When managing stroke, time is brain. Every minute that stroke therapy is delayed can make a major difference in outcomes for patients. Appropriate treatment of stroke requires a well-organized, protocol-driven, evidence-based approach to meet treatment goals. Goals include seeing patients with stroke symptoms within 15 minutes, performing a CAT scan and having it read within 25 minutes, and treating patients with tPA within an hour of their arrival. The challenge for physicians is that all of these goals must be accomplished within a limited amount of time.

Primary Stroke Center Certification

In an effort to improve stroke outcomes and eliminate disparities in access to acute stroke centers, the Joint Commission developed a primary stroke center certification program in collaboration with the American Stroke Association (ASA). The program encourages hospitals and medical centers to apply for a Certificate of Distinction for Primary Stroke Centers in order to be recognized as a center that makes exceptional efforts to improve performance measures in the treatment of stroke. Achievement of certification signifies that the services provided have the critical elements to achieve long-term success in improving outcomes. In order to receive certification, centers must have the appropriate infrastructure in place—including personnel and protocols—to deal with acute stroke and collect different data points so that performance can be tracked. Centers must also offer public education about stroke and medical education for members on the stroke service team.

“Every minute that stroke therapy is delayed
can make a major difference in outcome.”

The Joint Commission monitors certified centers longitudinally, using numerous performance indicators, to validate that the center is meeting certification parameters. Previous studies have shown that performance measures have been better met in centers that were certified when compared with those that were not. In addition to Joint Commission certification, the ASA and American Heart Association offer Get With The Guidelines (GWTG)-Stroke, a hospital-based quality improvement program that provides resources to ensure that stroke patients are treated and discharged appropriately. Temporal trends have documented a tremendous improvement in quality performance measures among centers using GWTG-Stroke. The longer the program is used, the better performance measures were met.

Public Awareness of Stroke

The ASA recently surveyed 1,000 Americans to assess the impact of recent marketing and educational initiatives to improve stroke awareness and knowledge. Findings of the survey demonstrated that patient awareness was suboptimal. While 72% reported that it was “very” or “somewhat” important that they know where stroke-certified hospitals are located in their area, 58% stated they didn’t know if hospitals in their community were stroke certified. The survey also showed that public awareness of stroke-certified hospitals varied by geographic location. According to the data, 41% of people polled in the Northeast were aware of hospitals in their area that specialized in stroke care. Conversely, rates of this awareness were as low as 26% in the West.

Continued Efforts Needed

Based on the survey results, it appears that continued reinforcement efforts with public education are needed to increase awareness of warning signs and symptoms of stroke. Equally important, the data suggest that more awareness is needed among patients about the importance of where stroke specialty hospitals are located so that they can receive care at these institutions. Physicians can play a critical role in disseminating education to patients about stroke specialty centers, especially to those at increased risk of stroke. With more effort, the hope is that the physician community can lead the charge to improve outcomes in stroke and reduce its burden in the future.


Adams HP Jr, del Zoppo G, Alberts MJ, et al. American Heart Association; American Stroke Association Stroke Council; Clinical Cardiology Council; Cardiovascular Radiology and Intervention Council; Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655-1711.

Christian AH, Rosamond W, White AR, et al. Nine-year trends and racial and ethnic disparities in women’s awareness of heart disease and stroke: An American Heart Association national study. J Women’s Health. 2007;16:68-81.

DuBard CA, Garrett J, Gizlice Z. Effect of language on heart attack and stroke awareness among U.S. Hispanics. Am J Prev Med. 2006;30:189-196.

Fonarow GC, Reeves MJ, Smith EE, et al; GWTG-Stroke Steering Committee and Investigators. Characteristics, performance measures, and in-hospital outcomes of the first one million stroke and transient ischemic attack admissions in get with the guidelines-stroke. Circ Cardiovasc Qual Outcomes. 2010;3:291-302.

Gropen TI, Gagliano PJ, Blake CA, et al. Quality improvement in acute stroke: the New York State Stroke Center Designation Project. Neurology. 2006;67:88-93.

Heart Disease and Stroke Statistics–2006 Update. A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Dallas, Texas: American Heart Association; 2006. Accessed January 2006 from: http://www.americanheart.org.