August 2010

PA96-514: Illinois' Stroke Law

In May 2009, the General Assembly unanimously approved legislation allowing the creation of stroke systems of care in Illinois. Public Act 96-514 intends to get stroke patients to the right hospital, with the right care, at the right time. Following the recommendations of the IHA Board of Trustees, IHA staff successfully worked with the American Heart/Stroke Association, the Illinois Department of Public Health (IDPH), EMS providers, and others, to incorporate member recommendations into PA96-514.

Illinois' stroke law creates a stroke system of care in each of Illinois' 11 EMS Regions by identifying hospitals capable of providing emergent stroke care and directing EMS providers to transport possible acute stroke patients to these hospitals. The Act enables hospitals to pursue voluntary IDPH designation as a Primary Stroke Center (PSC) or Emergent Stroke Ready Hospital (ESRH). It then requires EMS providers to transport possible acute stroke patients to a PSC or ESRH.

Other key provisions of PA96-514 include:

• Advisory committee in each EMS Region and a statewide advisory committee, both with hospital representation, to help determine stroke patient transport protocols and other ongoing activities of the Act.
• Publication of Department-collected PSC data after three years, with an opportunity for hospitals to check the data for accuracy.
• Identification of designated stroke centers on the Department website.
• Subject to appropriation, matching grants for PSCs, ESRHs, and hospitals seeking stroke center certification or designation.

Although the legislation was effective January 1, 2010, full implementation of the Act is unlikely until the rulemaking process is complete. IHA has worked with the Heart Association and IDPH on preliminary draft regulation and will continue to work closely with the Department and other stakeholders as rules are developed.

Stroke Center Requirements
Hospitals must meet criteria outlined in the Act to be eligible for State PSC or ESRH designation. To become a PSC or an ESRH, hospitals will need to review and adjust their emergent stroke care policies and procedures to better align with nationally recognized, evidence-based standards, such as those from the American Heart/Stroke Association and Brain Attack Coalition.

Primary Stroke Centers
Illinois has more than 50 PSCs certified by The Joint Commission (TJC) and the Health Facilities Accreditation Program (HFAP). Under the new law, these hospitals, and others, will have the opportunity to become State-designated PSCs. Hospitals certified a PSC by an organization such as TJC or HFAP may automatically qualify for voluntary designation by submitting verification of their PSC certification to IDPH. State PSC designation does not require hospitals to meet additional criteria.

IDPH may suspend or revoke State PSC designation in extenuating circumstances, but it does not have authority over a hospital's PSC certification obtained from a nationally recognized organization.

Emergent Stroke Ready Hospitals
Illinois was one of the first states in the nation to incorporate another level of stroke center into its law. ESRHs, hospitals that diagnose, treat, and transport acute stroke patients to a higher level of care as warranted, will likely be located throughout the state. Some hospitals, particularly small and rural hospitals, may find joining a stroke network presents additional resources to help meet necessary criteria.

ESRHs must annually attest to IDPH their continued compliance with criteria outlined in PA96-514, which will likely be clarified during the rulemaking process. ESRHs must comply with these criteria 24 hours a day, 365 days a year. The Department retains the ability to suspend or revoke ESRH designation for noncompliance or for extenuating circumstances.

ESRH designation criteria include:

• Written emergent stroke care protocols;
• Written transfer agreement with a hospital with neurosurgical expertise;
• Director of stroke care to oversee hospital stroke policies and procedures. This may be a clinical staff member or the designee of the hospital administrator;
• Administration of thrombolytic therapy (e.g. tPA);
• Ability to conduct brain image tests (e.g. CT scan) at all times;
• Ability to conduct blood coagulation studies at all times; and
• Maintenance of a stroke patient log, available for review by IDPH or any hospital with a written transfer agreement.

EMS & Stroke Patient Transport
The Act requires the creation of EMS protocols to transport possible acute stroke patients to PSCs and ESRHs unless circumstances warrant otherwise. EMS Regions retain authority over patient transport protocols; the stroke law mandates each Region adopt protocols that direct patients experience stroke symptoms to a PSC or ESRH. EMS Regions may incorporate additional stroke centers into regional plans as they are designated by IDPH.

PA96-514 creates an advisory committee in each EMS Region and a statewide advisory committee, both with hospital representation, to assist with the ongoing implementation of the Act. The regional committees will assist IDPH and EMS decision makers in each EMS Region with transport protocols for acute stroke patients and with the ongoing implementation of the Act. Statewide, the advisory committee will advise IDPH and EMS on the triage, treatment, and transport of acute stroke patients, and on other statewide stroke projects.

Lastly, the stroke legislation mandates EMS use a uniform stroke assessment tool (like the Cincinnati Prehospital or F.A.S.T. Stroke Scale) to clinically evaluate possible acute stroke patients in the field. The statewide stroke advisory committee will select this tool, and following IDPH approval, the tool will be distributed to each EMS System for adoption.

Resources

• Full text of HB2244
• IHA will keep members apprised of developments and will continue to conduct educational programs.

Conclusion
Although the Act became effective 1/1/2010, it is not practically feasible for IDPH to implement it without adopting new rules. EMS Regions, however, retain the ability to alter their transport protocols and may begin transporting stroke patients to PSCs or other hospitals at any time. Hospitals are advised to work within their EMS Region to ease local implementation of PA96-514.

IHA will continue to work with the Department and other stakeholders through the rulemaking process.

Staff Contact: Bridget McCarte 630.276.5843