Richard Jackson, MD
Adeoye O, Nyström KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, et al. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association. Stroke. 2019
Three years ago, I started a large community hospital’s stroke program, which recently received primary stroke center certification. The first piece was the inpatient side by necessity to be in compliance with Get With The Guidelines, which is based on the national Stroke Guidelines. The “Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update” by Adeoye et al. focuses on the pre- and post-hospital care of stroke patients.
After establishing compliant inpatient metrics, we have now started to focus on the follow-up in the clinic and have found that we have around 20% follow-up from discharge to clinic, problems making room for follow-up among scheduled general neurology patients, difficulty with coordination of care among rehab modalities, difficulty with standardization among providers, and difficulty with widespread education of the community .
I bet these are problems among many stroke systems of care, but not all. The systems update provides guidance as to where the focus should be and some of the information on how to do it. Education and awareness in the community and primary care offices are key to prevention and early treatment. Previous initiatives are cited and new cyber technology, such as social media, are mentioned as ways of the future. Specific initiations such as the Post-Acute Stroke Services model and the Global Stroke Services Action Plan lay out some specific algorithms with post-discharge problems to be assessed, which are helpful tools, as well as some cited references on primary prevention using antiplatelets, anti-hypertensives, and smoking cessation.