Primary stroke centers are special healthcare facilities that treat acute stroke patients and determine patients who require transfer to a higher level of care, such as comprehensive stroke centers. Primary stroke centers are certified by the Joint Commission if they meet standards for assessing, diagnosing, and treating stroke patients. These healthcare facilities provide resuscitation, stabilization, and evaluation of the stroke victim through a dedicated stroke-focused program and individualized care by qualified medical professionals trained in stroke care. The features of primary stroke centers entail access to neurological services within two hours of arrival, MRI and CT scan equipment, taking care of most stroke cases, and ensuring the transfer of complex patients. The healthcare centers have a median bed count of 263. The specialized services offered include intravenous tissue plasminogen activator (IV tPA), intra-arterial thrombectomy (IA therapy), discharge medications for atrial fibrillation and lipid-lowering, and deep vein thrombosis prophylaxis in appropriate patients. However, primary stroke centers do not offer minimally-invasive catheter procedures, and there is no requirement for a specialized intensive care unit for stroke patients.
There are nine major brain areas affected by stroke; thus, the effects of stroke vary depending on the affected area. These areas control the body’s sensory, motor, and cognitive functions. The physical effects of stroke include difficulty in holding things, limited ability to perform physical exercise, weakness on one side of the body, changes in sensation, and incontinence. These effects have a lasting impact on stroke victims as two-thirds of the employed cannot return to work. Stroke injuries can be mental as people find it hard to adjust to their previous lifestyle leading to anxiety and depression. Depression is common as people experience various emotions as a response to the situation and lack of communication. The psychosocial effects of strokes entail a high incidence of comorbid mental issues. Comorbidities pertinent to stroke patients include cognitive impairment, depression, anxiety, and insomnia. These psychosocial issues affect patients’ quality of life and lead to higher mortality rates (Perna, 2018). Cultural background is a critical barrier in providing care to stroke patients. The different perception of stroke in various cultures leads to patient needs differentiation as cultural bias affects the rehabilitation process and treatment options.
The effects of stroke on patients have been reduced based on new treatment strategies and medications developed over the years. However, many patients do not receive the recommended treatment early enough to alleviate these physical and psychological effects. The challenges include a low public awareness regarding stroke, its symptoms, and treatments leading to increased incidence of stroke. According to the Centers for Disease Control and Prevention (2021), stroke is the fourth leading cause of death and disability in the U.S, as approximately 137,000 people die due to stroke. These alarming figures are exacerbated because about 610,000 are first strokes, while the rest are second-time strokes within five years (Centers for Disease Control and Prevention, 2021). Stroke risk factors include high blood pressure, diabetes, heart disease, and previous stroke. Age is a defining factor as older adults aged 65 and above have the highest prevalence rate of strokes.
Another challenge is the extended stroke patient transport times, especially in rural areas leading to delayed assessment of symptoms. The delay between the start of stroke symptoms and arrival at the hospital significantly impacts the patient’s life. Every 10-minute delay between the onset and arrival at the primary stroke center leads to losing eight weeks of healthy life (Baatiema et al., 2017). Time is critical after a stroke as it affects the effectiveness of care and outcomes. This is because a stroke deprives brain tissue of oxygen, leading to its death from the fourth minute after the stroke onset. A fast approach is critical as the brain tissue is permanently lost when it dies.
The low utilization of intravenously administered tissue plasmogen activator (tPA), a clot-busting medication that is the only FDA-approved medical treatment for acute ischemic stroke, is a key concern affecting the population (Mathur et al., 2019). Intravenous tPA is restricted due to a lack of infrastructure that allows the medicine to be administered within the FDA-approved three-hour effectiveness window. Limited resources can affect first responders’ ability to swiftly get the stroke victim to a tPA-administering facility, which compounds this challenge. In some locations, stroke patients’ rehabilitation attempts are hampered by a lack of resources, especially neurological specialists (Mathur et al., 2019). This limitation leads to treatment delays that severely affect stroke recovery. Neurological specialists are critical in performing surgical procedures that enhance the chances of survival and reduce the risk of recurrent stroke events. Immediate access to a neurologist is key in preventing the clot from splitting and physically removing it in severe cases.
The most viable method of advocacy regarding the primary stroke centers is through policy changes to improve stroke care and funding for states to implement protocols that enhance cardiovascular health. The most viable policies that a healthcare manager should advocate include regulations and administrative rules. Health policy is frequently driven by state health department partners, lawmakers, and specialist recommendations, while state health departments often play a prominent role in executing these policies. Health care professionals, primary stroke centers, and emergency medical services must take steps for successful implementation.
A healthcare manager can influence policy change by collecting and presenting information regarding primary stroke centers’ efficiency in rehabilitating victims. The information includes the stroke mortality rates for adults aged 18 and above, funding status, and determining the quality of stroke care in the healthcare setting. The healthcare manager should advocate for healthcare bypass policies that enhance stroke treatment and rehabilitation. The bypass policy should entail telehealth services for remote stroke diagnosis, funding for marginalized populations, and the development of authorization for timely administration of tPA.
