UCSF Stroke Center Earns Highest Level of Certification for Complex Care

By Nina Bai

exterior of 400 Parnassus Avenue building

The UCSF Stroke Center has received designation as a Comprehensive Stroke Center, the highest and most demanding certification awarded to hospitals that can treat the most complex stroke cases.

“This designation recognizes our ability to provide the most advanced clinical services for complex stroke patients,” said Anthony Kim, MD, MS, neurologist and medical director of the UCSF Stroke Center. These services include the ability to remove blood clots that cause stroke, known as thrombectomy, treatment for aneurysms, and specialized neurocritical care.

That’s good news for anyone in the region who is affected by a stroke.

Stroke is the fourth leading cause of death in California and one in 12 Californians over the age of 65 has suffered a stroke.

The UCSF Stroke Center, located at UCSF’s Parnassus Heights campus, treats about 800 patients a year, including those with ischemic stroke, which is caused by a blockage of blood flow to the brain, as well as hemorrhagic stroke, which is caused by bleeding into the brain. UCSF has particular expertise in treating a type of hemorrhagic stroke called subarachnoid hemorrhage, which is caused by a ruptured aneurysm.

UCSF Medical Center is ranked among the top three hospitals nationwide for specialty neurological care in the 2019-2020 U.S. News & World Report rankings.

Although UCSF plays a key role in providing emergency care for stroke patients in the San Francisco Bay Area, about 40 percent of stroke patients are referred from outside the Bay Area as well, and these tend to be the more severe cases, said Kim.

The UCSF Stroke Center is the first in San Francisco and among the few in the Bay Area to attain Comprehensive Stroke Center certification from the Joint Commission, an independent health care accreditation organization, in collaboration with the American Heart Association and the American Stroke Association.

“We are incredibly proud of this new designation, which represents tremendous work by our multidisciplinary team and, more importantly, further establishes our center as a national leader for the care of stroke patients in our local region and far beyond,” said S. Andrew Josephson, MD, chair of the Department of Neurology and one of the core faculty members in the Stroke Center.

Comprehensive Stroke Center certification requires these high-level services to be delivered swiftly – which can reduce disability.

Anthony Kim, MD

Anthony Kim, MD

“The classic teaching in stroke care is that ‘time is brain,’ meaning that every passing minute can result in additional injury to the brain,” said Kim.

Speed became even more imperative in the mid-1990s with the advent of tPA, a medication that can break up blood clots. After studies demonstrated the benefits of tPA in treating stroke patients, especially if given as soon as possible after onset of symptoms, hospitals began to develop protocols, clinical pathways, and certification programs to ensure that stroke patients could be rapidly evaluated and treated with tPA.

“It caused a sea change in how we think about stroke care because now we had a treatment, but it had to be applied quickly,” said Kim.

At the UCSF Stroke Center, which is part of the Department of Neurology and the UCSF Weill Institute for Neurosciences, the goal is to provide tPA treatment, including an initial assessment and CT scan, within 30 minutes of a patient’s arrival. In more severe blockages that require endovascular thrombectomy, the goal is to have patients in the surgical suite having the clot removed within 90 minutes of arrival or within 60 minutes if transferred directly from another hospital.

Meeting these speed standards requires an all-hands-on-deck approach, said Kim. That includes not only having the best vascular, neurointerventional, and neurosurgery capabilities, but also having advanced neuroradiology services, expert nursing care with specific training in stroke, and emergency medicine and neuroanesthesiology expertise. It also includes extensive outreach, such as training EMS and hospital security staff to recognize the signs of stroke, and educating the community about warning signs and what to do in case of stroke.

“If you think someone might be having a stroke, the right answer is to call 9-1-1,” said Kim. “The EMS system will respond with lights and sirens and will quickly direct care to a stroke center from there.”

Referring physicians from other hospitals should know that the UCSF Stroke Center has an expedited pathway to rapidly receive patients for advanced stroke treatment that is activated through the UCSF Transfer Center, he added.

The Comprehensive Stroke Center designation is the highest of four tiers of certification given by the Joint Commission and is reviewed every two years. The certification requires continual efforts in quality improvement, including reporting process times and patient outcomes, as well as participating in clinical research.

“It really reflects UCSF’s ongoing commitment to provide the highest level of care,” said Kim.