Stroke Center Certification

Certification for Primary Stroke Center

- The Joint Commission

Hospitals are evaluated and receive a certification decision based on an assessment of:

• Compliance with consensus-based national standards
• Effective use of primary stroke center recommendations and clinical practice guidelines to manage and optimize care.
• Performance measurement and improvement activities.
  

The Joint Commission awards certification for one year to primary stroke centers that successfully demonstrate compliance in all three areas. A one-year extension is contingent on submitting an acceptable assessment of compliance with standards and performance measurement and management activities. Primary Stroke Centers will receive an on-site review every two years by The Joint Commission. - Source: Brain Attack Coalition

Recommendations for Comprehensive Stroke Centers
A Consensus Statement from the Brain Attack Coalition

There are a number of key areas supported by evidence-based medicine that are important for a comprehensive stroke center and its ability to deliver the wide variety of specialized care needed by patients with serious cerebrovascular disease. These areas include:

1. health care personnel with specific expertise in a number of disciplines, including neurosurgery and vascular neurology
2. advanced neuroimaging capabilities such as MRI and various types of cerebral angiography
3. surgical and endovascular techniques, including clipping and coiling of intracranial aneurysms, carotid endarterectomy, and intra-arterial thrombolytic therapy
4. and other specific infrastructure and programmatic elements such as an intensive care unit and a stroke registry
Integration of these elements into a coordinated hospital-based program or system is likely to improve outcomes of patients with strokes and complex cerebrovascular disease who require the services of a comprehensive stroke center. (Stroke. 2005;36:1597-1618.)

Personnel and Clinical Expertise

A CSC should have the following personnel:
1. a center director*
2. neurologists and neurosurgeons
3. surgeons with expertise performing carotid endarterectomy (CEA)
4. diagnostic radiologists
5. physicians with expertise in interventional endovascular neuroradiology procedures and techniques
6. ED personnel and links to emergency medical services (EMS)
7. radiology technologists
8. nursing staff who are trained in the care of stroke patients
9. advanced practice nurses (APNs)
10. physicians with expertise in critical care or neurointensive care, echocardiography, carotid ultrasound (U/S), and transcranial Doppler (TCD)
11. physicians and therapists with training in rehabilitation
12. case managers and social workers

*The CSC director might be a neurologist or neurosurgeon, although other medical professionals could fulfill this role. Examples of qualifications for a CSC director include 2 of the following:

• a board-certified neurologist or neurosurgeon who has completed a stroke fellowship or vascular neurosurgery fellowship or has equivalent experience
• a board certified in vascular neurology
• a fellow of the Stroke Council of the American Heart Association (AHA)
• a clinician who diagnoses and treats 50 patients with cerebrovascular disease annually
• a clinician with 10 peer-reviewed publications dealing with cerebrovascular disease
• a clinician with 12 continuing medical education (CME) credits each year in areas directly related to cerebrovascular disease
• other criteria as determined by the local health care system.

Source: Brain Attack Coalition

Brian Attack Coalition Checklist

• Does the hospital have a Stroke Team led by a healthcare professional with training and expertise in stroke? A Stroke Team is a professional staff available around the clock, seven days a week to evaluate the patient within 15 minutes of arrival.
• Does the hospital have written guidelines for emergency treatment for stroke patients?
• Does the city's emergency medical system transport patients with suspected strokes as rapidly as possible to the hospital?
• Is the hospital's emergency department physicians trained to rapidly diagnose and treat acute stroke?
• Does the hospital provide coordinated stroke care beyond the emergency department physician's evaluation? If not, is the hospital prepared to transfer the patient to a hospital that does?
• Does the hospital have a neurosurgeon available around the clock, seven days a week? If not, is the hospital prepared to transfer the patient to a hospital that does?
• Is the hospital administration committed to the Stroke Center?
• Does the hospital have capability around the clock, seven days a week to perform and interpret either a head CT scan or a brain MRI scan within 45 minutes of the stroke patient being admitted?
• Is the hospital lab open around the clock, seven days a week?
• Does the hospital track patient outcomes, perform ongoing program evaluation, and strive for improvements?
• Does the hospital staff of the Stroke Center receive at least eight hours per year of continuing medical education?
• Does the hospital have at least two annual programs to educate the public about stroke prevention, diagnosis, and the availability of acute therapies

• Source: Brain Attack Coalition

ASTP Program Capacity Assessment Tool

This document is the core piece of the Acute Stroke Treatment Program (ASTP), which provides hospitals with a tool to help strengthen their acute stroke delivery infrastructure and evaluate their readiness to treat stroke.

Source: American Stroke Association

Performance measurement for certified primary stroke centers
Effective January 1, 2010, certified primary stroke centers must collect and report on eight National Inpatient Hospital Quality Measures for stroke. Data are submitted quarterly to The Joint Commission through the secure extranet site no later than 45 days following the end of the calendar quarter. The measures include:
• Venous thromboembolism (VTE) prophylaxis
• Discharged on antithrombotic therapy
• Anticoagulation therapy for atrial fibrillation/flutter
• Thrombolytic therapy
• Antithrombotic therapy by end of hospital day two
• Discharged on statin medication
• Stroke education
• Assessed for rehabilitation

The eight measures have been endorsed by the National Quality Forum and approved as a core measure set for use in the Joint Commission’s ORYX program after October 1, 2009. For more information, go to the Web site.
Source: The Joint Commission

Useful Links:

Joint Commission accreditation and certification

The Acute Stroke Treatment Program (ASTP) Guides hospitals through a step-by-step process for establishing a Primary Stroke Center in their facility