Stroke Designation

On February 17, 2022, updated stroke designation rules went into effect. Stroke rules were legislated in 2005, when Senate Bill 330 was passed during the 79th Legislature. The purpose of the bill was to develop a state emergency stroke treatment system. This allows responders to identify and transport a person with acute stroke signs and symptoms to an appropriate designated facility. The hospital designation requirements were established to ensure prompt and appropriate treatment for possible stroke victims.

The stroke requirements now include an Advanced Stroke Center designation which differentiates hospitals that are capable of providing thrombectomy procedures, but are not a Comprehensive Center.

The four levels of stroke designation are:

• Level I – Comprehensive
• Level II – Advanced
• Level III – Primary
• Level IV – Acute Stroke Ready 

The Texas Department of State Health Services (DSHS) has the authority to designate facilities. The EMS/Trauma Systems Section of DSHS works with hospitals and Regional Advisory Councils (RACs) to:

• Develop facility designation protocols,
• Develop policies and guidelines, and
• Improve the overall care and outcomes of stroke patients.

Overview

• Rule 157.133 Requirements for Stroke Facility Designation
• Texas Department of State Health Services Heart Disease and Stroke Program

Councils

• Governor's EMS & Trauma Advisory Council (GETAC)
• Regional Advisory Councils (RACs)

The Brain Attack Coalition (BAC) recommendations are the department-approved national stroke standard requirements for Comprehensive, Primary and Acute Stroke Ready Stroke Center designation per Texas Administrative Code (TAC) §157.133. The BAC has not published recommendations for the Advanced Level II Stroke Center requirements.  The department approved stroke standard requirements.

The BAC requirements for Comprehensive, Primary and Acute Stroke Ready are located at: brainattackcoalition.org/

Documents

• Applications and Forms
• DSHS Virtual Survey Guidelines
• DSHS Designation Program: Facility Update Form 
• New Advanced (Level II) Stroke Designation Department Approved Guidelines

Fees

The non-refundable stroke application fees for a stroke designation period are as follows:

• Level I (Comprehensive) stroke facility application fee is $100.00.
• Level II (Advanced) stroke facility application fee is $100.00.
• Level III (Primary) stroke facility application fee is $100.00.
• Level IV (Acute Stroke Ready) stroke facility application fee is $100.00.

Facilities

• List of facilities by Designation Level
• Guidance for Change of Legal Owner of a Hospital Facility (CHOW) and/or Change in Physical Location of a Hospital Facility and/or Impact on Stroke Facility Designation

Map

• EMS/Trauma Systems Interactive Map
   

Policies

• Policy and Procedure:- Facility with Conditional Certification as Comprehensive or Primary Stroke Center and De-Certification with The Joint Commission, Det Norske Veritas (DNV), or Healthcare Facilities Accreditation Program (HFAP)

For the purposes of Stroke Facility designation, DSHS will accept certifications or survey results from these recognized organizations:

• The Joint Commission (TJC)
  Comprehensive, Advanced, Primary, and Acute Stroke Ready
• Det Norske Veritas Global Healthcare (DNV-GL)
  Comprehensive, Advanced, Primary, and Acute Stroke Ready
• The Center for Improvement in Healthcare Quality (CIHQ)
  Comprehensive, Advanced, Primary, and Acute Stroke Ready
• Texas EMS Trauma & Acute Care Foundation (TETAF)
  Acute Stroke Ready