Definition and criteria for Stroke centers (Referral hospitals)
Referral hospitals: hospitals with infrastructure, human resources and training to adequate implement acute stroke therapy and care. This hospitals should be equipped and prepared to offer at least emergency treatment, computed tomography and neurologist 24h per day, neurosurgeon available less than 2h after request (evaluation at the origin hospital or referral hospital), Intensive Care Unit and Blood Bank as needed. We encourage these hospitals to have specific structure to treat acute stroke (stroke unit: 3 beds per 500.000 habitants), vascular diseases (vascular unit: 5 beds per 500.000 habitants) and intergrated interdisciplinary units for latter treatment and follow up (mixed stroke unit: 20 beds per 700.000 habitants). These hospitals should organize a full line of care involving all levels of care.
These hospitals should organize a full line of care involving all levels of care, demonstrate their integration and coordination with the regional network and local health care. They also should assist in the organization and continued education of all team involved with patient care, at least every 6 months, concerning stroke acute treatment, etiologic research and prevention: hospital staff, pre-hospital and and primary health units. In the absence of referral hospitals with a neurologist available 24 hours a day it is possible to organize an structured referral hospital for acute stroke treatment in which the neurologist indicate the need for thrombolysis using telemedicine.
We classified the referral hospitals in three levels:
Level C hospitals: hospital with the basic framework for the care of acute stroke, with organized and trained medical and nursing staff, but no neurologist available 24hours a day. In these hospitals the emergency physician shall conduct the thrombolysis via telemedicine. The guidance should be performed by a neurologist experienced in stroke care at level A hospital responsible for the level C hospital.
Level B hospitals: hospital with the basic structure for the stroke care and vascular neurologist available on demand 24 hours a day.
Level A hospitals: should have the same characteristics of the level B hospitals with addition of availability of endovascular treatment, MRI, neuroradiology, stroke unit and coaching capabilities of other centers via telemedicine. It has auxiliary role of a technical nature, assisting in the training of other centers.
Auxiliary hospitals: hospitals with a less complex structure but also treating stroke patients. Patients that cannot receive thrombolytic therapy will be transfered to auxiliary hospitals that should be able to offer acute care, etiologic investigation, prevention and rehabilitation. They also will be encouraged to structure mixed stroke units.