Staten Island

University Hospital
Comprehensive
Stroke Center
October 2nd, 2020

1
To improve the
health and
quality of life
for the people
and
communities
we serve by
providing
world-class
service and
patient-
centered care.
Agenda
1. Staten Island University Hospital Overview
2. Comprehensive Stroke Center
• Current
• Needs
• Future
3. Neurovascular Performance Improvement Measures
4. Neurovascular Data
5. Research
6. Overview

October 2nd, 2020 3

SIUH North Campus
 Designated Primary Stroke Center
 ACS Adult Level 1 Trauma Center
 Pediatric Level 2 Trauma Center
 Regional Burn Center
 Region’s Heart Center
 Level 3 Perinatal Center

October 2nd, 2020 4

 2021 Finish
NCC Get
unit Comprehensive
Stroke Center
2020
CompleteOnboard Certification
a
NCC CSC Gap NCC Director,
unit on 8 Analysis Become
NCC intensivist,
designated ICU the NCC
NCC 8 ACP
beds admitting
Preform 2019 service
Onboard an
Complex
administrative
Procedures
Start Director
Research
Studies 2018

onboard a board certified

Neurointerventionist
5
Comprehensive
Stroke Center
Needs

October 2nd, 2020 6

CSC Eligibility

Physical
Education
Space

Volume Technology EMS/

Transfers

Research Stroke Team Telemedicine

Performance
Improvement Rehab
Comprehensive Stroke Center Needs

Education /
Policies

Quality and
Processing/
Technology

Staffing/ Physical
Space
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Education

Neuro ACP Nurses

IR Tech &
Patient
RN

Community
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October 28, 2020

Quality

Neurovascular
Peer Review M&M Core Stroke Conference –
Bi-Annually
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Month Day, Year

Staffing
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Month Day, Year

Technology
Program Needs comments
Concept
Technology Stroke Unit or NCCU upgrade -The number of beds in Stroke Unit needs to be
proportionate to the number of stroke
admission/yr.
-More beds with all modalities needed to
monitor all elements of patient’s Vital Signs
Availability of MR Studies 24/7

“Code Stroke” portable Box:

Peer Review Meeting
M&M Meeting and process
Core Stroke Committee
Conference - Bi-Annually
NV/NCC/NI/Rad/Rehab/ED/EMS collaboration.
Quality and A person (Technologist) in charge of NI Inventory
Processing update, HUD devices, quality and process
needs improvement
24/7 coverage of NI procedures by Trained Staff,
including Nurses, Technologists, and First
Assistant:
Weekly NV meeting

13
October 2nd, 2020
Click icon to add picture
Month Day, Year

Staffing/ Physical Space

Program Concept Advanced Comprehensive Stroke Certification Staten Island University Hospital – North
Eligibility *General eligibility requirements; use of standardized INSERT OUT NUMBERS HERE FOR
method of delivering care including intravenous SAH:
thrombolytic therapy centered on evidence-based T-PA
guidelines for stroke care Coiling:
Ischemic Stroke:
*Treatment of 20 SAH Mechanical Thrombectomy:
*Capable of treating aneurysms by performing 10 coiling
or microsurgical clipping procedures annually DSPR.6. The program has current reference
and resource materials
*Organization must have performed mechanical
thrombectomy and post-procedure care for at least 15 Gap in Finalized Policy's
patients with ischemic stroke over the past 12 months
*Neurointerventionalists who perform mechanical
thrombectomy at the organization applying for
certification must perform 15 mechanical
thrombectomies over the past 12 months (or 30 over
past 24 months)

Program Medical Has extensive expertise; available 24/7, experienced in

Director caring for stroke patients, physician on hospital staff,
licensed in NYS, and board certified in Neurology,
Neurosurgery, Interventional Neuro-Radiology, Vascular
Neurology or Neuro-Critical Care.

15
Program Concept Advanced Comprehensive Stroke Certification Staten Island University Hospital
Acute Stroke Team Available 24/7, at bedside within 15 min, as defined by the Compliant
hospital but must have an individual that is privileged by the
hospital to make treatment decisions.

