California
Acute Stroke Ready Hospitals.
22 CCR 100153.01
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22 CCR 100153.01
22 CCR 100153.01
ยง 100153.01. Acute Stroke Ready Hospitals.
(a)
Eligibility. A licensed general acute care hospital (GACH) meeting the requirements of this section may be designated by the local EMS agency (LEMSA) as an acute stroke ready hospital.
(b)
Requirements.
(1)
Capabilities.
(A)
Neuro-Imaging Services. Neuro-imaging services that include, at a minimum:
(i)
Computed tomography (CT) services;
(ii)
Twenty-four (24) hours a day, seven (7) days a week, 365 days per year availability for imaging to be performed and reviewed by a physician within forty-five (45) minutes of emergency department arrival. Neuro-imaging review must be performed by a physician with appropriate expertise such as a:
(I)
Board-certified radiologist;
(II)
Board-certified neurologist;
(III)
Neurosurgeon who is board-certified by the American Board of Neurological Surgery; or
(IV)
Residents who interpret such studies as part of their training in an Accreditation Council for Graduate Medical Education- (ACGME-) approved radiology, neurology, or neurosurgery training program.
(B)
Thrombolytic Services. Provision of intravenous thrombolytic treatment when clinically indicated.
(C)
Other Clinical Services. Other diagnostic services that include, at a minimum:
(i)
Laboratory, cardiac, and x-ray services;
(ii)
Twenty-four (24) hours a day, seven (7) days a week, 365 days per year availability for diagnostic services to be completed and reviewed by a physician within sixty (60) minutes of emergency department arrival.
(D)
Available Stroke Team. Twenty-four (24) hours a day, seven (7) days a week, 365 days per year availability of the GACH's stroke team, as described in paragraph (2)(B) of this section, to evaluate a patient identified as a potential acute stroke patient, either in person or via telehealth, within fifteen (15) minutes of emergency department arrival.
(E)
Rapid Transfer Ability. The ability to rapidly transfer stroke patients to a higher level of care stroke center when clinically appropriate. This capability shall include written transfer protocols or arrangements with one or more higher level of care stroke centers and prearranged agreements with EMS providers, in compliance with all LEMSA policies and procedures, as well as service provider contracts and designations.
(2)
Program Staffing.
(A)
Stroke Medical Director. A stroke medical director meeting the qualifications and responsible for the functions defined in Section 100150.10 of this subchapter.
(B)
Stroke Program Manager. A stroke program manager that performs the functions described in Section 100150.12 of this subchapter and who is either a registered nurse or an individual with a higher medical degree. The stroke program manager shall complete at least four (4) hours of continuing education in cerebrovascular disease per calendar year and may also serve as a member of the stroke team.
(C)
Stroke Team. A stroke team performing the functions described in Section 100150.14 of this subchapter and that, at a minimum, consists of a nurse and a physician with training and expertise in acute stroke care.
(3)
System Operations. Collaboration between the GACH and the LEMSA to define policies and procedures for an EMS system notification when stroke care services are unavailable. Acute stroke ready hospitals shall follow the LEMSA's diversion policies.
(4)
Policies. Written emergency department policies and procedures that shall include written protocols and standardized orders for the emergency care of stroke patients.
(5)
Continuing Education. Continuing education in stroke critical care shall be provided for:
(A)
Organized medical staff;
(B)
Staff nurses;
(C)
Staff allied health personnel;
(D)
EMS personnel; and
(E)
Other community physicians and health care personnel.
(6)
Data Collection, QI, and Evaluation. Acute stroke ready hospitals designated under this section are subject to the requirements of Article 5 of this subchapter. In addition, acute stroke ready hospitals shall have:
(7)
Additional Requirements. A LEMSA medical director may establish requirements for designation as an acute stroke ready hospital in addition to those required under this section.
(c)
Acute Stroke Ready Hospitals Designated Prior to Effective Date of Regulations. An acute stroke ready hospital designated by the LEMSA prior to the effective date of these regulations may continue to operate as an acute stroke ready hospital; however, any such acute stroke ready hospital shall meet the requirements of these regulations within twelve (12) months following a program review described in Article 5, Section 100154.03(a) of this subchapter.
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