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Understanding Stroke Center Certification Variability

Stroke centers are vital in providing specialized care during the critical moments following a stroke.

However, a recent study (AHA Journals) reveals considerable variability across the United States in how states handle Stroke Center Certification and designate these centers. This post explores the nuances of these processes and discusses how virtual neurology services, like those provided by Sevaro, are crucial in navigating these complexities.

Categories of State Stroke Center Certification Processes

The requirements for stroke center certification are mandated at the state level, and for some states, certification does not require an (external) certifying organization to grant a given level of stroke center certification.

Some states rely on a self-certification or independent stroke center designation – others have no state certification or designation process at all. 

Stroke patient arriving at a certified stroke center, that has passed its Stroke Center Certification
The study categorizes state processes into three main groups:
  1. No State Certification or Designation (Category A): Some states do not have their own certification processes, relying instead on hospitals to seek national accreditation independently.
  2. State Designation Reliant on National Certification (Category B): In these states, hospitals must obtain national certification to be recognized as stroke centers, ensuring adherence to high standards of care.
  3. Self-Certification or Independent Designation (Category C): These states allow hospitals to either certify themselves or undergo state-specific designation processes, which may not rely on national standards.
Figure. Categorization of states with state-level stroke center certification or designation processes. States are categorized by the presence of a state-level certification or designation process for hospitals. Many hospitals choose to pursue certification through certifying organizations outside of the state-level process; this is not represented in this figure. Categories include A: no state certification or designation process; B: state designation reliant on national certification only; or C: state has option for self-certification or independent designation. *In addition to the 4 national certifying organizations, Texas also accepts certifications from the Texas EMS Trauma & Acute Care Foundation for level IV (Acute Stroke Ready) hospitals. **The Michigan Department of Health and Human Services publishes a list of hospitals participating in the Paul Coverdell National Acute Stroke Program (PCNASP) and corresponding stroke certification levels. While PCNASP is not a state designation program, state recognition of hospital stroke certification categorizes Michigan’s process as category B. Washington DC was not included in this study. Figure created with
Impact of Certification Variability

This heterogeneity can significantly impact the clinical performance of stroke centers and patient outcomes. The classification for levels of certification may vary greatly between different certifying organizations and can be confusing for EMS agencies, patients, and even for members of a given health care organization. 

Two of the major national certifying organizations and their respective classifications for stroke levels of stroke center certification are compared below. 

Stroke Certification

Hospitals in states with rigorous certification requirements tend to have better-equipped facilities and more trained staff, leading to higher-quality care and better patient outcomes.

Sevaro’s Role in Enhancing Stroke Care

Sevaro’s telestroke services are designed to complement these varying certification processes. By providing rapid access to board-certified vascular neurologists and employing data-driven insights, Sevaro helps hospitals meet and exceed certification standards, regardless of their state’s specific requirements.

I recently underwent our stroke center accreditation survey and our surveyor was extremely impressed with Sevaro’s documentation. The surveyor mentioned multiple times that Sevaro’s documentation was exactly what she needed from an accreditation perspective.” -Stroke Coordinator, Indiana

Bridging the Gaps in Stroke Care

Sevaro effectively integrates with hospital systems to streamline the certification process and enhance the overall stroke care pathway. This support is crucial for hospitals navigating the complexities of state-specific certification and aiming to improve their stroke care capabilities.

At Sevaro, we understand the rigors and nuances of the accreditation process – Sevaro Health has earned The Joint Commission’s Gold Seal of Approval® Accreditation by demonstrating continuous compliance with its performance standards. 

We work with our hospital partners across the country to achieve and maintain various levels of stroke center certification with multiple certification bodies. 

Certified Comprehensive Stroke Center
The Joint Commission Gold Seal of Approval


As the landscape of stroke center certification continues to evolve, understanding the implications of these processes is more important than ever. For hospitals looking to enhance their stroke care services, partnering with a telestroke provider like Sevaro can be a game-changer, ensuring that they not only meet but exceed the standards required to achieve and maintain certification.


About The Author

Melanie J. Winningham, MD
Regional Stroke Director – Sevaro

Drawn to Sevaro’s innovative blend of physician leadership and technology, Dr. Winningham combines her expertise as a vascular neurologist & comprehensive stroke center medical director with a deep commitment to improving stroke care.

Her time spent as Chair for the Virginia Stroke Systems Task Force gives her a particular understanding of regional systems of stroke care and the importance of stroke epidemiology in improving those systems.

Dr. Winningham holds a bilingual medical degree from Ponce Health Sciences University in Puerto Rico. She completed her Neurology residency and Vascular Neurology fellowship training at the Emory University School of Medicine in Atlanta and spent time there as an NIH StrokeNet research fellow prior to relocating to Charlottesville, VA.