About stroke center issued by the hospital construction and management guidelines (trial)

The 2016-11-25 national health and population and family planning commission of the People's Republic of China

Countries who do medical letter [2016] no. 1235

Provinces, autonomous regions and municipalities directly under the central government health and family planning commission, the xinjiang production and construction corps health bureau:

To promote the establishment of a multidisciplinary joint stroke diagnosis and management mode, improve the level of diagnosis and treatment standardization of stroke, the national health and family planning commission stroke prevention engineering committee office to make the hospital stroke center construction and management guidelines (trial) ", and hereby printed and distributed to you (available from the national health and family planning commission official website "medical administration medical tube" download), for the family planning administrative department of public health and medical institutions to carry out to use as a reference for the construction and management of stroke. At the same time put forward the following requirements:

Around one, the family planning administrative department of public health management attaches great importance to the treatment of stroke, according to the local population, medical needs and layout plan of the establishment of medical institutions and medical resources, optimizing the resources distribution of stroke diagnosis and treatment, encourage relevant hospitals in stroke center construction, meet the demand of local stroke diagnosis and treatment.

Around two, to take measures to promote the construction of the stroke disease classification system. To strengthen hospital stroke center and the grassroots medical institutions, the connection between the rehabilitation of medical institutions, nursing homes, building perfect "the first option at the grass-roots level, two-way referral, upper and lower linkage, slow divide and conquer" the classification of diagnosis and treatment system, realize the grading treatment and rehabilitation in stages; Ensure timely treatment in patients with stroke, timely recovery.

Three, to increase the construction of hospital stroke center around the management work guidance and supervision; Guiding the perfect hospital stroke center management system standard and working process, the implementation of the relevant guidelines, technical specifications and clinical pathway; To strengthen the quality control and evaluation of stroke diagnosis and treatment work, guarantee medical quality and safety.

Four, the national health office of family planning stroke prevention engineering committee to guide the construction of expert group of stroke center around the hospital, evaluation and management of technical support and guidance.

General office of national health and family planning commission

On November 17, 2016

Hospital stroke center construction and management guidelines

(trial)

To further standardize and improve the level of diagnosis and treatment of stroke, guarantee medical quality and patient safety, making the hospital stroke center construction and management guidelines (try out) "(hereinafter referred to as the" guidelines "), the hospital may follow the guiding principles for the construction and management.

One, 2 class hospital stroke center

(a) basic conditions.

1. Secondary general hospital or related specialized subject hospital.

2. Set the neurology, neurosurgery, emergency medicine and other subjects related to diagnosis of stroke diagnosis and treatment.

3. The personnel engaged in the work of relevant clinical stroke qualified medical practitioners and other health technical qualifications.

4. Have satisfy the standard of severe stroke patients treated in intensive care unit.

5. Has the early rehabilitation of stroke rehabilitation medicine diagnosis and treatment of subjects.

(2) the organization and management.

1. Set up in hospital director, the competent business leaders to relevant functional departments, clinical, medical department and information department for members of the diagnosis and management of stroke, head of the leading group, administrative office, clear the responsibilities and work system.

2. Set up in neurology, neurosurgery doctor, nurse, as the main body, diagnosis and treatment related treatment of medical staff based on stroke group.

3. Establishing and perfecting the guarantee of stroke treatment related quality and safety management system, personnel at various levels and of responsibility.

4. According to the guidelines on disease diagnosis and treatment of stroke, technical specifications and clinical pathway for all types of stroke disease treatment specification, establish the green channel, to establish and implement the appraisal system on a regular basis and working process of continuous improvement measures, strengthen the continuing education and scientific research work.

5. Shall be the responsibility of the personnel, strengthen the follow-up of stroke patients, health education, strengthen the related clinical information of registration, statistics and analysis.

(3) the construction requirements.

1. The hospital layout is reasonable, open up stroke propaganda column and first-aid green passage, obvious prompt identification, equipped with the equipment and facilities meet the demand of treatment in patients with stroke.

2. Emergency treatment should be established including emergency physicians, neurologists, and interventional, inspection and imaging practitioner of stroke first aid team, 24 hours / 7 days on-the-job. Conditional unit shall establish cerebrovascular disease ZhuanBing emergency room.

