Stroke Patients’ Bill of Rights
The care of stroke patients presents unique challenges to the health care system. Patients must rapidly gain entry into a well prepared healthcare delivery system if they are to be considered candidates for intravenous tissue plasminogen activator, currently the only U.S. FDA approved treatment for ischemic stroke. Care for patients with stroke is expensive. However, attempts at cost containment must not be done at the expense of patient outcomes. Studies consistently have shown that subspecialty care delivered by stroke teams or services reduces morbidity and mortality. We propose the following Stroke Patients’ Bill of Rights to highlight the medical needs of stroke survivors.
I. Emergency Medical Services
- Patients and family members should be able to access their local Emergency Medical. system when they recognize symptoms consistent with stroke
- EMS transport of stroke patients should occur at the highest level of urgency (similar to that of myocardial infarction, or trauma)
- Transport should be to the closest medical facility capable of providing acute stroke care (especially thrombolysis), even if this involves bypassing closer, but ill-equipped facilities
- Third party payers should cover the emergency evaluation of patients who have symptoms that any prudent layperson would believe to be consistent with a stroke. This should be done even if the final diagnosis rendered by the physician is not stroke.
- Hospital Emergency Departments that accept EMS-transported stroke patients should have procedures and personnel in place (such as a Stroke Team) to emergently evaluate and treat stroke patients
II. Acute Hospital Care
- Stroke patients should receive care in facilities that are equipped to deal with the wide range of medical issues and complications related to stroke, including neurologic critical care. Hospitals not so equipped should have relationships with appropriately equipped centers so that transfer can be promptly accomplished when necessary.
- The care of stroke patients should be managed by physicians with expertise in the evaluation and treatment of stroke (either as their primary physician or as a consultant)
- Stroke patients should have an etiologic evaluation to identify the cause of their stroke and to help plan a secondary prevention program. This evaluation should be as extensive as is medically appropriate (as determined by the stroke expert), and should not be arbitrarily limited by third party payers or hospitals purely because of financial concerns.
III. Rehabilitation and Post-hospital Care
- Stroke patients should receive all appropriate in patient and outpatient rehabilitation services necessary to obtain optimal functional recovery. Rehabilitation should not be limited purely because of financial concerns.
- The rehabilitation of stroke patients should be directed by a physician with expertise in this field.
- Acute care hospitals should have systems in place to seamlessly discharge stroke patients to an appropriate rehabilitation setting.
Prior to discharge home, stroke patients should receive appropriate information about comminity resources and their own personalized plan for prevention of another stroke and avoiding stroke-related complications. A customized plan for functionally adapting to any residual disability should be developed for each stroke survivor recognizing occupational and avocational activities that are uniquely important to the individual.