Circular No. 47/2016/TT-BYT on the organization of stroke diagnosis and treatment at medical facilities

CIRCULAR

REGULATIONS ON THE ORGANIZATION OF STROKE DIAGNOSIS AND TREATMENT IN MEDICAL FACILITIES

Decree No. 63/2012/NĐ-CP dated August 31, 2012 of the Government on functions, tasks, powers, and organizational structure transmission within the scope of payment of the health insurance fund.

At the proposal of the Director of the Department of Medical Examination and Treatment Management;m, treatment, Ministry of Health issues this Circularizing the organization of stroke diagnosis and treatment in medical facilities1. This Circular stipulates the organization of stroke diagnosis and treatment in medical facilities.1. Ensuring the quality of diagnosis and treatment and safety for patients.

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation and Applicability

2. This Circular applies to state and private medical facilities, including emergency services 115 (hereinafter referred to as medical facilities).

Article 2. Forms of organization for stroke diagnosis and treatment in medical facilities:

Depending on actual conditions, medical facilities organize one of the following forms of stroke diagnosis and treatment:

1. Stroke team;

2. Stroke unit;

3. Stroke department;

4. Stroke center.

Article 3. General principles in organizing stroke diagnosis and treatment

1. The stroke team, stroke unit, stroke department, and stroke center at medical facilities must ensure continuous operation 24/24 hours a day, 7 days a week.

2. A stroke patient is considered an emergency case. Medical facilities must prioritize all human resources, equipment, and infrastructure to promptly handle emergencies, quickly diagnose, and provide early treatment and functional recovery for stroke patients.

FUNCTIONS, TASKS, AND ORGANIZATION OF THE STROKE TEAM

Chapter II

Article 4. Functions of the stroke team

The stroke team is a rapid response team for strokes established by medical facilities, with the function of receiving, quickly assessing, classifying, providing initial emergency care, and assisting in transporting stroke patients.

Article 5. Tasks of the stroke team

1. Receiving, quickly assessing, classifying, and providing initial emergency care for stroke

a) Receiving requests for emergency assistance for stroke patients from clinical units of medical facilities and conducting quick assessments and classifications of strokes. The person receiving information must record all patient information in the patient stroke information logbook according to the model prescribed in Appendix 1 attached to this Circular.

b) Providing initial emergency care for stroke patients: In cases where stroke patients are in clinical units of medical facilities, the stroke team collaborates with these clinical units to provide initial emergency care.

c) Quickly informing about the condition of stroke patients to the stroke unit or stroke department or stroke center of that medical facility or the most appropriate medical facility so that these facilities can prepare to receive the patient.

2. Assisting in transporting acute stroke patients to the nearest stroke unit or stroke department or stroke center.

3. Participating in supporting emergency care, diagnosis, and treatment of stroke at other medical facilities when requested.

4. Implementing statistical and professional reporting systems as prescribed by law.

5. Performing other related tasks in diagnosis and treatment when conditions permit and upon approval by competent authorities.

5. Perform other tasks related to medical examination and treatment when having the necessary conditions and being approved by the competent authority.

Article 6. Scale, manpower, and equipment of the stroke team

1. Medical examination and treatment facilities with less than 100 stroke patients in a year shall establish a stroke team.

2. Manpower of the stroke team: including at least one general practitioner trained and certified in stroke and one nurse trained in stroke.

3. Equip with essential medical devices according to the Equipment List prescribed in Appendix 02 issued together with this Circular.

Chapter III

FUNCTIONS, DUTIES AND ORGANIZATION OF THE STROKE UNIT

Article 7. Functions of the stroke unit

The stroke unit is a department under the clinical department of medical examination and treatment facilities, performing functions similar to those of the stroke team, emergency care, diagnosis, intensive treatment, functional recovery, and prevention of stroke for patients.

