Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.710 - Definitions and Abbreviations Relating to Stroke Centers

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment adds virtual reviews to the
				  definitions for stroke centers.
(1) As used in
				19 CSR
				30-40.720 and
				19 CSR
				30-40.730, the following terms shall mean-
(A) Acute-an injury or illness that happens
				or appears quickly and can be serious or life threatening;
(B) Anesthesiologist assistant (AA)-a person
				who-
1. Has graduated from an
				anesthesiologist assistant program accredited by the American Medical
				Association's Committee on Allied Health Education and Accreditation or by its
				successor agency;
2. Has passed the
				certifying examination administered by the National Commission on Certification
				of Anesthesiologist Assistants;
3.
				Has active certification by the National Commission on Certification of
				Anesthesiologist Assistants;
4. Is
				currently licensed as an anesthesiologist assistant in the state of Missouri;
				and
5. Provides health care
				services delegated by a licensed anesthesiologist;
(C) Board-admissible/board-eligible-a
				physician who is eligible to apply or has applied to a specialty board of the
				American Board of Medical Specialties, the American Osteopathic Association
				Board of Osteopathic Specialists, or the Royal College of Physicians and
				Surgeons of Canada and has received a ruling that he or she has fulfilled the
				requirements to take the examinations. Board certification is generally
				obtained within five (5) years of the first appointment;
(D) Board-certified-a physician who has
				fulfilled all requirements, has satisfactorily completed the written and oral
				examinations, and has been awarded a board diploma in a specialty field by the
				American Board of Medical Specialties, the American Osteopathic Association
				Board of Osteopathic Specialists, or the Royal College of Physicians and
				Surgeons of Canada;
(E) Catchment
				area-the surrounding area served by the institution (the stroke
				center);
(F) Certified registered
				nurse anesthetist (CRNA)-a registered nurse who-
1. Has graduated from a school of nurse
				anesthesia accredited by the Council on Accreditation of Education Programs of
				Nurse Anesthesia or its predecessor;
2. Has been certified as a nurse anesthetist
				by the Council on Certification of Nurse Anesthetists; and
3. Has been licensed in Missouri pursuant to
				Chapter 335, RSMo;
(G)
				Clinical staff-an individual that has specific training and experience in the
				treatment and management of stroke patients. Examples include: physicians,
				registered nurses, advanced practice nurses, physician assistants, pharmacists,
				and technologists;
(H) Clinical
				team-a team of healthcare professionals involved in the care of the stroke
				patient and may include, but not be limited to, neurologists,
				neuro-interventionalists, neurosurgeons, anesthesiologists, emergency medicine,
				and other stroke center clinical staff. The clinical team is part of the
				hospital program's stroke team;
(I)
				Continuing education-education approved or recognized by a national and/or
				state professional organization and/or stroke medical director;
(J) Continuing medical education (CME)- the
				highest level of continuing education for physicians that is approved or
				recognized by a national and/or state professional organization and/or stroke
				medical director;
(K) Core team-a
				subunit of the hospital stroke team consisting of a physician experienced in
				diagnosing and treating cerebrovascular disease (usually the stroke medical
				director) and at least one (1) other health care professional or qualified
				individual competent in stroke care as determined by the hospital (usually the
				stroke program manager/coordinator);
(L) Credentialed or credentialing-a
				hospital-specific system of documenting and recognizing the qualifications of
				medical staff and nurses and authorizing the performance of certain procedures
				and establishing clinical privileges in the hospital setting;
(M) Department-the Missouri Department of
				Health and Senior Services;
(N)
				Door-to-needle time-the time from arrival at the hospital door to initiation of
				lytic therapy to restore blood flow in an obstructed blood vessel;
(O) Emergency medical service regions- the
				six (6) regions in the state of Missouri that are defined in
				19 CSR
				30-40.302;
(P) Hospital-an establishment as defined by
				section 197.020.2, RSMo, or a hospital
				operated by the state;
(Q)
				Immediately available (IA)-being present at the bedside at the time of the
				patient's arrival at the hospital when prior notification is possible and no
				more than twenty (20) minutes from the hospital under normal driving and
				weather conditions;
(R) In-house
				(IH)-being on the hospital premises twenty-four (24) hours a day;
(S) Lytic therapy (also known as
				fibrinolysis/thrombolysis)-a drug therapy used to dissolve clots blocking flow
				in a blood vessel. It refers to drugs used for that purpose, including
				recombinant tissue plasminogen activator. This type of therapy can be used in
				the treatment of acute ischemic stroke and acute myocardial
				infarction;
(T) Missouri stroke
				registry-a statewide data collection system comprised of key data elements as
				defined in
				19 CSR
				30-40.730 that are used to compile and trend
				statistics of stroke patients in both pre-hospital and hospital settings, using
				a coordinated electronic reporting method provided by the department;
(U) Multidisciplinary team-a team of
				appropriate representatives of hospital units involved in the care of the
				stroke patient. This team supports the care of the stroke patient with the
				stroke team;
(V) Neurologist-a
				licensed physician with the appropriate specialty training;
(W) Neuro-interventionalist-a licensed
				physician with the appropriate specialty training;
(X) Neuro-interventional team-a team of
				physicians, nurses, and other clinical staff, and technical support that
				perform the neuro-interventions and who are part of the stroke clinical
				team;
(Y) Neurology service-an
				organizational component of the hospital specializing in the care of patients
				who have had strokes or some other neurological condition or
				disorder;
(Z) Patient-an individual
				who is sick, injured, wounded, diseased, or otherwise incapacitated or
				helpless, or dead, excluding deceased individuals being transported from or
				between private or public institutions, homes, or cemeteries, and individuals
				declared dead prior to the time an ambulance is called for
				assistance;
(AA) Peer review
