Recognizing UCSF Medical Center's exceptional efforts to foster better outcomes in stroke care, the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) recently certified the hospital as a Primary Stroke Center. UCSF is the first hospital in San Francisco to receive this designation. "We are thrilled to be officially recognized as a Primary Stroke Center," said S. Claiborne Johnston, MD, PhD, director of the stroke center. "Over the last decade, UCSF has strived to provide cutting-edge, high-quality care and to build a world-class research program." Staffed with personnel trained to diagnose and treat stroke quickly and effectively, the stroke center provides all aspects of stroke care, including prevention, acute care and follow-up. A neurologist is on site 24 hours a day as part of a response team that works together to determine the best treatment option for each patient. In addition, UCSF offers the latest treatments and tools that aid in dissolving or removing the clots causing a stroke, offering patients a greater chance of complete recovery. One device, the Mercy Retriever, has been used to safely remove clots in patients experiencing a stroke past the three-hour window that the anticlotting drug, tPA, can be used. The tiny corkscrew device is placed in a catheter and threaded through an artery to reach and remove clots. UCSF has other clinical device trials underway as well. "Unfortunately, not all patients receive these new treatments because hospitals are not prepared and staff is not trained in stroke diagnosis and care," said Johnston. "We hope to work with the community to change this." One focus of the newly certified stroke center will be to conduct outreach with other hospitals and clinics in the San Francisco area. "Many hospitals in the area cannot keep a neurologist on staff to deal with emergencies and lack updated equipment, such as new CT scanners, which aid in diagnosis," he explained. "As a result, patient diagnosis and treatment may be delayed or even inappropriate." Citywide Improvements Recognizing that patients can only receive the best care reliably if a network of prepared hospitals is in place, Johnston and colleagues hope to see improvements in stroke care throughout San Francisco. They are exchanging information with other health care providers in San Francisco and the greater Bay Area, sharing their knowledge of stroke care and helping to foster stroke centers in other hospitals in the area. In parts of Northern California, such as Santa Clara County, ambulances may preferentially bring patients with signs of stroke to hospitals with JCAHO stroke center certification. Although such policies might improve care for stroke patients, Johnston cautioned that it might not work yet in San Francisco, given that UCSF is the only certified center. "UCSF cannot battle stroke alone, nor is it necessary given the other capable hospitals here. As a community, we need to work together to ensure patients have access to quality care at more hospitals in the city," added Johnston. "A stroke does not have to be deadly or even debilitating; if more hospitals focus on raising the standards for stroke care, we can obtain much better outcomes." Stroke is the number one cause of disability and the number three cause of death in the United States. More than 700,000 people have a stroke each year. About 160,000 of these cases result in death.