From the Suburban Journals, October 17, 2005

Barnes-Jewish Hospital continues to add to its reputation as one of the nation's elite health care institutions.

This time, the hospital has been named a Primary Stroke Center by the Joint Commission on Accreditation for Healthcare Organizations (JCAHO), the nation''s predominant standards setting and accrediting body in health care.

"It means that you meet the national standards when dealing with acute stroke patients," said Dr. Abdul Nassief, a neurologist, director of the clinical stroke center and director of the neurology training program at Washington University School of Medicine and Barnes-Jewish Hospital. "The stroke center here exceeds those standards."

According to the American Stroke Association, stroke is a cardiovascular disease, which affects the arteries leading to and within the brain. Stroke can be caused either by a clot obstructing the flow of blood to the brain or by a blood vessel rupturing and preventing blood flow to the brain.

The Primary Stroke Center designation, given to Barnes-Jewish Hospital in August, has only been awarded to institutions for the past two years. Barnes-Jewish Hospital is the first in St. Louis to receive it, Nassief said. Barnes-Jewish Hospital started calling itself a stroke center in 1994.

"I''m excited we got this," Nassief said. "As a leader in the nation and community it''s like telling everybody to step up to the plate. It''s better for the community. It will let the community know we can take care of patients well and encourage other hospitals to follow our steps."

Each year in St. Louis 7,000 people suffer from strokes, of which Barnes-Jewish Hospital admits 1,000 patients and the remainder are treated at other hospitals.

"My personal goal is to reach out to surrounding hospitals and set up local protocols for them," Nassief said.

JCAHO uses a standardized set of criteria to measure each institution and make sure they meet the needed requirements before they are certified as a primary stroke center. The program is voluntary and medical institutions invite JCAHO in to evaluate their performance and practices.

A surveyor reviewed Barnes-Jewish Hospital for its ability to complete a CT Scan in a reasonable amount of time, conduct lab tests with a certain time, administer the drug tPA in a timely manner and prevent complications from strokes.

The JCAHO criteria looks at things from the moment a patient hits the door, to the care a patient receives, to stroke prevention, to what steps are in place to rehabilitate the patient, Nassief said.

"When a stroke patient comes into the emergency room we activate the stroke protocol," he said.

A nurse will immediately draw a patient''s blood for lab tests and they are given priority for a CT Scan, which is the main test used to determine the type of stroke a patient may have incurred.

These procedures are carried out to evaluate if a patient is a candidate for tPA. Lab tests are conducted on a blood count of platelets to make sure a patient has the proper levels so they won''t bleed to death and to make sure they have no bleeding tendencies, Nassief said.

Being designated as Primary Stroke Center means an institution has to be able to administer tPA within three hours from the time of the first symptom.

The JCAHO certification strictly looks at the time it takes an institution to administer tPA because 80 percent of the strokes that occur are ischemic, a type of stroke in which a clot forms inside a blood vessel, stopping the flow of blood to the brain.

"Stroke patients cared for by stroke units are less likely to die and less likely to end up with a permanent disabilities," Nassief said. "The designation doesn''t change how we care for our patients."