3. Stroke treatment group by the qualification of neurology and neurosurgery doctor in charge of doctor of vice director of (and above), group members by the related training of neurology, neurosurgery, intervention, image division, healing practitioner, and master the carotid artery colour to exceed, TCD, TCCD (TCCS), via thoracic echocardiography, and transesophageal echocardiography (tee) examination of ultrasound doctors, and through professional training of nursing team, etc.

4. Stroke treatment team professional rapid reaction, business skilled, able to provide diagnosis, assessment, treatment for stroke patients and transfer the superior stroke center, etc., for emergency time window to provide specification and fast diagnosis and treatment services.

5. Establish and grassroots medical institutions counterpart support and cooperation, the establishment and docking outside emergency system and to the superior hospital consultation, remote treatment and referral of patients with stroke mechanism and system.

6. To establish a standard stroke cases follow-up information registration, statistical analysis, system and database.

(4) work requirements.

1. The implementation of the acute phase of stroke normalization treatment, optimize the diagnosis and treatment process, improve the efficiency of medical treatment, for diagnosis of acute stroke patients, accepts evaluation, perfect the relevant examination and treatment in time.

2. According to the indication choice thrombolysis treatment.

3. Perform one, the secondary prevention of stroke in standardization.

4. To carry out the early rehabilitation of stroke.

5. Able to carry out basic stroke etiology and common risk factors related to check.

6. Ensure the electrocardiogram, chest X-ray examination was conducted for all-weather.

7. Ensure all-weather craniocerebral CT scan.

8. Use scale for stroke in patients with ischemic stroke.

9. To prevent pneumonia correlation of stroke in patients with stroke, deep vein thrombosis of the common complications such as the necessary measures.

10. Conventional liquid and nutritional status assessment in patients with stroke, can't normal food but gastrointestinal conditions allow patients to early nasogastric, and carry on effective monitoring.

11. The clinic doctors can actively advocate and promote the stroke prevention and control the five basic steps: specification intervention of high blood pressure, diabetes, and stroke risk factors such as dyslipidemia; Physical activity and regular exercise; A healthy diet, avoiding obesity; Quitting alcohol; To grasp the method of identify early warning stroke symptoms and response, regular physical examination.

12. Make the plan of community health education and prevention of stroke, health education work of the masses in this area. Organization in towns and townships and urban community health service centers of gp training work for stroke prevention.

Secondary and tertiary hospital stroke center

(a) basic conditions.

1. Level 3 general hospital or related specialized subject hospital.

2. Set the neurology, neurosurgery, emergency medicine, interventional medicine, rehabilitation medicine and other subjects related to diagnosis of stroke diagnosis and treatment.

3. Open the conform to the standards for ward cerebrovascular disease diagnosis and treatment.

4. Set the standard neurological intensive care unit or beds, opened more than 10 beds.

5. The opening of a stroke specialist outpatient service, can carry out the standard stroke screening, high-risk population intervention and follow-up.

6. Open stroke rehabilitation clinic or ward, or medical institutions to establish cooperative relations with relevant recovery.

7. Establish stroke health propaganda and education, professional and technical training and stroke center staff continuing medical education system.

8. Stroke center in accordance with the relevant provisions of the management of medical record writing, combined with the specialized subject characteristic, to carry out the informatization construction of medical records; Establish the employee to stroke diagnosis and data statistics, analysis, and follow-up data information system, to regulate stroke diagnosis and treatment, strengthening clinical quality control and improve the medical quality and efficiency.

(2) the organization and management.

1. Set up in hospital director, the competent business leaders to relevant functional departments, clinical, medical department and information department for members of the diagnosis and management of stroke, head of the leading group, administrative office, clear the responsibilities and work system.

2. Set up step in neurology, neurosurgery, medicine, emergency medicine doctor, nurse, as the main body, diagnosis and treatment related treatment of medical staff based on stroke group. To set up the cerebrovascular disease emergency window, ensure smooth stroke center green channel.

3. According to the stroke related guidelines, technical specifications, make all kinds of disease of stroke treatment plans and the work process.