Article 8. Duties of the stroke unit

1. Perform the duties of the stroke team as stipulated in Article 5 of this Circular.

2. Emergency care, diagnosis, and treatment for stroke patients, including:

a) Emergency care and patient management for stroke patients.

b) Rapid diagnosis of stroke: Coordinate with the radiology department and related departments to rapidly diagnose stroke.

c) Intensive internal medicine treatment: Coordinate with related departments in providing intensive treatment for stroke patients.

d) Use thrombolytic drugs: Coordinate with related departments to administer thrombolytic drug therapy if indicated.

đ) Vascular intervention: Coordinate with related departments to perform vascular intervention if indicated.

e) Surgery: Coordinate with neurosurgeons and relevant specialists to consult and treat patients if neurosurgical surgery is indicated.

g) Functional recovery for stroke patients: Coordinate with the Physical Medicine and Rehabilitation Department to provide functional recovery for patients according to the instructions of a specialist in rehabilitation.

3. Transporting stroke patients: When exceeding the professional capacity, the stroke unit will notify and participate in transporting patients to the nearest stroke department or stroke center.

4. Preventing recurrent stroke.

5. Developing and updating technical guidance on stroke.

6. Coordinating with related units within the medical examination and treatment facility and the stroke medical network in emergency care, diagnosis, and treatment of stroke.

7. Communicating, educating about health, and advising on the prevention and control of stroke.

Article 9. Organizational structure of the stroke unit

1. The stroke unit is a department under the Neurology Department, or the Emergency Department, or the Intensive Care Unit, or the Cardiology Department of the medical examination and treatment facility.

2. Specialized sections:

a) Neurological emergency - stroke;

b) Intensive neurological treatment - acute stroke;

c) Subacute stroke treatment;

d) Neurological functional recovery - stroke;

đ) Techniques (perform some rapid diagnoses);

e) Consultation;

g) Stroke team.

3. The head of the medical examination and treatment facility decides on the organizational structure of the stroke unit as stipulated in Clause 2 of this Article and assigns specific tasks to the specialized sections of the stroke unit based on the conditions of the medical examination and treatment facility.

Article 10. Scale, manpower, and equipment of the stroke unit

1. Medical examination and treatment facilities with less than 500 stroke patients in a year shall establish a stroke unit. The scale of beds in the stroke unit is less than 20 beds.

2. Manpower

a) The stroke unit has neurologists, or emergency doctors, or intensive care doctors, trained in stroke and nurses trained in stroke.

b) The number of doctors and nurses depends on the scale of beds and the actual conditions of the medical examination and treatment facility.

3. Essential equipment

a) Equip with essential medical devices according to the Equipment List prescribed in Appendix 02 issued together with this Circular.

b) The stock of essential equipment is decided by the head of the medical examination and treatment facility based on the scale of beds and medical examination and treatment needs.

Chapter IV

FUNCTIONS, DUTIES AND ORGANIZATION OF THE STROKE DEPARTMENT

Article 11. Functions of the Stroke Department

The Stroke Department is a clinical department of a medical examination and treatment facility that performs the functions of a stroke unit and provides comprehensive internal medicine treatment for stroke patients.

Article 12. Duties of the Stroke Department

1. Perform the duties of a stroke unit as prescribed in Article 8 of this Circular.

2. Provide intensive and comprehensive internal medicine treatment for stroke patients.

3. Conduct or coordinate with specialized units within the medical examination and treatment facility to perform vascular interventions for stroke patients.

Article 13. Organizational Structure of the Stroke Department

The Stroke Department is organized into specialized units as prescribed in Clause 2, Article 9 of this Circular. Depending on the conditions of the medical examination and treatment facility and the requirements of stroke medical examination and treatment activities, the Stroke Department may organize additional units.

Article 14. Scale, Human Resources, and Equipment of the Stroke Department

1. A medical examination and treatment facility treating less than 1,000 stroke patients annually shall establish a Stroke Department. The scale of hospital beds in the Stroke Department is less than 50 beds.

2. Human resources: as prescribed in Clause 2, Article 10 of this Circular and according to current regulations on the organizational structure and operation of clinical departments.