There is a lack of a universal stroke treatment and rehabilitation program, thus leading to different policies distinct for each state. Regardless of the severity of the stroke, most state statutes direct paramedics to the nearest hospital with a stroke unit. Paramedics can only transport stroke patients to hospitals within their boundaries in certain states. Ohio, Arizona, Colorado, Rhode Island, Tennessee, and Virginia require paramedics to take patients with a severe stroke to a hospital, provided it’s possible to reach one within a specified time. According to Jarva et al. (2021), patients who reported to emergency rooms with strokes were misdiagnosed or received a delayed diagnosis. Stroke misdiagnosis can lead be fatal as it leads to wrong medication input aggravating the stroke injury.
Financial regulations affect the implementation of quality healthcare in primary stroke centers since hospitals must adhere to existing billing practices and laws. Adding a stroke care policy creates complexities and conflicts within the existing policy. Primary stroke centers’ assumption that neural specialists can easily rotate between stroke centers and hospitals, especially for telemedicine services, is unattainable due to the current credentialing (Jarva et al., 2021). The state’s billing practices affect clinical credentials at rural stroke centers by numerous offsite neurologists providing diagnosis and treatment via telemedicine. In addition, stroke centers are designated as PSCs and thus are not in a position to treat uninsured patients generated by emergency medical services policies.
Various modifications are needed in primary stroke centers to improve the quality and access of services for stroke patients from the start of symptoms through treatment and rehabilitation. First, there is a need to ensure the availability of resources as they are vital in establishing and supporting a functioning stroke care system. The resources include basic funding, trained specialists, information systems, and necessary equipment authorized in the policy recommendation (Adeoye et al., 2019). Regular support should be available for the personnel regarding processing expenses involved with stroke center accreditation and review. In addition, it is prudent to provide grants, incentives, and cost-sharing proposals for certification. Resources can come from public or private sources, foundations, or legislation, or they can come from agency discretionary funding.
Through evidence-based practice, primary stroke centers can reduce the high mortality rate caused by stroke. The focus on protocol and timeframes is a hallmark of evidence-based practice. Deep vein thrombosis and anti-coagulation medication are the usual treatments for stroke victims. Furthermore, the compression stocking is utilized as a prophylactic measure since it squeezes the limbs up and down, allowing blood to circulate continuously. The emphasis on timetables means that medical professionals must work quickly to get lab findings within a short time frame to assess the stroke’s severity. Various illnesses, such as hypoglycemia, might mimic stroke symptoms; thus, check your blood glucose to rule out other possibilities.
There is a need to improve communication among key stakeholders such as neurologists, emergency medical services staff, and stroke coordinators. These collaborating entities must be able to exchange information quickly and accurately and smoothly transfer patients for diagnosis, testing, and treatment. Emergency medical dispatch and emergency medical services need to know whether a specific stroke center can admit and treat patients in real-time and provide a detailed description of the patient’s symptoms to enhance survival outcomes. Transfer protocols and practices must be in place to foster timely care and improve patient outcomes.
Communication between stakeholders entails disseminating stroke treatment protocols among stroke centers and sharing contemporary information about therapy among clinicians. In addition, the communication initiative should consider convening frequent meetings of varied stakeholders to discuss best practices, concerns, and difficulties in stroke care. Telemedicine should be adopted as the defined strategy for providing access to marginalized patients due to the time-dependent nature of stroke care. There should be discretionary funding protocols for equipment and adjustment of physician practices to enable consulting from a distance if telemedicine is to attain its full potential in eliminating urban-rural gaps in acute stroke care. Conclusion
Stroke is a leading cause of death, a situation exacerbated by the time lapse between the onset of symptoms and treatment. Primary stroke centers are special healthcare facilities that treat acute stroke patients and determine patients who require transfer to a higher level of care. The challenges of this population include prolonged transport times, lack of public awareness regarding symptoms, low use of tPA, and limited access to medical resources. Policy recommendations can reduce the effect of these challenges by eliminating disparities in care and supporting stroke care systems.
Adeoye, O., Nyström, K. V., Yavagal, D. R., Luciano, J., Nogueira, R. G., Zorowitz, R. D., & Jauch, E. C. (2019). Recommendations for the establishment of stroke systems of care: a 2019 update: a policy statement from the American Stroke Association. 50(7), e187-e210.
Baatiema, L., Otim, M. E., Mnatzaganian, G., de-Graft Aikins, A., Coombes, J., & Somerset, S. (2017). Health professionals’ views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review. Implementation Science, 12(1).
Centers for Disease Control and Prevention. (2021). Stroke facts. CDC.org.
Jarva, E., Mikkonen, K., Tuomikoski, A., Kääriäinen, M., Meriläinen, M., Karsikas, E., Koivunen, K., Jounila‐Ilola, P., & Oikarinen, A. (2021). Healthcare professionals’ competence in stroke care pathways: A mixed‐methods systematic review. Journal of Clinical Nursing, Volume30, (Issue9/10).
Mathur, S., Walter, S., Grunwald, I. Q., Helwig, S. A., Lesmeister, M., & Fassbender, K. (2019). Improving prehospital stroke services in rural and underserved settings with mobile stroke units. Frontiers in neurology, 10, 159.
Perna, R. (2018). Psychosocial issues associated with stroke. Journal of Psychology & Clinical Psychiatry, Volume 9(Issue 5).