Emergency Access to protocols used by EMS, routing plans; records from Compliant
Medical Services transfer; tracks pre-notification information
Collaboration
Emergency 100% of staff trained annually on stroke symptoms Compliant
Department Staff /activation of stroke code and knowledge of protocols
Stroke Unit Has a neurointensive care unit or designated intensive care DSDF.1 Practitioners are qualified and
beds for complex stroke patients available 24/7; on-site competent.
neurointensivist coverage 24/7 Although we have designated beds: Nurses
and ACP must be trained on care
of Neurocritical Care Patients
DSPR5. 7d. The comprehensive stroke
center is required to have the following
practitioners and staff members available
24/7 Currently do not have
24/7 Neurointensivist Coverage
Initial Assessment Emergency Department physician Compliant
of Patient

Diagnostic Testing CT, MRI, labs, CTA MRA, catheter angiography 24/7; other Compliant
Capability cranial and carotid duplex ultrasound, TEE, TTE as indicated.
Neurologist Meets concurrently emergent needs of multiple complex DSPR. 5 The program determines the care,
Accessibility stroke patients; written call schedule for attending treatment, and services it provides
physicians providing availability 24/7 Gap in on-site 24/7 Neurointerventionalist
Need written on call plan

October 2nd, 2020 16

Program Concept Advanced Comprehensive Stroke Certification Staten Island University Hospital – North
Neurosurgical 24/7 availability: Neurointerventionist; DSPR. 5 The program determines the care,
Services Neuroradiologist; Neurologist; Neurosurgeon. treatment, and services it provides
GAP in 24/7 Coverage for Neurointerventionist

Rehabilitation PT/OT/SLP available as needed 7 days a week; staff Compliant

Services with ability to perform a bedside swallow screen
24/7

Telemedicine Available 24/7 within 20 minute to assess patients Compliant

at PSC and TSCs within catchment area.

Treatment IV thrombolytics;
Capabilities Endovascular therapy;
microsurgical neurovascular clipping of
aneurysms;
neuroendovascular coiling of aneurysms;
stenting of extracranial carotid arteries;
carotid endarterectomy.

17
October 2nd, 2020
Program Concept Advanced Comprehensive Stroke Certification Staten Island University Hospital – North
Transfer For receiving transfers and circumstances for not DSDF.5 The program manages comorbidities
Protocols accepting transferred patients; shall have transfer and concurrently occurring conditions and/or
agreement with referring TSC and PSCs within their communicates the necessary information to
catchment area. manage these conditions to other
Transfer agreements must have: practitioners.
• 24/7 emergency contact information of acute stroke
team and/or the receiving team at the receiving facility
authorized to accept transfers
• The target timeframe for transfer identified in the
transfer agreement.
• Expectations/criteria for advanced imaging prior to
transfer, including CTA/CTP or other imaging
modalities, and time frame for diagnostic service
completion and image sharing process clearly defined.
• Specified time for triage and transport of suspected
large vessel occlusion to an appropriate facility.
• Clearly delineate responsibility related to who will
perform a CTA (sending or receiving facility) and under
which clinical circumstances.
Can demonstrate required elements of the transfer
agreement through references to policies and procedures
incorporated into the agreement.
The ACSC shall be able to identify another ACSC that
they will transfer to when case complexity determines
that further specialized care is needed, or high volume
exceeds resources dictating a need for transfer. This can
be identified through a policy document, such as a surge
policy and does not need to be in the form of a transfer
agreement.

October 2nd, 2020 18

Program Concept Staten Island University Hospital – North
E-Quality and
Processing
needs
Physical Dedicated NCCU
CT Holding Bay
Stroke Unit

Training Develop a stroke educational plan for:

Neuro ACP

All Nurses

IR Tech
TCD Training

Stroke / PI coordinator
Clinical pharmacist
NV and NCC Administration
Enough ACPs to run the NV/Stroke/NCC services 24/7
Staffing Dedicated Stroke Educator
Stroke Outreach and Advertisement for NV, NI and NCC
Program
24/7 Coverage Neurointerventional ACP
CSC Research Coordinator

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October 2nd, 2020
Multidisciplinary Stroke Committee

EMS
QI
ED
Coordinator

Divisions involved in Stroke

Core Stroke
Performance Improvement Pharmacy
Committee
Process.

Different SIUH Private

Departments working Rehabilitation PATIENT Neurology
Staff
collectively to achieve
Comprehensive Stroke
Center Social Nursing
Work

Case Radiology
Management
Laboratory

October 2nd, 2020 20

Past

Month Day, Year 21

SIUH North – Past status

• No NCC unit
• No Board certified fellowship trained interventionist.
• No Neurointensivist
• No Neurology Administrative Director
• No Research Studies - Stroke
• Quality measures below average benchmark and DOH goal.
• Only DOH primary center certified
• No Stroke Coordinator for 2 years.
The above mention list, consists of items SIUH Neurology department was deficient in.

