Good Samaritan among first to get stroke center designation
Troy May

Good Samaritan Hospital in San Jose is one of the first five hospitals in the nation to be certified by an outside organization as a stroke center. A San Jose City council member, who was treated at Good Samaritan for a stroke, played an instrumental role in helping the hospital get the certification.

The Joint Commission on Accreditation of Healthcare Organizations, which accredits hospitals nationwide, started to offer certification for stroke care in December.

Good Samaritan quickly applied for the certification to get an outside endorsement on its stroke program, which has been in place for seven years, says Linda Catalli, coordinator of the stroke center at the hospital. The certification is expected to draw more patients to the hospital.

Stanford University Hospital and Clinics plans to submit its application for certification by this summer.
Certification identifies a hospital that has met a long list of standards such as having a nurse, physicians and technicians trained in stroke care and having the technology and commitment to providing care for stroke patients as outlined by national experts.

Hospitals which are certified will also be part of a national study to evaluate best practices for stroke care.
A stroke is an attack on the brain that can have crippling or fatal results if not treated within three hours. Good Samaritan can assemble its medical team within minutes of getting a stroke victim.

On average, there are 700,000 strokes a year in the United States, and 163,538 people were killed from strokes in 2001, according to the American Stroke Association. It's the third leading cause of death, and the leading cause of disability.
Pat Dando, vice mayor of San Jose, was a stroke victim two years ago. She was treated at Good Samaritan Hospital with a healthy outcome. That experience led her to an advocacy role in stroke treatment.

She is on the board of the local Stroke Awareness Foundation, which plans to launch a public relations campaign about the stroke certification once Stanford University has been certified, Ms. Dando says.

Vice Mayor Dando had been working for more than a year to improve awareness and stroke care in the San Jose area. In the process, she discovered that the Joint Commission was starting a certification program for stroke. She quickly convinced Good Samaritan and Stanford to get the certification.

Good Samaritan met more than 30 Joint Commission standards to get its certification, says Maureen Potter, executive director of disease specific certification at the commission.

The other certified hospitals include University of California, Irvine; Sacred Heart Medical Center in Spokane, Wash.; Rochester General Hospital in Rochester, N.Y.; and St. Joseph's/Candler Health System in Savannah, Ga.
The Joint Commission expects to review about 80 applications in six months from hospitals nationwide to be certified as stroke centers.

"There are about 350 hospitals that want to be certified," says Ms. Potter.

The certification at Good Samaritan could have enough influence to change the county's emergency medical services policy on where patients are taken for stroke treatment, says Dr. David Ghilarducci, emergency medical services medical director for Santa Clara County.

There is still debate on weather an ambulance should take a stroke victim directly to a stroke center instead of the nearest hospital, says Dr. Ghilarducci. One key to good treatment for stroke is by identifying the type of stroke very quickly with a CAT scan, which can often be done at any hospital.

There are two types of stroke -- ischemic and hemorraghic. An ischemic stroke is a blood clot in a brain vessel that has cut off blood supply to brain tissue which can cause the tissue to die. Ischemic strokes can be treated with blood-thinning drugs, says Dr. Ghilarducci.

A more serious stroke is hemorraghic, which means a blood vessel has burst in the brain. Once again, brain tissue is at risk of being destroyed. This type of stroke typically requires specialized surgery that most hospitals can't do, says Dr. Ghilarducci.

If surgery is needed, then the patient must be quickly transported to a hospital that can perform neurosurgery.
There hasn't been enough research to support a call for an ambulance bypassing the nearest hospital for a stroke center across town. That's expected to change this year with the release of more data that will help emergency physicians to rewrite policy on the best route for a stroke victim, Dr. Ghilarducci says.

"It's not clear on how this certification will change policy for the EMS," says Dr. Ghilarducci. "But I suspect there is a benefit to the stroke center."