Circular No. 47/2016/TT-BYT dated December 30, 2016 of the Ministry of Health on regulations on medical examination and treatment for strokes in medical facilities

THE MINISTRY OF HEALTH

Circular No. 47/2016/TT-BYT datedDecember 30, 2016 of the Ministry of Health on regulations on medical examination and treatment for strokes in medical facilities

Pursuant to the Government s Decree No. 63/2012/ND-CP dated August 31, 2012 defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the request of general director of the Agency of Medical Services Administration, the Minister of Health promulgates the Circular stipulating examination and treatment for strokes in medical facilities.

Chapter I

GENERAL PROVISIONS

Article 1. Scope of adjustment andsubject of application

1. This Circular stipulates medical examination and treatment for strokes in medical facilities.

2. This Circular applies to state-owned and private medical facilities including Emergency 115 facilities (hereinafter referred to as ‘medical facilities’).

Article 2. Manners of medical examination and treatment of strokes in medical facilities:

A health facility may choose organize its stroke treatment activities in one of following manners:

1. Stroke team;

2. Stroke unit;

3. Stroke department;

4. Stroke center.

Article 3. General principles of organizing medical examination and treatment of strokes

1. Stroke teams, stroke units, stroke departments and stroke centers in medical facilities shall work 24/7.

2. A stroke is considered as an emergency case. A medical facility must concentrate all its personnel, equipment and equipment on administration of first aid, quick diagnosis, provision of treatment and rehabilitation.

Chapter II

FUNCTIONS, DUTIES AND ORGANIZATIONAL STRUCTURE OF A STROKE TEAM

Article 4. Functions of a stroke team

A stroke team is a team which performs rapid response to strokes and is established by a medical facility. Functions of the team include receiving stroke patients and performing rapid assessment, classification, initial emergency treatment and transportation of stroke patients.

Article 5. Duties of a stroke team

1. Receive stroke patients and perform rapid assessment, classification and administration of first aid.

a) Receive requests for administration of first aid to acute stroke patients from clinical units of the medical facility and perform rapid assessment and classification of strokes. Information about stroke patients must be fully recorded using the form provided in Annex 1 enclosed herewith.

b) Administer first aid to stroke patients: If a stroke patient is in a clinical unit of the medical facility, the stroke team shall cooperate with such clinical unit in administering first aid.

c) Make quick report on the condition of a stroke patient to the stroke unit or stroke department or stroke center of such medical facility or the most capable medical facility in order for it to prepare for the admission of the patient.

2. Assist in transportation of the patient to the stroke unit, stroke department or stroke center of the nearest medical facility.

3. Assist in administration of first aid, medical examination and treatment for stroke patients in other medical facilities as requested.

4. Making statistical and professional reports according to laws.

5. Perform other duties related to medical examination and treatment if capable and approved by competent authorities.

Article 6. Scope, personnel and equipment of a stroke team

1. Any medical facility that receives fewer than 100 stroke patients a year shall establish a stroke team.

2. A stroke team is composed of at least one general practitioner and one nurse who are trained in stroke treatment.

3. A stroke team must have adequate essential equipment on the list in Annex 02 enclosed herewith.

Chapter III

FUNCTIONS, DUTIES AND ORGANIZATIONAL STRUCTURE OF A STROKE UNIT

Article 7. Functions of a stroke unit

A stroke unit is part of the clinical department of a medical facility which performs the functions of a stroke team and is responsible for administration of first aid, diagnosis, intensive treatment, stroke rehabilitation and prevention.

Article 8. Duties of a stroke unit

1. Perform duties of a stroke team as prescribed in Article 5 herein.

2. Administer first aid, diagnosis and treatment to stroke patients, including:

a) Administration of first aid and care to stroke patients.

Quick diagnosis: Cooperate with medical imaging department and relevant departments in performing quick diagnosis of strokes.

c) Intensive internal treatment: Cooperate with relevant departments in providing intensive treatment for stroke patients.

d) Use of streptokinase: Cooperate with relevant departments in performing streptokinase-related treatment as indicated.

dd) Coronary intervention: Cooperate with relevant departments in performing coronary intervention as indicated.

e) Surgery: Cooperate with neurosurgeons and relevant experts in performing medical consultation and surgery as indicated.

g) Stroke rehabilitation: Cooperate with physical therapy and rehabilitation department in stroke rehabilitation.

3. Transport stroke patients: If the case is beyond the stroke unit’s capacity, it must make a written notice and transport the patient to the nearest stroke department or stroke center.

4. Prevent stroke relapse.

5. Compile and update professional instructions on stroke treatment.

6. Cooperate with relevant units in the medical facility and the stroke treatment network in administration of first aid, diagnosis and treatment of strokes.

7. Disseminate knowledge about stroke prevention and treatment.

Article 9. Organizational structure of a stroke unit

1. A stroke unit is part of the internal neurology department, emergency department or intensive care department or cardiology department of a medical facility.

2. Sub-units:

a) Neurologic – stroke emergencies;

b) Intensive acute neurologic –stroke therapies;

c) Sub-acute stroke treatment;

d) Stroke - neurological rehabilitation;

dd) Techniques (performing quick diagnosis);

e) Consultation;

g) Stroke groups.

