Stroke Systems of Care and Stroke Centers

Stroke systems of care (SSoC) define a care paradigm that extends from education about basic stroke risk factors and primary prevention through EMS responses, acute care interventions, rehabilitation, and secondary prevention. Each component in an SSoC requires dedicated personnel, protocols, infrastructure, and resources to be fully effective and successful. The network of stroke centers in the United States forms the backbone of an SSoC in many areas. The different levels of stroke centers have well-defined components and protocols to assist in the initial diagnosis and treatment of patients with an acute stroke. Well-established care metrics are key components of most types of stroke centers. A contemporary SSoC includes rapid local telecommunications capabilities with audio-video connectivity for field triage of patients. The components of a “core” SSoC focus on the initial recognition of the patient, EMS response, triage, and transportation, as well as acute care intervention such as IV lytics, mechanical thrombectomy, and/or urgent surgery, and admission to a facility with a Stroke Unit or neurocritical care unit. An “expanded” SSoC includes primary prevention programs, post-stroke rehabilitation, and secondary prevention measures. Telemedicine links across a region can be an element of a core or expanded SSoC, depending on the local needs. Mobile Stroke Units are a new element for an expanded SSoC, as are palliative care services. Both types of an SSoC would likely require support and resources from local and state agencies as well as private or corporate funding. The vision is that a robust SSoC will improve patient care and outcomes for all patients within a region. By providing coordinated care, efficiencies will be maximized and costs will be reduced.