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 100270.226 - Acute Stroke Ready Hospitals

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Hospitals designated by the local EMS agency as an acute stroke ready hospital shall
				  meet all the following minimum criteria:
(1) A
				  clinical stroke team available to see, in person or via telehealth, a patient
				  identified as a potential acute stroke patient within twenty (20) minutes following
				  the patient's arrival at the hospital's emergency department.
(2) Written policies and procedures for emergency
				  department stroke services that are reviewed, revised as needed, and implemented at
				  least every three (3) years.
(3)
				  Emergency department policies and procedures shall include written protocols and
				  standardized orders for the emergency care of stroke patients.
(4) Data-driven, continuous quality improvement
				  process including collection and monitoring of standardized performance
				  measures.
(5) Neuro-imaging 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 imaging shall be
				  performed and reviewed by a physician within forty-five (45) minutes following
				  emergency department arrival.
(6)
				  Neuro-imaging services shall, at a minimum, include CT or MRI, or both.
(7) 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.
(8) Laboratory services shall, at a minimum,
				  include blood testing, electrocardiography and x-ray services, and be available
				  twenty-four (24) hours a day, seven (7) days a week, three hundred and sixty-five
				  (365) days per year, and able to be completed and reviewed by physician within sixty
				  (60) minutes following emergency department arrival.
(9) Neurosurgical services shall be available,
				  including operating room availability, either directly or under an agreement with a
				  thrombecotomy-capable, primary or comprehensive stroke center, within three (3)
				  hours following the arrival of acute stroke patients to an acute stroke-ready
				  hospital.
(10) Provide IV thrombolytic
				  treatment and have transfer arrangements with one or more thrombectomy-capable,
				  primary or comprehensive stroke center(s) that facilitate the transfer of patients
				  with strokes to the stroke center(s) for care when clinically warranted.
(11) There shall be a medical director of an acute
				  stroke-ready hospital, who may also serve as a member of a stroke team, who is a
				  physician or advanced practice nurse who maintains at least four (4) hours per year
				  of educational time in cerebrovascular disease;
(12) Clinical stroke team for an acute
				  stroke-ready hospital at a minimum shall consist of a nurse and a physician with
				  training and expertise in acute stroke care.