A Stroke Care Model at an Academic, Comprehensive Stroke Center During the 2020 COVID-19 Pandemic

J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104927. doi: 10.1016/j.jstrokecerebrovasdis.2020.104927. Epub 2020 May 8.


Background and purpose: The COVID-19 pandemic has required the adaptation of hyperacute stroke care (including stroke code pathways) and hospital stroke management. There remains a need to provide rapid and comprehensive assessment to acute stroke patients while reducing the risk of COVID-19 exposure, protecting healthcare providers, and preserving personal protective equipment (PPE) supplies. While the COVID infection is typically not a primary cerebrovascular condition, the downstream effects of this pandemic force adjustments to stroke care pathways to maintain optimal stroke patient outcomes.

Methods: The University of California San Diego (UCSD) Health System encompasses two academic, Comprehensive Stroke Centers (CSCs). The UCSD Stroke Center reviewed the national COVID-19 crisis and implications on stroke care. All current resources for stroke care were identified and adapted to include COVID-19 screening. The adjusted model focused on comprehensive and rapid acute stroke treatment, reduction of exposure to the healthcare team, and preservation of PPE.

Aims: The adjusted pathways implement telestroke assessments as a specific option for all inpatient and outpatient encounters and accounts for when telemedicine systems are not available or functional. COVID screening is done on all stroke patients. We outline a model of hyperacute stroke evaluation in an adapted stroke code protocol and novel methods of stroke patient management.

Conclusions: The overall goal of the model is to preserve patient access and outcomes while decreasing potential COVID-19 exposure to patients and healthcare providers. This model also serves to reduce the use of vital PPE. It is critical that stroke providers share best practices via academic and vetted social media platforms for rapid dissemination of tools and care models during the COVID-19 crisis.

Keywords: COVID-19; Stroke; Stroke code; Systems of care.

MeSH terms

  • Academic Medical Centers
  • Betacoronavirus / pathogenicity*
  • COVID-19
  • California
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / therapy*
  • Coronavirus Infections / virology
  • Critical Pathways / organization & administration
  • Delivery of Health Care, Integrated / organization & administration*
  • Health Services Needs and Demand / organization & administration*
  • Host-Pathogen Interactions
  • Humans
  • Infection Control / organization & administration
  • Infectious Disease Transmission, Patient-to-Professional / prevention & control
  • Models, Organizational
  • Needs Assessment / organization & administration*
  • Neurology / organization & administration*
  • Occupational Exposure / adverse effects
  • Occupational Exposure / prevention & control
  • Occupational Health
  • Pandemics
  • Patient Safety
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / therapy*
  • Pneumonia, Viral / virology
  • Risk Assessment
  • Risk Factors
  • SARS-CoV-2
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / therapy*
  • Time Factors