroke.
(A) At a minimum, a clinical stroke team shall
				  consist of:
(i) A neurologist, neurosurgeon,
				  interventional neuro-radiologist, or emergency physician who is board certified or
				  board eligible in neurology, neurosurgery, endovascular neurosurgical radiology, or
				  other board-certified physician with sufficient experience and expertise in managing
				  patients with acute cerebral vascular disease as determined by the hospital
				  credentials committee.
(ii) A registered
				  nurse, physician assistant or nurse practitioner capable of caring for acute stroke
				  patients that has been designated by the hospital who may serve as a stroke program
				  manager.
(8) Written
				  policies and procedures for stroke services which shall include written protocols
				  and standardized orders for the emergency care of stroke patients. These policies
				  and procedures shall be reviewed at least every three (3) years, revised as needed,
				  and implemented.
(9) Data-driven,
				  continuous quality improvement process including collection and monitoring of
				  standardized performance measures.
(10)
				  Neuro-imaging services capability that is available twenty-four (24) hours a day,
				  seven (7) days a week, three hundred sixty-five (365) days per year, such that
				  imaging shall be initiated within twenty-five (25) minutes following emergency
				  department arrival.
(11) CT scanning or
				  equivalent neuro-imaging shall be initiated within twenty-five (25) minutes
				  following emergency department arrival.
(12) Other imaging shall be available within a
				  clinically appropriate timeframe and shall, at a minimum, include:
(A) MRI.
(B) CTA and / or Magnetic resonance angiography
				  (MRA).
(C) TEE or
				  TTE.
(13) Interpretation of
				  the imaging.
(A) If teleradiology is used in image
				  interpretation, all staffing and staff qualification requirements contained in this
				  section shall remain in effect and shall be documented by the hospital.
(B) Neuro-imaging studies shall be reviewed by a
				  physician with appropriate expertise, such as a board-certified radiologist,
				  board-certified neurologist, a board-certified neurosurgeon, or residents who
				  interpret such studies as part of their training in ACGME-approved radiology,
				  neurology, or neurosurgery training program within forty-five (45) minutes of
				  emergency department arrival.
(i) For the purpose
				  of this subsection, a qualified radiologist shall be board certified by the American
				  Board of Radiology or the American Osteopathic Board of Radiology.
(ii) For the purpose of this subsection, a
				  qualified neurologist shall be board certified by the American Board of Psychiatry
				  and Neurology or the American Osteopathic Board of Neurology and
				  Psychiatry.
(iii) For the purpose of
				  this subsection, a qualified neurosurgeon shall be board certified by the American
				  Board of Neurological Surgery.
(14) Laboratory services capability that is
				  available twenty-four (24) hours a day, seven (7) days a week, three hundred and
				  sixty-five (365) days per year, such that services may be performed within
				  forty-five (45) minutes following emergency department arrival.
(15) Neurosurgical services shall be available,
				  including operating room availability, either directly or under an agreement with a
				  thrombectomy-capable, comprehensive or other stroke center with neurosurgical
				  services, within two (2) hours following the arrival of acute stroke patients to the
				  primary stroke center.
(16) Acute care
				  rehabilitation services.
(17) Transfer
				  arrangements with one or more higher level of care centers when clinically warranted
				  or for neurosurgical emergencies.
(18)
				  There shall be a stroke medical director of a primary stroke center, who may also
				  serve as a physician member of a stroke team, who is board-certified in neurology or
				  neurosurgery or another board-certified physician with sufficient experience and
				  expertise dealing with cerebral vascular disease as determined by the hospital
				  credentials committee.