4. To establish a hospital registration and registration database, stroke set up someone who's in charge of case management, follow-up of stroke management related system.

5. Set the specialist is responsible for the stroke health propaganda and education, continuing education, and scientific research team.

(3) the construction requirements.

1. Set the cerebrovascular disease emergency green channel, establish the system of emergency duty (24 hours / 7 days). Cerebrovascular disease emergency duty should by professional training after stroke, head of the attending physician and above title of neurology and neurosurgery doctor.

2. Configuration with a qualified professional and technical personnel.

3. The multidisciplinary collaboration with stroke unit group, health education, psychological support, functional exercise and comprehensive physical therapy, etc.

4. To establish a "green channel" acute cerebral apoplexy patients diagnosis and treatment, integration of the emergency department, imaging, clinical laboratory, neurology, neurosurgery, etc., of the acute phase of stroke thrombolysis, endovascular treatment and surgery professional team; Associated with the region's emergency center and medical institutions to keep close contact, for referral to the center of the cerebrovascular disease emergency patients receive timely and effective treatment.

5. Can carry out carotid intima stripped, carotid angioplasty and stent implantation, removal of intracranial hematoma, and bone flap decompression, ventricle drainage, aneurysm clip, aneurysm, arteriovenous malformation surgery and endovascular treatment endovascular treatment, and so on.

6. Developing stroke rehabilitation conditions and technical ability, including: physical therapy, homework therapy, language therapy, cognitive and psychological therapy and other technology projects and the treatment equipment. Physicians for nutritional disorders management.

7. Establish a multidisciplinary joint operation system, consultation system and two-way referral system; Can provide the best treatment for the patient.

8. According to the stroke related disease diagnosis and treatment guidelines, technical specifications and clinical path, making the center stroke diagnosis and treatment process, and regularly review and revision.

(4) service requirements.

1. The standard diagnosis and treatment of stroke, increase in line with the indication of intravenous thrombolysis of acute ischemic cerebrovascular disease rate, reduce the patients with symptomatic and asymptomatic carotid stenosis surgery complications.

2. Early rehabilitation medicine, the basic function of patients with evaluation in time, early rehabilitation.

3. 24 hours to provide services, medical imaging diagnosis for stroke patients CT or MRI is preferred; CT and MRI perfusion imaging are available, such as vascular imaging examination.

4. The ability of whole cerebral angiogram (24 hours / 7 days) and blood vessel function evaluation.

5. Make a neurosurgery, specialized technical means such as vascular surgery and interventional therapy treatment or prevention of various types of stroke: acute ischemic and hemorrhagic stroke, spontaneous subarachnoid hemorrhage, intracranial vascular malformation, aneurysm, etc.

6. To all levels of two-way referral hospital patients and provide remote consultation, implementing information data network for stroke.

Appendix: stroke center hospital diagnosis and treatment process and quality control index

The appendix

Center hospital stroke index of diagnosis and treatment process and quality control

A process, main diagnosis and treatment

1. Accepts medical services

1.1 history collection, physical examination and neural function defect score (NIHSS) scores, vital signs, evaluation;

1.2 head imaging examination, blood biochemical and other auxiliary examination;

1.3 the corresponding application within the time window r - tPA or urokinase; People told; Dynamic, intravenous thrombolysis, mechanical bolt, intervention and surgical operation treatment.

2. After admission diagnosis and treatment

2.1 antiplatelet therapy;

2.2 prevention of deep vein thrombosis (DVT);

2.3 anticoagulant therapy in patients with atrial fibrillation;

2.4 early rehabilitation assessment and treatment;

2.5 early nutrition support therapy;

2.6 early swallowing function evaluation;

2.7 health mission (quit smoking, etc.).

2.8 evaluation and management of blood pressure;

2.9 evaluation and management of blood sugar;

2.10 evaluation and management of blood fat;

2.11 blood vessel function evaluation.

3. Before discharge diagnosis and treatment

3.1 in discharge antithrombotic therapy;

3.2 when the discharge stroke complications in patients with corresponding drugs;

3.3 dietary balance principle and individualized rehabilitation guidance;

3.4 risk factors of stroke control, stroke attack warning, medication compliance, such as mission;

3.5 discharge function assessment, and quality of life assessment.

