Essential Components of a Stroke Center
A comprehensive stroke center must have a dedicated stroke unit with specialized staff, 24/7 advanced imaging capabilities, interventional procedures, and established protocols for acute stroke management to optimize patient outcomes and reduce mortality.
Core Physical and Staffing Requirements
Dedicated Stroke Unit
- A geographically defined area/ward specifically for stroke patients 1
- Minimum admission capacity of 200 stroke/TIA patients per year 1
- Adequate nurse staffing: 1.5 nurses per monitored bed (24-hour duty) 1
- Step-down rehabilitation capabilities or formal agreements with rehabilitation facilities 1
Specialized Multidisciplinary Team
- Stroke-trained physicians with one dedicated to the stroke unit 1
- 24/7 on-call stroke physician who can be on-site within 30 minutes 1
- Multidisciplinary team including:
- Physiotherapists (full-time)
- Occupational therapists
- Speech and swallowing therapists
- Social workers
- Clinical neuropsychologists (where available) 1
- Regular (weekly) multidisciplinary team meetings 1
Diagnostic and Treatment Capabilities
Imaging Services (24/7)
- CT scanner (minimum 64-slice) 1
- MRI with diffusion-weighted imaging, perfusion-weighted imaging, and MR angiography 1
- CT angiography and perfusion CT 1, 2
- Priority access for stroke patients 3
Interventional Capabilities
- Intravenous thrombolysis protocols available 24/7 1, 3
- Intra-arterial interventions (thrombolysis and mechanical thrombectomy) available 24/7 1
- Door-to-needle time target of <60 minutes 1
Additional Medical Services
- 24/7 access to neurosurgical expertise (on-site or within 2 hours via telemedicine) 1
- Vascular surgical services (consultation within 72 hours) 1
- Cardiology expertise with 24/7 consultation and transesophageal echocardiography 1
- ICU availability within the same hospital 1
Protocols and Quality Management
Written Protocols for:
- Acute stroke intervention 1
- Standard stroke management (prehospital through post-discharge) 1
- Early secondary stroke prevention 1
- Patient monitoring (vital signs and neurological status) 1
Quality Indicators and Benchmarking
- Local stroke registry for outcomes tracking 1
- Monitoring of key quality indicators:
- Door-to-needle time <60 minutes for thrombolysis
- Percentage of patients treated on the stroke unit
- Brain imaging rates
- Appropriate antithrombotic therapy at discharge
- Swallowing disorder screening 1
Administrative Support
- Institutional commitment and support 1
- Designated stroke center director with cerebrovascular expertise 1
- Participation in stroke system of care 1
- Educational programs for both public and professionals 1
Referral Network Functions
- Serving as a referral center (hub) for peripheral hospitals 1
- Telemedicine capabilities for consultations with other facilities 1, 4
- Written transfer protocols for patients requiring higher levels of care 1
- Participation in clinical stroke research 1
Common Pitfalls to Avoid
- Inadequate nurse staffing leading to poorer outcomes
- Lack of written protocols for acute management and transitions of care
- Insufficient monitoring of quality indicators
- Delays in imaging or treatment decision-making
- Poor coordination between multidisciplinary team members
- Inadequate arrangements for rehabilitation continuity
The European Stroke Organisation emphasizes that a stroke center is not a stand-alone unit but must be integrated into the hospital infrastructure with clear pathways for the entire continuum of stroke care, from prehospital management through rehabilitation 1. While smaller hospitals may function as stroke-ready hospitals or primary stroke centers with more limited capabilities, comprehensive stroke centers require all the elements described above to effectively reduce mortality and improve outcomes for stroke patients 4.