Missouri Code of State Regulations
Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES
Division 30 - Division of Regulation and Licensure
Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations
Section 19 CSR 30-40.710 - Definitions and Abbreviations Relating to Stroke Centers
Universal Citation: 19 MO Code of State Regs 30-40.710
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment adds virtual reviews to the definitions for stroke centers.
(1) As used in 19 CSR 30-40.720 and 19 CSR 30-40.730, the following terms shall mean-
(A) Acute-an injury or illness that happens
or appears quickly and can be serious or life threatening;
(B) Anesthesiologist assistant (AA)-a person
who-
1. Has graduated from an
anesthesiologist assistant program accredited by the American Medical
Association's Committee on Allied Health Education and Accreditation or by its
successor agency;
2. Has passed the
certifying examination administered by the National Commission on Certification
of Anesthesiologist Assistants;
3.
Has active certification by the National Commission on Certification of
Anesthesiologist Assistants;
4. Is
currently licensed as an anesthesiologist assistant in the state of Missouri;
and
5. Provides health care
services delegated by a licensed anesthesiologist;
(C) Board-admissible/board-eligible-a
physician who is eligible to apply or has applied to a specialty board of the
American Board of Medical Specialties, the American Osteopathic Association
Board of Osteopathic Specialists, or the Royal College of Physicians and
Surgeons of Canada and has received a ruling that he or she has fulfilled the
requirements to take the examinations. Board certification is generally
obtained within five (5) years of the first appointment;
(D) Board-certified-a physician who has
fulfilled all requirements, has satisfactorily completed the written and oral
examinations, and has been awarded a board diploma in a specialty field by the
American Board of Medical Specialties, the American Osteopathic Association
Board of Osteopathic Specialists, or the Royal College of Physicians and
Surgeons of Canada;
(E) Catchment
area-the surrounding area served by the institution (the stroke
center);
(F) Certified registered
nurse anesthetist (CRNA)-a registered nurse who-
1. Has graduated from a school of nurse
anesthesia accredited by the Council on Accreditation of Education Programs of
Nurse Anesthesia or its predecessor;
2. Has been certified as a nurse anesthetist
by the Council on Certification of Nurse Anesthetists; and
3. Has been licensed in Missouri pursuant to
Chapter 335, RSMo;
(G)
Clinical staff-an individual that has specific training and experience in the
treatment and management of stroke patients. Examples include: physicians,
registered nurses, advanced practice nurses, physician assistants, pharmacists,
and technologists;
(H) Clinical
team-a team of healthcare professionals involved in the care of the stroke
patient and may include, but not be limited to, neurologists,
neuro-interventionalists, neurosurgeons, anesthesiologists, emergency medicine,
and other stroke center clinical staff. The clinical team is part of the
hospital program's stroke team;
(I)
Continuing education-education approved or recognized by a national and/or
state professional organization and/or stroke medical director;
(J) Continuing medical education (CME)- the
highest level of continuing education for physicians that is approved or
recognized by a national and/or state professional organization and/or stroke
medical director;
(K) Core team-a
subunit of the hospital stroke team consisting of a physician experienced in
diagnosing and treating cerebrovascular disease (usually the stroke medical
director) and at least one (1) other health care professional or qualified
individual competent in stroke care as determined by the hospital (usually the
stroke program manager/coordinator);
(L) Credentialed or credentialing-a
hospital-specific system of documenting and recognizing the qualifications of
medical staff and nurses and authorizing the performance of certain procedures
and establishing clinical privileges in the hospital setting;
(M) Department-the Missouri Department of
Health and Senior Services;
(N)
Door-to-needle time-the time from arrival at the hospital door to initiation of
lytic therapy to restore blood flow in an obstructed blood vessel;
(O) Emergency medical service regions- the
six (6) regions in the state of Missouri that are defined in
19 CSR
30-40.302;
(P) Hospital-an establishment as defined by
section 197.020.2, RSMo, or a hospital
operated by the state;
(Q)
Immediately available (IA)-being present at the bedside at the time of the
patient's arrival at the hospital when prior notification is possible and no
more than twenty (20) minutes from the hospital under normal driving and
weather conditions;
(R) In-house
(IH)-being on the hospital premises twenty-four (24) hours a day;
(S) Lytic therapy (also known as
fibrinolysis/thrombolysis)-a drug therapy used to dissolve clots blocking flow
in a blood vessel. It refers to drugs used for that purpose, including
recombinant tissue plasminogen activator. This type of therapy can be used in
the treatment of acute ischemic stroke and acute myocardial
infarction;
(T) Missouri stroke
registry-a statewide data collection system comprised of key data elements as
defined in
19 CSR
30-40.730 that are used to compile and trend
statistics of stroke patients in both pre-hospital and hospital settings, using
a coordinated electronic reporting method provided by the department;
(U) Multidisciplinary team-a team of
appropriate representatives of hospital units involved in the care of the
stroke patient. This team supports the care of the stroke patient with the
stroke team;
(V) Neurologist-a
licensed physician with the appropriate specialty training;
(W) Neuro-interventionalist-a licensed
physician with the appropriate specialty training;
(X) Neuro-interventional team-a team of
physicians, nurses, and other clinical staff, and technical support that
perform the neuro-interventions and who are part of the stroke clinical
team;
(Y) Neurology service-an
organizational component of the hospital specializing in the care of patients
who have had strokes or some other neurological condition or
disorder;
(Z) Patient-an individual
who is sick, injured, wounded, diseased, or otherwise incapacitated or
helpless, or dead, excluding deceased individuals being transported from or
between private or public institutions, homes, or cemeteries, and individuals
declared dead prior to the time an ambulance is called for
assistance;
(AA) Peer review
system-the process the stroke center establishes for physicians to review