4. Follow-up after discharge

Second, the main quality indicators

1. Arrived in the emergency department to accept the proportion of NIHSS score in patients with stroke.

2. Thrombolysis in patients with ischemic stroke in patients with venous thrombolysis time window.

3. In arriving at a hospital within 60 minutes, in patients with acute ischemic stroke patients received intravenous thrombolysis.

4. To arrive within 6 h of the hospital in patients with acute ischemic stroke, arrive from the emergency department to start to do multimodal cranial CT/MRI/CTA or MRA. The proportion of complete skull CT < 25 minutes;

5. In patients with acute ischemic stroke, endovascular treatment from the hospital to start time.

6. In patients with ischemic stroke in the venous thrombolysis treatment occurred within 36 h the proportion of patients with symptomatic intracranial bleeding.

7. In patients with acute ischemic stroke, in endovascular treatment for 36 h occurred obviously the proportion of patients with intracranial hemorrhage (ich).

8. To receive intravenous thrombolysis or endovascular treatment of acute ischemic stroke patients have a 90 day mRS record the percentage of patients after treatment.

9. Diagnostic whole cerebral angiography revealed with 24 hours after stroke incidence and mortality.

10. CEA or CAS treated patients with stroke incidence and mortality within 30 days.

11. Patients with SAH, for example, AVM on admission rate of illness severity evaluation.

12.48 hours aneurysm rupture SAH patients from visits to the aneurysm clip or average time of interventional treatment.

13. AVM in stroke patients in 30 days adept in proportion to the surgical or endovascular treatment.

14. Stroke patients to the proportion of bone disc decompression, removal of hematoma and mortality.

15. The proportion of patients with intraventricular external drainage and stroke mortality.

16. In intracerebral haemorrhage associated with warfarin therapy rate; Patients with elevated INR (INR > 1.4) from the hospital to give blood coagulation INR standard of the average time after treatment.

17. Each type of stroke, intracranial artery stenosis, SAH or TIA patients into the group of related clinical trials.

English comments:

TCD Transcranial Doppler Transcranial Doppler (TCD). One dimensional doppler flow imaging (cdfi), used in the detection of intracranial arterial blood flow mechanics.

TCCD Transcranial Color Coded Doppler/TCCS Transcranial Color Coded Sonography Transcranial Color Doppler flow imaging (cdfi). Two dimensional doppler ultrasound blood flow imaging, detect intracranial artery blood flow imaging and blood flow dynamics. TCCD and TCCS of different abbreviations of expressing the same check technology.

CT Computed Tomography CT scan.

The CTA Computed Tomography Angiography CT Angiography.

MRI Magnetic Resonance Imaging Magnetic Resonance Imaging (fmri).

MRA Magnetic Resonance Agiography Magnetic Resonance angiography.

MRS Magnetic Resonance Spectroscopy Resonance Spectroscopy analysis.

NIHSS National Institute of Health Stroke Scale of the us National institutes of Health Stroke Scale (used in patients with cerebral apoplexy "neural function defect score/Stroke Scale").

R - tPA Recombinant Tissue Plasminogen Activator Recombinant Tissue fibrinolytic enzyme Activator, for acute stroke in patients with venous thrombolysis treatment.

The CEA Carotid Endarterectomy, Carotid Endarterectomy. For patients with carotid stenosis reascularization surgical treatment.

CAS Carotid Artery Stent Carotid Artery Stent. For patients with carotid stenosis reascularization surgical minimally invasive treatment (intervention).

SAH Subarachnoid Hemorrhage bead retinal Hemorrhage. As a result of aneurysm and arteriovenous malformation in subarachnoid hemorrhage.

ICH Intracranial Hematoma Intracranial Hematoma.

AVM Arteriovenous Malformation cerebral Arteriovenous Malformation.

INR International standard thewire International standard Ratio. Coagulation four inspection of a reference standard.

TIA Transient ischemic attack Transient ischemic attack. Cerebral ischemia signs or symptoms disappear within 24 hours.