Ultimate stroke care

Augusta hospital named comprehensive stroke center
Dr. Jeffrey Switzer

Georgia Regents Medical Center is the first hospital in Georgia—and one of only 20 hospitals in the country—to be named an Advanced Comprehensive Stroke Center. That gives the Augusta hospital serious bragging rights over its counterparts in metro Atlanta.

Primary stroke centers offer basic stroke care. They can administer the IV stroke drug, TPA, to patients 24/7. Hospitals who earn Advanced status have to offer much more, says vascular neurologists Jeffrey Switzer, director of Georgia Regents’ Comprehensive Stroke Center.

Why is this a big deal?
It’s long been recognized that complex patients couldn’t be managed by all hospitals and not by all primary stroke centers. There are hemorrhagic stroke patients that could benefit from additional acute therapies, and patients with complex ischemic strokes that could benefit from interventions to remove clots or surgery to remove brain swelling. This certification is a much higher bar for hospitals to achieve. I think we’re about the 15th hospital certified in the U.S. The first was Stanford.

What are the qualifications?
It’s typically hospitals that are performing research. They look at the personnel that you have on board, the infrastructure, the availability of equipment 24 hours a day, 7 days a week. They want to see that you have expertise in neurology, neurosurgery, and neuroradiology. They want centers that are managing a high volume of complex patients. They want centers with a close-working relationship with EMS in the community. They want to see that you’re working with hospitals in your region.

Were you high-fiving yourselves that you were certified before any of the Atlanta hospitals?
In Augusta, the Medical College of Georgia is here—a teaching hospital—and we’re kind of the ugly stepchild in comparison to Emory. So when The Joint Commission first announced they were taking applications, we tried to get ours in right away. Certainly Emory or Grady have the personnel and infrastructure and will undergo the review process, but we were first!

What was the actual process like?
It was an intensive two-day onsite visit. Two experts came and they reviewed charts and met with patients. They asked ask tough questions about how decisions are made, thought processes, follow-through… It was very stressful. It took us 3-4 months to prepare for the onsite visit. We say that the hospital is in top form everyday whether you’re going to be reviewed or not, but the halls looked extra nice those days.

Other than bragging rights, what does this mean? Will people come from all over?
We’ll obviously be recognized regionally as the stroke experts. One goal particularly in urban areas where there are primary stroke centers is that pre-hospital providers (EMTs) would be able to decide where the best place would be to deliver that patient—a primary stroke center or a comprehensive stroke center. Acute strokes will be steered toward the appropriate hospital. If it’s a likely a complex stroke, patients will go to a comprehensive stroke center.

Georgia is in the “stroke belt.” What does that mean?
The risk of dying from a stroke is higher here in the Southeast than in other areas of the country. There’s an area of active research as to why the stroke belt even exists. A whole range of speculations have been proposed and none of them completely answer the question: access to care, lack of primary care, racial disparity, something in the soil, it’s the sweet tea.