				system-the process the stroke center establishes for physicians to review
				stroke cases on patients who are admitted to the stroke center, transferred out
				of the stroke center, or die as a result of the stroke (independent of hospital
				admission or hospital transfer status);
(BB) Physician-a person licensed as a
				physician pursuant to Chapter 334, RSMo;
(CC) Promptly available (PA)-arrival at the
				hospital at the patient's bedside within thirty (30) minutes after notification
				of a patient's arrival at the hospital;
(DD) Protocol-a predetermined, written
				medical care guideline, which may include standing orders;
(EE) Qualified individual-a physician,
				registered nurse, advanced practice nurse, and/or physician assistant licensed
				in the state of Missouri who demonstrates administrative ability and shows
				evidence of educational and clinical experience in the care of cerebrovascular
				patients;
(FF) Regional outcome
				data-data used to assess the regional process for pre-hospital, hospital, and
				regional patient outcomes;
(GG)
				Repatriation-the process used to return a stroke patient to his or her home
				community from a level I or level II stroke center after his or her acute
				treatment for stroke has been completed. This allows the patient to be closer
				to home for continued hospitalization or rehabilitation and follow-up care as
				indicated by the patient's condition;
(HH) Reperfusion-the process of restoring
				normal blood flow to an organ or tissue that has had its blood supply cut off,
				such as after an ischemic stroke or myocardial infarction;
(II) Requirement (R)-a symbol used to
				indicate that a standard is a requirement for stroke center designation at a
				particular level;
(JJ) Review-the
				inspection of a hospital to determine compliance with the rules of this
				chapter;
(KK) Stroke-a sudden brain
				dysfunction due to a disturbance of cerebral circulation. The resulting
				impairments include, but are not limited to, paralysis, slurred speech, and/or
				vision loss. Ischemic strokes are typically caused by the obstruction of a
				cerebral blood vessel. Hemorrhagic strokes are typically caused by rupture of a
				cerebral artery;
(LL) Stroke call
				roster-a schedule that provides twenty-four (24) hours a day, seven (7) days a
				week neurology service coverage. The call roster identifies the physicians or
				qualified individuals on the schedule that are available to manage and
				coordinate emergent, urgent, and routine assessment, diagnosis, and treatment
				of the stroke patients;
(MM) Stroke
				care-emergency transport, triage and acute intervention, and other acute care
				services for strokes that potentially require immediate medical or surgical
				intervention or treatment, and may include education, primary prevention, acute
				intervention, acute and sub-acute management, prevention of complications,
				secondary stroke prevention, and rehabilitative services;
(NN) Stroke center-a hospital that is
				currently designated as such by the department to care for patients with a
				stroke.
1. A level I stroke center is a
				receiving center staffed and equipped to provide total care for every aspect of
				stroke care, including care for those patients with complications, that also
				functions as a resource center for the hospitals within that region, and
				conducts research.
2. A level II
				stroke center is a receiving center staffed and equipped to provide care for a
				large number of stroke patients within the region.
3. A level III stroke center is a referral
				center staffed and equipped to initiate lytic therapy and initiate timely
				transfer to a higher level of care. The level III stroke center also provides
				prompt assessment, indicated resuscitation, and appropriate emergency
				intervention for stroke patients. A level III stroke center may admit and
				monitor patients as in-patients if there are designated stroke beds and an
				established relationship exists with a level I or level II stroke center
				through which the level I or level II stroke center provides medical direction
				and oversight for those stroke patients kept at the level III stroke center
				under that relationship.
4. A level
				IV stroke center is a referral center in an area considered rural or where
				there are insufficient hospital resources to serve the patient population
				requiring stroke care. A level IV stroke center provides prompt assessment,
				indicated resuscitation, appropriate emergency intervention, and arranges and
				expedites transfer to a higher level stroke center as needed;
(OO) Stroke medical director-a
				physician designated by the hospital who is responsible for the stroke service
				and performance improvement and patient safety programs related to stroke
				care;
(PP) Stroke program-an
				organizational component of the hospital specializing in the care of stroke
				patients;
(QQ) Stroke program
				manager/coordinator-a qualified individual designated by the hospital with
				responsibility for monitoring and evaluating the care of stroke patients and
				the coordination of performance improvement and patient safety programs for the
				stroke center in conjunction with the stroke medical director;
(RR) Stroke team-a component of the hospital
				stroke program consisting of the core stroke team and the clinical stroke
				team;
(SS) Stroke unit-the
				functional division or facility of the hospital that provides care for stroke
				patients admitted to the stroke center;
(TT) Symptom onset-to-treatment time- the
				time from symptom onset to initiation of therapy to restore blood flow in an
				obstructed blood vessel;
(UU)
				Telemedicine-the use of medical information exchanged from one (1) site to
				another via electronic communications to improve patient's health status. A
				neurology specialist will assist the physician in the center in rendering a
				diagnosis. This may involve a patient "seeing" a specialist over a live, remote
				consult or the transmission of diagnostic images and/or video along with
				patient data to the specialist;
(VV)
				Thrombolytics-drugs, including recombinant tissue plasminogen activator, used
				to dissolve clots blocking flow in a blood vessel. These thrombolytic drugs are
				used in the treatment of acute ischemic stroke and acute myocardial infarction;
(WW) Transfer agreement-a document
				which sets forth the rights and responsibilities of two (2) hospitals regarding
				the inter-hospital transfer of patients; and
(XX) Virtual review-a type of review
				conducted through the use of secure virtual video and audio conferencing and
				secure file transfers in order to determine compliance with the rules of this
				chapter.