stroke cases on patients who are admitted to the stroke center, transferred out
of the stroke center, or die as a result of the stroke (independent of hospital
admission or hospital transfer status);
(BB) Physician-a person licensed as a
physician pursuant to Chapter 334, RSMo;
(CC) Promptly available (PA)-arrival at the
hospital at the patient's bedside within thirty (30) minutes after notification
of a patient's arrival at the hospital;
(DD) Protocol-a predetermined, written
medical care guideline, which may include standing orders;
(EE) Qualified individual-a physician,
registered nurse, advanced practice nurse, and/or physician assistant licensed
in the state of Missouri who demonstrates administrative ability and shows
evidence of educational and clinical experience in the care of cerebrovascular
patients;
(FF) Regional outcome
data-data used to assess the regional process for pre-hospital, hospital, and
regional patient outcomes;
(GG)
Repatriation-the process used to return a stroke patient to his or her home
community from a level I or level II stroke center after his or her acute
treatment for stroke has been completed. This allows the patient to be closer
to home for continued hospitalization or rehabilitation and follow-up care as
indicated by the patient's condition;
(HH) Reperfusion-the process of restoring
normal blood flow to an organ or tissue that has had its blood supply cut off,
such as after an ischemic stroke or myocardial infarction;
(II) Requirement (R)-a symbol used to
indicate that a standard is a requirement for stroke center designation at a
particular level;
(JJ) Review-the
inspection of a hospital to determine compliance with the rules of this
chapter;
(KK) Stroke-a sudden brain
dysfunction due to a disturbance of cerebral circulation. The resulting
impairments include, but are not limited to, paralysis, slurred speech, and/or
vision loss. Ischemic strokes are typically caused by the obstruction of a
cerebral blood vessel. Hemorrhagic strokes are typically caused by rupture of a
cerebral artery;
(LL) Stroke call
roster-a schedule that provides twenty-four (24) hours a day, seven (7) days a
week neurology service coverage. The call roster identifies the physicians or
qualified individuals on the schedule that are available to manage and
coordinate emergent, urgent, and routine assessment, diagnosis, and treatment
of the stroke patients;
(MM) Stroke
care-emergency transport, triage and acute intervention, and other acute care
services for strokes that potentially require immediate medical or surgical
intervention or treatment, and may include education, primary prevention, acute
intervention, acute and sub-acute management, prevention of complications,
secondary stroke prevention, and rehabilitative services;
(NN) Stroke center-a hospital that is
currently designated as such by the department to care for patients with a
stroke.
1. A level I stroke center is a
receiving center staffed and equipped to provide total care for every aspect of
stroke care, including care for those patients with complications, that also
functions as a resource center for the hospitals within that region, and
conducts research.
2. A level II
stroke center is a receiving center staffed and equipped to provide care for a
large number of stroke patients within the region.
3. A level III stroke center is a referral
center staffed and equipped to initiate lytic therapy and initiate timely
transfer to a higher level of care. The level III stroke center also provides
prompt assessment, indicated resuscitation, and appropriate emergency
intervention for stroke patients. A level III stroke center may admit and
monitor patients as in-patients if there are designated stroke beds and an
established relationship exists with a level I or level II stroke center
through which the level I or level II stroke center provides medical direction
and oversight for those stroke patients kept at the level III stroke center
under that relationship.
4. A level
IV stroke center is a referral center in an area considered rural or where
there are insufficient hospital resources to serve the patient population
requiring stroke care. A level IV stroke center provides prompt assessment,
indicated resuscitation, appropriate emergency intervention, and arranges and
expedites transfer to a higher level stroke center as needed;
(OO) Stroke medical director-a
physician designated by the hospital who is responsible for the stroke service
and performance improvement and patient safety programs related to stroke
care;
(PP) Stroke program-an
organizational component of the hospital specializing in the care of stroke
patients;
(QQ) Stroke program
manager/coordinator-a qualified individual designated by the hospital with
responsibility for monitoring and evaluating the care of stroke patients and
the coordination of performance improvement and patient safety programs for the
stroke center in conjunction with the stroke medical director;
(RR) Stroke team-a component of the hospital
stroke program consisting of the core stroke team and the clinical stroke
team;
(SS) Stroke unit-the
functional division or facility of the hospital that provides care for stroke
patients admitted to the stroke center;
(TT) Symptom onset-to-treatment time- the
time from symptom onset to initiation of therapy to restore blood flow in an
obstructed blood vessel;
(UU)
Telemedicine-the use of medical information exchanged from one (1) site to
another via electronic communications to improve patient's health status. A
neurology specialist will assist the physician in the center in rendering a
diagnosis. This may involve a patient "seeing" a specialist over a live, remote
consult or the transmission of diagnostic images and/or video along with
patient data to the specialist;
(VV)
Thrombolytics-drugs, including recombinant tissue plasminogen activator, used
to dissolve clots blocking flow in a blood vessel. These thrombolytic drugs are
used in the treatment of acute ischemic stroke and acute myocardial infarction;
(WW) Transfer agreement-a document
which sets forth the rights and responsibilities of two (2) hospitals regarding
the inter-hospital transfer of patients; and
(XX) Virtual review-a type of review
conducted through the use of secure virtual video and audio conferencing and
secure file transfers in order to determine compliance with the rules of this
chapter.
*Original authority: 192.006, RSMo 1993, amended 1995; 190.185, RSMo 1973, amended 1989, 1993, 1995, 1998, 2002; and 190.241, RSMo 1987, amended 1998, 2008.
Disclaimer: These regulations may not be the most recent version. Missouri 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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
