California Code of Regulations
Title 22 - Social Security
Division 9 - Prehospital Emergency Medical Services
Chapter 7.2 - Stroke Critical Care System
Article 4 - Hospital Stroke Care Requirements and Evaluations
Section 100270.226 - Acute Stroke Ready Hospitals
Universal Citation: 22 CA Code of Regs 100270.226
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Hospitals designated by the local EMS agency as an acute stroke ready hospital shall meet all the following minimum criteria:
(1) A clinical stroke team
available to see, in person or via telehealth, a patient identified as a
potential acute stroke patient within twenty (20) minutes following the
patient's arrival at the hospital's emergency department.
(2) Written policies and procedures for
emergency department stroke services that are reviewed, revised as needed, and
implemented at least every three (3) years.
(3) Emergency department policies and
procedures shall include written protocols and standardized orders for the
emergency care of stroke patients.
(4) Data-driven, continuous quality
improvement process including collection and monitoring of standardized
performance measures.
(5)
Neuro-imaging services capability that is available twenty-four (24) hours a
day, seven (7) days a week, three hundred and sixty-five (365) days per year,
such that imaging shall be performed and reviewed by a physician within
forty-five (45) minutes following emergency department arrival.
(6) Neuro-imaging services shall, at a
minimum, include CT or MRI, or both.
(7) Interpretation of the imaging.
(A) If teleradiology is used in image
interpretation, all staffing and staff qualification requirements contained in
this section shall remain in effect and shall be documented by the
hospital.
(B) Neuro-imaging studies
shall be reviewed by a physician with appropriate expertise, such as a
board-certified radiologist, board-certified neurologist, a board-certified
neurosurgeon, or residents who interpret such studies as part of their training
in ACGME-approved radiology, neurology, or neurosurgery training program within
forty-five (45) minutes of emergency department arrival.
(i) For the purpose of this subsection, a
qualified radiologist shall be board-certified by the American Board of
Radiology or the American Osteopathic Board of Radiology.
(ii) For the purpose of this subsection, a
qualified neurologist shall be board-certified by the American Board of
Psychiatry and Neurology or the American Osteopathic Board of Neurology and
Psychiatry.
(iii) For the purpose
of this subsection, a qualified neurosurgeon shall be board-certified by the
American Board of Neurological Surgery.
(8) Laboratory services shall, at a minimum,
include blood testing, electrocardiography and x-ray services, and be available
twenty-four (24) hours a day, seven (7) days a week, three hundred and
sixty-five (365) days per year, and able to be completed and reviewed by
physician within sixty (60) minutes following emergency department
arrival.
(9) Neurosurgical services
shall be available, including operating room availability, either directly or
under an agreement with a thrombecotomy-capable, primary or comprehensive
stroke center, within three (3) hours following the arrival of acute stroke
patients to an acute stroke-ready hospital.
(10) Provide IV thrombolytic treatment and
have transfer arrangements with one or more thrombectomy-capable, primary or
comprehensive stroke center(s) that facilitate the transfer of patients with
strokes to the stroke center(s) for care when clinically warranted.
(11) There shall be a medical director of an
acute stroke-ready hospital, who may also serve as a member of a stroke team,
who is a physician or advanced practice nurse who maintains at least four (4)
hours per year of educational time in cerebrovascular disease;
(12) Clinical stroke team for an acute
stroke-ready hospital at a minimum shall consist of a nurse and a physician
with training and expertise in acute stroke care.
(b) Additional requirements may be stipulated by the local EMS agency medical director.
1. New section filed 4-17-2019; operative 7-1-2019 (Register 2019, No. 16).
Note: Authority cited: Sections 1797.107, 1797.176 and 1798.150, Health and Safety Code. Reference: Sections 1797.103, 1797.204, 1797.220, 1797.222 and 1798.172, Health and Safety Code.
The amended version of this section by Register 2024, No. 38, effective 1/1/2025 is not yet available.
Disclaimer: These regulations may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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