3. The head of a medical facility shall make decision on organizational structure of the stroke unit as prescribed in Clause 2 of this Article and assign particular tasks to sub-units of the stroke unit according to conditions of the medical facility.

Article 10. Scope, personnel and equipment of a stroke unit

1. Any medical facility that receives fewer than 500 stroke patients a year must establish a stroke unit. A stroke unit has fewer than 20 beds.

2. Personnel

a) A stroke unit consists of Neurologists, emergency physicians or intensive recovery specialists and nurses who have been trained in stroke treatment.

b) The number of physicians and nurses shall depend on number of beds and conditions of the medical facility.

3. Essential equipment

a) A stroke unit must have adequate equipment on the list of equipment in Annex 02 enclosed herewith.

b) The quantity of essential equipment shall be decided by the head of the medical facility according to the quantity of beds and needs for medical examination and treatment.

Chapter IV

FUNCTIONS, DUTIES AND ORGANIZATIONAL STRUCTURE OF A STROKE DEPARTMENT

Article 11. Functions of a stroke department

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

Article 12. Duties of a stroke department

1. Perform duties of a stroke unit as prescribed in Article 8 herein.

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

3. Perform or cooperate with specialties in medical facilities in performing coronary intervention to stroke patients.

Article 13. Organizational structure of a stroke department

A stroke department consists of the units prescribed in Clause 2, Article 9 herein. Depending on conditions of the medical facility and needs for medical examination and treatment of strokes, the stroke department may have other units.

Article 14. Scope, personnel and equipment of a stroke department

1. Any medical facility that receives fewer than 1,000 stroke patients a year must establish a stroke department. A stroke department has fewer than 50 beds.

2. Personnel: prescribed in Clause 2, Article 10 herein and applicable regulations on organizational structure and activities of clinical departments.

3. Essential equipment:

a) A stroke department must have adequate equipment on the list of equipment in Annex 02 enclosed herewith.

b) The quantity of equipment shall be decided by the head of the medical facility according to the quantity of beds and needs for medical examination and treatment.

Chapter V

FUNCTIONS, DUTIES AND ORGANIZATIONAL STRUCTURE OF A STROKE CENTER

Article 15. Functions of a stroke center

Stroke center is clinical department of a medical facility which performs the functions of a stroke department and provides surgical treatment to stroke patients.

Article 16. Dutiesof a stroke center

1. Perform duties of a stroke department as prescribed in Article 12 herein.

2. Perform coronary intervention techniques.

3. Perform neurosurgery

4. Perform physical therapy – rehabilitation techniques.

Article 17. Organizational structureof a stroke center

1. Organizational structure of a unit center shall include the units prescribed in Clause 2, Article 9 herein and the following units:

a) Surgery – anesthesiology unit;

b) Coronary intervention unit;

c) Stroke – neurological rehabilitation room.

2. Other units of the stroke center shall be decided by head of the medical facility.

Article 18. Scope, personnel and equipment of a stroke center

1. Any medical facility accommodating fewer than 1,000 stroke patients a year must establish a stroke center. A stroke center has at least 50 beds.

2. Personnel: In addition to the personnel prescribed in Clause 2, Article 10 herein, the internists, brain surgeons, coronary intervention physicians, rehabilitation physicians, therapeutic exercise technicians, language therapists, physical therapy technicians and other medical specialists are also included. These personnel may come from other departments of the medical facility as decided by head of the medical facility.

3. Essential equipment:

a) A stroke center must have adequate equipment on the list of equipment in Annex 2 enclosed herewith.

b) The quantity of equipment shall be decided by the head of the medical facility according to the quantity of beds and needs for medical examination and treatment.

Chapter VI

IMPLEMENTATION

Article 20. Implementation roadmap

1. Roadmap:

a) For special class general hospitals: establish stroke departments by 2020 and stroke centers by 2025.

b) For first class general hospitals: establish stroke units by 2020 and stroke departments by 2025.

c) For other general hospitals: establish stroke teams by 2020 and stroke units by 2025.

2. The establishment of stroke centers, stroke departments, stroke units and stroke teams must be in compliance with laws.

Article 21. Responsibility

1. The Agency of Medical Services Administration shall preside over and cooperate with relevant units in directing, organizing and inspecting the implementation of this Circular by medical facilities across the country.

2. The Services of Health of provinces, heads of health authorities of Ministries shall direct, organize and inspect the implementation of this Circular by medical facilities within competence.

3. Any medical facility that has a stroke center, stroke department, stroke unit or stroke team must develop a plan for personnel recruitment and training, investment and upgrading of infrastructure and medical equipment to meet requirements prescribed herein.

4. Commune-level medical stations, Emergency 115 facilities must prepare plans for sending staff to undergo training in strokes to be able to receive, evaluate stroke patients and provide emergency treatment, and make notification to medical facilities that have stroke teams, stroke departments, stroke centers or medical facilities of higher levels before transferring patients.

Article 22. Effect

This Circular takes effect on March 01, 2017.

Any difficulties that arise during the implementation of this Circular should be reported to the Agency of Medical Services Administration - the Ministry of Health./.

For the Minister

The Deputy Minister

Nguyen Viet Tien