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Preparing for Stroke Certification

Stroke Coordinator Boot Camp

April 17, 2015

AHA Stroke Boot Camp 4 17 15- 2

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Presenter Disclosure Information

MJ HampelPreparing for Stroke Certification

Financial Disclosure: No relevant financial relationship exists


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Models of Stroke Care

CSC75 – 200

Academic medical center, tertiary care facility

Wide range of hospitals; standard stroke care; stroke unit; uses tPA

Rural hospitals; basic care; drip and ship; use tele-technologies

2012

2003

July2015


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Certified Stroke Centers By the Numbers

PSC CSC TOTAL

USA 1060 85 1145

Indiana 22 1 23

Illinois 54 5 59

Michigan 29 3 32

Nebraska 13 0 13

< Data as of 4/8/15 >


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PSC vs. ASRHPrimary Stroke Center

– Stabilize and provide emergency care for patients with acute stroke

– Designated beds for acute stroke patients

– Either admit or transfer to a CSC

Acute Stroke Ready Hospital– Provide emergency care for patients with acute

stroke

– Does not have designated beds for stroke patients

– Drip and ship

– Use telemedicine technologies


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Characteristics of an ASRH Small, rural Acute Care Hospital or Critical Access Hospital

(~100 beds or less) No designated stroke beds Relationship with local EMS fostering communication from the

field during transport and sharing educational opportunities Use of stroke protocols and an acute stroke team to expedite

the assessment and treatment of a patient presenting with a stroke

Teleconsult capability and transfer agreements with facilities that provide primary or comprehensive stroke services

The ability to administer intravenous thrombolytics, if needed, prior to transferring the patient to a facility that provides primary or comprehensive stroke services


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Advanced Certification Model

Quality & Safety of Care for Patients

Process Clinical Practice

Guidelines

Structure Standards + program specific requirements

OutcomeStandardized

Performance Measures


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Structure: ASRH Requirements

Initial AssessmentTelemedicineTransfer ProtocolStaff EducationPerformance Measurement


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ASRH Initial AssessmentPerformed by physician, nurse practitioner or

physician assistant within 15 minutes of arrival

Includes NIHSS, CT/MRI, blood glucose test and dysphagia screen (prior to oral intake)

24/7 access toStroke expertise, including consultation for

IV-thrombolytic therapyCT/MRI, lab tests, ECG, and chest x-ray

WHEN ORDERED. Results available within 45 minutes (60 minutes for MRI)


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ASRH Telemedicine

Can provide informed consultation to ED practitioners, including evaluation of images

Telemedicine/teleradiology equipment is onsite

Telemedicine link is initiated within 20 minutes of when it is deemed necessary


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ASRH Transfer Protocol(s)

Agreement with one PSC or CSCTransfer IV-thrombolytic and

neurosurgical patientsPatients should leave the hospital within

2 hours of ED arrival or when medically stable

Written protocol includes communication and feedback from receiving facility


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ASRH Staff Education

Members of core stroke team receive at least 4 hours of stroke education annually

ED staff (not including physicians) participate in 2 stroke educational activities per year

Makes educational opportunities available to prehospital personnel


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ASRH Performance Measurement

Monitor ability to administer t-PA within 60 minutes

Monitor t-PA complications including symptomatic intracerebral hemorrhage and serious life-threatening systemic bleeding

Committee meets twice a year to evaluate protocols and practice patterns


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Additional Requirements for ASRHTopic Standard Number

Relationship with EMS DSPR.3, EP 4

Stroke team log DSPM.3, EP 2a

Stroke registry DSPM.3, EP 2b


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Process: Clinical Practice GuidelinesCurrent evidence-based guidelines are

embedded in the ASRH standing orders. Evaluated thru patient tracer activityMost frequently-cited requirement for

improvement: 31% of reviews in 2014 cited for not delivering care through the use of CPGs

On-line resources: – American Heart Assn at www.heart.org– National Guideline Clearinghouse at

www.guideline.gov


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Outcome: Performance Measurement Criteria

Four process or outcome measures to monitor on an ongoing basis – Select from the universe of measures; or– Create your own measures

Two of the measures must be clinicalOther two measures can be clinical,

administrative, utilization, or satisfaction


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ASRH Performance Measurement

Potential choices include– Door to needle time– Turn around time for head CT/laboratory tests– Practitioner response time to code stroke– Patient complications– Time to telemedicine link initiation– Any of the stroke core measures

Resource for measures: http://www.qualitymeasures.ahrq.gov/


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Benefits of Certification

Builds the structure required for a systematic approach to clinical care

Reduces variability and improves the quality of patient care

Pushes you to look at yourself more closelyCreates a loyal, cohesive clinical teamProvides an objective assessment of clinical

excellenceDifferentiates clinical care in the marketplacePromotes achievement to referral sources


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Contact Information

MJ Hampel, MPH, MBA

Director, Clinical Services Certification

The Joint Commission

630-792-5720

[email protected]


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The Joint Commission Disclaimer

These slides are current as of 4/17/15. The Joint Commission reserves the right to change the content of the information, as appropriate.

These slides are only meant to be cue points, which were expounded upon verbally by the original presenter and are not meant to be comprehensive statements of standards interpretation or represent all the content of the presentation. Thus, care should be exercised in interpreting Joint Commission requirements based solely on the content of these slides.

These slides are copyrighted and may not be further used, shared or distributed without permission of the original presenter or The Joint Commission.

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