Hospital is recognized for stroke care Designation acknowledges Nebraska Medical Center's ability to treat complex stroke cases at all hours

The Nebraska Medical Center has become the first hospital in the region to earn the nation's highest certification for stroke care.

The designation as a comprehensive stroke center recognizes that the hospital has the infrastructure and expertise in place to care for and manage the most complex stroke cases, including specialized treatments, and to be available to do them 24 hours a day, seven days a week, 365 days a year.

Previously, the closest facilities with the comprehensive designation were in Kansas City, Iowa City and Denver. Many hospitals in the region can treat some of the complexities, medical center officials said, but no other hospital can provide them all at all times.

Dr. Pierre Fayad, a neurologist and medical director of the hospital's stroke center, said the medical center has been building the capacity to meet patients' more complex needs, based on the latest scientific evidence, since it established the first primary stroke center in 2005. Certification is based on criteria established by the Joint Commission and the American Heart Association/American Stroke Association.

Care for strokes is evolving rapidly, Fayad said, "and we as a center of excellence are closely involved in the national and international research for stroke."

Recently, the University of Nebraska Medical Center, the hospital's academic partner, served as one of 69 sites involved in a major research study that determined that using a device to plug a small hole in the hearts of patients who suffer strokes from unknown causes in combination with medication may provide an extra layer of protection from subsequent strokes.

Dr. Bill Thorell, a neurosurgeon at the medical center, said comprehensive centers not only must be prepared to handle clot-caused strokes at any time, like a primary center, but also to treat hemorrhagic strokes, including aneurysms. That means having experienced neurosurgeons on call.

"You've got the whole package," he said.

Delivering those treatments effectively, Fayad said, has to be done in a way that's well planned and executed. "We're talking about really complex systems and teams that all have to be coordinated," he said.

It also has to be done in a timely manner. Some treatments can only be given within a certain window. And a shorter time with symptoms typically means better outcomes for patients and less time in rehabilitation. "No matter where the patient goes," Fayad said, "the most important part is they seek care as soon as possible."

Providing more timely treatment and better outcomes also is the aim of the state's stroke treatment system. A law establishing the system took effect Jan. 1. Nebraska joined 17 other states plus the District of Columbia in having state-legislated systems that designate hospitals according to their ability to provide various elements of stroke treatment and that establish protocols to help emergency responders evaluate patients and select the hospital that can provide the appropriate level of care.

Stroke was the fifth-leading cause of death in Nebraska in 2015, with more than 3,700 strokes reported that year. It's also the fifth-leading cause of death nationwide and a leading cause of disability among adults.

The new state protocols include tools to screen for and measure the severity of strokes. The state this summer designated 13 hospitals, including the medical center, as primary stroke centers. The system is similar to the one responders use in trauma cases.

CHI Health is in the process of seeking the comprehensive designation at Immanuel Medical Center, which houses the CHI Health Neurosciences Institute. In the meantime, it will apply in January for a new advanced stroke certification for hospitals equipped to use a device called a stent retriever to remove clots blocking large brain vessels. Doctors have called the treatment, mechanical thrombectomy, a game-changer in treating such blockages.

julie.anderson@owh.com, 402-444-1066