Updating Care for Stroke Patients in New Jersey Hospitals

Move to expand and improve treatment, raise awareness, and highlight steps that could save lives

Touring the Capital Health Mobile Stroke Unit outside the State House to learn how patients are treated
New Jersey hospitals that specialize in stroke care will be required to meet updated guidelines, undergo regular outside review, and subscribe to standardized protocols in diagnosing and treating the condition, under a plan backed by heart-health advocates.

Some 14 years after New Jersey created the nation’s first designated stroke centers, representatives of the American Heart Association joined stroke survivors, healthcare providers and a pair of Democratic lawmakers yesterday to raise awareness about the dangers of stroke — an interruption of blood-flow to the brain — to highlight the steps it takes to save lives and improve outcomes, and advocate for legislation designed to expand and improve the state’s system of stroke care. While all but three of the state’s 70 acute-care hospitals are already designated to care for stroke patients, advocates believe it is time to modernize the system.

The legislation — sponsored by Senate health committee chairman Joseph Vitale (D-Middlesex), and Assemblyman Dan Benson (D-Mercer), who joined the event — would create a new category of stroke-care facility for patients with the least complex cases. The two existing designations would continue to exist for more complex and the most complex cases. All three would need to create formal agreements to work together to coordinate patient care.

The bill would also ensure all three categories of designated stroke centers met national standards, which require greater access to specialists and technology for more complex cases. It would also require all hospitals to submit quarterly data that show they continue to meet certain metrics. And it would standardize diagnosis and treatment protocols for all emergency providers.

“As the third leading cause of death for New Jerseyans, we all have family and friends who have been affected by this terrible disease,” Benson said. “We need to ensure that stroke victims get the best care possible throughout the state and this bill will help achieve that.”

A leading cause of death in NJ

Nearly 800,000 Americans suffer a stroke each year and some 140,000 die as a result, including approximately 3,400 New Jersey residents, making it one of the state’s leading causes of death. As with many health issues, there is a racial disparity: black Americans are nearly twice as likely to suffer from a stroke as white Americans and it is more likely to be fatal for blacks.

As many as eight in 10 strokes can be prevented, according to the American Heart Association and American Stroke Association, largely by controlling blood pressure. Avoiding smoking, obesity, inactivity, and unhealthy food can all reduce the chance of stroke, the groups advised.

Stroke victims are more likely to be disabled than killed from an attack, these advocates said. The quicker someone can get treatment, the less damage they are likely to suffer from blood loss to the brain, which can cause problems with speech, memory, movement and more. More than 90 percent of patients who received a stent, or a surgical procedure to increase blood flow within two-and-a-half hours of suffering a stroke had little disability as a result, advocates noted in a fact sheet.

“Quick and appropriate treatment can be the difference between life and death for stroke patients,” said Corinne Orlando, director of government relations for the American Heart Association and American Stroke Association of New Jersey, which has been advocating for the bill. “When a loved one has a stroke, it is important that they receive the right treatment as quickly as possible,” she said.

Fast action

For that reason, advocates also showed off Capital Health’s Mobile Stroke Unit and demonstrated a “stroke simulation” as part of yesterday’s event, to underscore how important it is for people to recognize when someone is having a stroke and to take action on that person’s behalf. The stroke association created the acronym F.A.S.T. to help the public with the process. If an observer notices someone’s face drooping, F, along with arm weakness, A, and speech difficulty, S, they should know it is time, T, to call 911.

“When someone has a stroke, they need help immediately, but are not able to advocate for themselves in the moment. This legislation will save lives by ensuring that patients are transported to a facility that can provide the treatment they need without delay,” Vitale said.

New Jersey has historically been a leader in stroke care, the advocates noted, and it was the first state to designate two levels of stroke care facilities, in 2004: primary level facilities, which provided more basic care, and comprehensive centers with greater expertise. The primary facilities are designed to stabilize, care for or transfer stroke patients, while the state’s dozen comprehensive facilities have a greater availability of specialists, like neurosurgeons, equipment including MRI machines, and rehabilitation services, that enable them to handle more complex cases.

Many of these facilities, advocates said, submit to regular assessments from outside accreditation agencies. But, they said, care could be improved further if all facilities were required to meet uniform conditions established by national experts. Many new techniques and best practices have been identified since the standards for the existing designations were created, in 2004, they noted.

The Vitale/Benson bill, which passed the Senate when it was first introduced last year, would update the 2004 law by adding a third category of stroke facility, “acute stroke ready hospital,” to expand options for those with the least-complicated cases. Under this plan, patients experiencing a stroke could still be triaged at any designated hospital and, depending on the complexity of their case, be transferred to a secondary (or so-called called primary) facility if needed, or be sent directly for advanced care at a comprehensive stroke center.

Public database

The measure (S995/A3670), also sponsored by Assemblyman Thomas Giblin (D-Bergen), would require the Department of Health, which licenses hospitals, to adopt standards crafted by the American Heart Association or the Joint Commission — an independent nonprofit that accredits healthcare facilities — for certifying the new acute stroke-ready hospitals, as well as primary facilities and comprehensive stroke centers. Facilities that are already designated as primary or comprehensive would have a year to get re-certified under the new standards.

In addition, the legislation requires all stroke facilities to submit quarterly data to independent regulators and to the DOH, which would incorporate this information into a stroke database accessible to the public. It would also create a 13-member stroke advisory panel with government officials, clinicians, and other experts to help guide the state’s public policy on strokes.

The proposal also calls for the DOH Office of Emergency Medicine to adopt a standardized stroke triage and assessment tool and a protocol that can be used as a guide for local policies by emergency medicine providers statewide, including hospital emergency rooms and ambulance corps.

The bill awaits a hearing in both the Senate and the Assembly.