Get With The Guidelines-Stroke
What is Get With The Guidelines-Stroke?
Get With The Guidelines-Stroke is an in-hospital program designed to improve acute stroke treatment and prevent future strokes and cardiovascular events. Get With The Guidelines-Strokefocuses on quick diagnosis and treatment of stroke patients through Primary Stroke Centers. It also involves care team protocols once patients are admitted to ensure that they are treated and discharged appropriately.
How do I implement Get With The Guidelines-Stroke?
Implementing Get With The Guidelines-Stroke includes several steps. The first step is for participating hospitals to develop a Primary Stroke Center within their facility. The next step is to assess current treatment rates by collecting data on 30 patients and determining a baseline. Learn more
What tool should I use to collect patient data?
The Patient Management ToolTM* (PMT) is an online, interactive assessment and reporting system that helps implement Get With The Guidelines-Stroke. It provides patient-specific guideline information and enables each institution to track its adherence to the guidelines individually as well as against national benchmarks over time. The PMT enables the clinician to collect and collate relevant information to make better guideline-based decisions. Other key features of the tool include:
- Generates automated patient education materials.
- Faxes letters to referring primary care physicians.
- With permission, transmits data to third parties including CMS and JCAHO for ORYX® core measures.
*The PMT is powered by Outcome, Cambridge, Mass.
What is a Primary Stroke Center?
The Brain Attack Coalition (BAC), of which American Stroke Association is a member, classifies a Primary Stroke Center as a hospital-based center that stabilizes and provides emergent care to acute stroke patients, transfers patients to a Comprehensive Stroke Center or admits patients and provides further care depending on the patient’s needs and the center’s capabilities.
Does my Primary Stroke Center need to be certified to participate in Get With The Guidelines-Stroke?
No. However, the Primary Stroke Center Certification Program uses the Recommendations for Primary Stroke Centers published by the Brain Attack Coalition and ASA guidelines for stroke. The program evaluates stroke care provided by hospitals. The American Stroke Association, in collaboration with a large multi-specialty advisory group and the Brain Attack Coalition, worked closely with JCAHO to establish the criteria for certification.
What resources are available to help implement the program?
The AHA and ASA have compiled a multitude of helpful resources that participating hospitals can access free to help implement the program. A comprehensive list of the tools and resources for each step of implementation is available on the Toolbox page.
What types of results have others seen from this program?
Many Get With The Guidelines-Stroke participating hospitals have been nationally recognized for their successes within the program. Learn more about recognition.
These hospitals have documented improvements in several key measures and retain 85 percent adherence to these performance measures over time, thus improving patient outcomes.
How can I learn more about Get With The Guidelines-Stroke?
Take the online "Getting Started" course to learn about the steps to implement Get With The Guidelines-Stroke in your hospital. Contact your local Quality Improvement Representative.
Acute Stroke Treatment Program (ASTP)
What is the purpose of ASTP?
ASTP complements the Recommendations for the Establishment of Primary Stroke Centers: A Consensus Statement from the Brain Attack Coalition (published in the June 21, 2000 edition of the Journal of the American Medical Association). While the Brain Attack Coalition (BAC), of which the American Stroke Association is a member, created guidelines for hospitals to follow, ASTP takes the next step by providing detailed information to hospitals on how to implement those guidelines. The BAC guidelines and Acute Stroke Treatment Program work together to support the overall goal of increasing the number of early stroke diagnoses in hospitals. Learn more
What is the difference between the Acute Stroke Treatment Program and Get With The Guidelines-Stroke?
The Acute Stroke Treatment Program (ASTP) provides resources to hospitals developing a Primary Stroke Center, and is based on Recommendations from the Brain Attack Coalition. Get With The Guidelines-Stroke is a program focused on improving acute stroke treatment and preventing future strokes and cardiovascular events. Establishing a Primary Stroke Center is the first step in implementing Get With The Guidelines-Stroke. Both programs can help hospitals become ready for certification by JCAHO.
What is the average cost (or estimated range) of establishing a Primary Stroke Center?
The average cost for a facility is $20,000-$30,000 per year. These funds go toward public education, additional staff, quality improvement program management and material development and printing. The JAMA article breaks out the costs as follows:
Acute Stroke Team -- $5,000-$20,000
Stroke Unit* -- $0-$120,000
Radiology Technician -- $0-$50,000
Physician Leader -- $0-$20,000
Staff Education Support -- $1,000-$5,000
Public Education -- $2,000-$10,000
Marketing -- $0-$20,000
Range of $8,000-$245,000
*Cost of more staff for stroke team. Does not include cost for any new infrastructure required.
- Improved efficiency of patient care
- Reduced morbidity and mortality among patients
- Enhanced image of the medical system as a whole
- Reduced costs to healthcare system
- Increased use of acute stroke therapies
- Fewer peristroke complications
- Improved long-term outcomes
- Increased patient satisfaction
- Potential marketing tool for the hospital
The average lifetime cost of a stroke is $100,000 for each survivor. If just one more stroke could be treated emergently each year by the stroke center concept, it will more than pay for itself.
Explain the gap between BAC's Primary Stroke Center Recommendations for rehabilitation and the information found in ASTP.
We recognize that rehabilitation is an important part of stroke care. Early rehabilitation is a part of all stroke care maps and protocols that can be implemented at the discretion of the hospital. The BAC did not make this a part of the recommendations because the majority of hospitals do not have stroke rehabilitation facilities on site. Thus, to require rehabilitation protocols, given this infrastructure, would make it more difficult for hospitals to comply with the recommendations.
How do we address the perceived concerns for increased patient visits to the emergency department as we heavily promote stroke awareness?
The public is not very knowledgeable of the warning signs of a stroke; therefore, while we are making a concerted effort to make progress in this area, it is realistic to expect increased traffic to emergency rooms. It is important to break the inertia of stroke patients "waiting it out" at home. It is better if people seek emergency treatment regardless of the outcome.
Why is the "trauma center" analogy used if the BAC or any other organization is not actively and aggressively pursuing stroke center designation?
The trauma center analogy is used because a lot of similarities exist between treating trauma and stroke:
- They are both serious conditions.
- They are both common conditions.
- Time is of the essence.
- Medical expertise must meet with the patient to improve outcomes.
The trauma center concept has been successful and is a good model for us to follow.
When will the Comprehensive Stroke Center Recommendations be available? What are the key differences between the Primary and Comprehensive Stroke Center recommendations?
Recommendations for the Establishment of Comprehensive Stroke Centers: A Consensus Statement from the Brain Attack Coalition was published in the July 2005 edition of Stroke. Read BAC Recommendations.
The Comprehensive Stroke Center Recommendations, created by the Brain Attack Coalition, enhance and expand the Primary Stroke Center Recommendations and have more stringent requirements. For instance, the Comprehensive Stroke Center Recommendations require:
- A fully functioning stroke unit
- Advanced neuroradiological imaging techniques
- Round-the-clock neurosurgery
- Increase in the continuing medical education requirements
- Increase in the clinical/scientific research requirements
These recommendations also include more information about rehabilitation protocols.
Didn't find the answer to your questions? Contact your local Quality Improvement Representative.