October 2nd, 2020 22

Current

Month Day, Year 23

SIUH North – Current Status
• Apply for Comprehensive Stroke Center Certification in Jan 2021
• Complete GAP Analysis
• Educate and Improve Staff Performance Outcomes – PI Projects
• Start NCC Unit Project Implementation – in progress
• Widen the Scope of Research Studies – in progress
• 24/7 ACP Coverage – In progress
• Create a Multidisciplinary Committee for CSC
• Develop New and Improved SIUH Stroke Policies
• Start Stroke Core, Peer Review, and M&M meetings
• Stroke Coordinator
• Neuroscience Educator

Month Day, Year 24

Performance Improvement Projects

• Door to Needle [30 – 45 min goal]

• Door to Puncture [90 min goal]
• VTE Prophylaxis [85% benchmark]
• Outpatient Stroke Follow up – 7 day, 30 Day, and 90 Day
• Stroke Education Discharge Bags
o Follow up info
o Contact info
o Education
• Stroke Policies Review
• Staff Stroke Education

Month Day, Year 25

Future

October 2nd, 2020 26

SIUH North – Future Status

• Increase in Complex Procedures

• Joint Commission Comprehensive Stroke Center Certified
• Neurology Residency
• Fellowship
• Increased Research Studies
• Research Grants
• NCC Unit
• EMS Patient Diversion to SIUH
• Increase in Endovascular Patient volume

October 2nd, 2020 27

SIUH
Comprehensive
Stroke Data

October 2nd, 2020 28

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October 2nd, 2020 29

2019 to 2020 Stroke Volume
SIUH - North 2019
2019 Jan Feb March April May June July Aug Sept Oct Nov Dec Total
Acute Ischemic Stroke 42 39 37 48 35 35 43 33 51 29 35 33 460
Transient Ischemic Attack 10 10 16 10 11 19 15 12 12 11 8 10 144
Subarachnoid Hemorrhage 3 1 0 2 4 0 1 1 0 1 0 1 14
Intracerebral Hemorrhage 4 5 6 4 6 7 5 7 2 4 5 10 65
Overall Total 59 55 59 64 56 61 64 53 65 45 48 54 683

SIUH - North 2020

2020 Jan Feb March April May June July Aug Sept Oct Nov Dec Total

Acute Ischemic Stroke 47 37 35 23 26 33 39 240

Transient Ischemic Attack 9 8 10 4 7 2 3 43

Subarachnoid Hemorrhage 3 5 2 1 0 0 2 13
Intracerebral Hemorrhage 6 3 4 7 9 7 5 41

Overall Total 65 53 51 35 53 42 49 0 0 0 0 0 348

October 2nd, 2020 30

2019 vs 2020 North SIUH
2019 vs 2020 tPA
12
10
8
6
4
2
0
Jan Feb Mar Apr May Jun July Aug

2019 2020

2019 vs 2020 MER Procedures

6

0
Jan Feb March April May June July August
2019 2020

October 2nd, 2020 31

Neurovascular Procedures
Neuroendovascular Procedures Neuroendovascular Procedures
Total January 2019 - December 2019 Total
January 2020 - August 2020
Diagnostic Cerebral Angiogram 29 Diagnostic Cerebral Angiogram 78
Diagnostic Spinal Angiogram 0 Diagnostic Spinal Angiogram 2
WADA Test 0 WADA Test 2
Mechanical Thrombectomy 22 Mechanical Thrombectomy 43
Carotid artery stenting 8 Carotid artery stenting 11
Elective Aneurysm coil Embolization 3 Elective Aneurysm coil Embolization 8
Embolization of a-SAH 3 a-SAH Embolization 1
ECA Embolization for Epistaxis 1 ECA Embolization for Epistaxis 3
Embolization of intracranial tumor 0 Embolization of intracranial tumor 1
MMA Embolization 6 MMA Embolization 5
Spinal Artery Embolization 0 Spinal Artery Embolization 2
Total 72 Total 154

October 2nd, 2020 32

Month Day, Year 33
Neurovascular
Performance
Improvement
Measures

October 2nd, 2020 34

Staten Island University North
Quality Measures

October 2nd, 2020 35

Research

October 2nd, 2020 36

Neurology Research

Research studies in
• Neurovascular – 2 current studies, and 2 pending Studies
• Neuromuscular
• Epilepsy

• Publish Case Review Articles with SIUH Medical Residents

• Neurology Medical Research Observers
• SIUH faculty and ACPs as PI investigators and Sub-investigators
• Apply for research grants

October 2nd, 2020 37

Staten Island University Hospital
The neurology department at SIUH is collectively working on
creating a holistic and comprehensive stroke center with involving:

• Data Monitoring
• Quality Performance Improvement
• Complex Procedures
• Research Studies
• Public Outreach and Education
• Comprehensive Outpatient Follow up
• AHA Awards
• 24/7 ACP Coverage
• NCC Unit

October 2nd, 2020 38

Thank You

October 2nd, 2020 39