3. Essential equipment:

a) Equip with essential medical devices according to the Equipment List prescribed in Appendix 02 issued together with this Circular.

b) The stock of essential equipment is decided by the head of the medical examination and treatment facility based on the scale of beds and medical examination and treatment needs.

Chapter V

FUNCTIONS, DUTIES AND ORGANIZATION OF THE STROKE CENTER

Article 15. Functions

The Stroke Center is a clinical unit of a medical examination and treatment facility that performs the functions of a Stroke Department and provides surgical treatment for stroke patients.

Article 16. Duties

1. Perform the duties of a Stroke Department as prescribed in Article 12 of this Circular.

2. Perform vascular intervention techniques.

3. Perform neurosurgical procedures.

4. Perform physical therapy and functional rehabilitation techniques.

Article 17. Organizational Structure of the Stroke Center

1. The Stroke Center is organized to include specialized units as prescribed in Clause 2, Article 9 of this Circular and the following units:

a) Surgery - Anesthesia and Intensive Care;

b) Vascular Intervention;

c) Rehabilitation Neurology - Stroke Exercise Room.

2. Other units of the Stroke Center are decided by the head of the medical examination and treatment facility.

Article 18. Scale, Human Resources, and Equipment of the Stroke Center

1. A medical examination and treatment facility treating approximately 1,000 or more stroke patients annually shall establish a Stroke Center. The scale of hospital beds in the Stroke Center is 50 beds or more.

2. Human resources: In addition to the human resources of the Stroke Department as prescribed in Clause 2, Article 10 of this Circular, the human resources of the Stroke Center also includes general internists; neurosurgeons, vascular interventionalists; rehabilitation physicians, physiotherapy technicians, speech-language pathology technicians, and physical therapy technicians, and other specialists. These healthcare staff may be from other departments of the medical examination and treatment facility, as decided by the head of the medical examination and treatment facility.

3. Essential equipment:

a) Must have essential equipment as listed in the Equipment List attached as Appendix 2 to this Circular.

b) The stock of essential equipment is decided by the head of the medical examination and treatment facility based on the scale of beds and medical examination and treatment needs.

Chapter V

IMPLEMENTATION

Article 20. Implementation Roadmap

1. Implementation Plan:

a) For special-class general hospitals: strive to establish a Stroke Department by 2020 and a Stroke Center by 2025.

b) For first-class general hospitals: strive to establish a Stroke Unit by 2020 at minimum and a Stroke Department by 2025.

c) For remaining general hospitals: strive to establish a Stroke Team by 2020 at minimum and a Stroke Unit by 2025.

2. The establishment of Stroke Centers, Stroke Departments, Stroke Units, and Stroke Teams must comply with the provisions of the law.

Article 21. Responsibilities for Implementation

1. The Department of Medical Examination and Treatment shall take the lead and coordinate with relevant units to direct, organize, and inspect the implementation of this Circular for medical examination and treatment facilities nationwide.

2. Provincial Health Departments, Health Directors of Ministries and sectors shall direct, organize, and inspect the implementation of this Circular for medical examination and treatment facilities under their management authority.

3. Medical examination and treatment facilities with Stroke Centers, Stroke Departments, Stroke Units, or Stroke Teams must develop plans for recruitment, training, allocation of human resources, investment, and upgrading of infrastructure and medical equipment to meet the conditions stipulated in this Circular.

4. Health stations, emergency services 115: develop plans to send personnel for training on stroke to participate in receiving, assessing, and providing emergency care for stroke patients and notify facilities with Stroke Teams, Stroke Departments, or Stroke Centers, or higher-level medical examination and treatment facilities before transferring patients to a higher level.

Article 22. Effectiveness

This Circular takes effect from March 1, 2017.

During the implementation process, if there are difficulties or obstacles, agencies, organizations, and individuals are advised to report to the Department of Medical Examination and Treatment, Ministry of Health for consideration and resolution./.