1. Preparing for Stroke Certification
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Preparing for Stroke Certification
Stroke Coordinator Boot Camp
April 17, 2015

2. Presenter Disclosure Information
MJ Hampel
Preparing for Stroke Certification
Financial Disclosure:
No relevant financial relationship exists

4. Acute Stroke Ready Hospitals
Models of Stroke Care
Primary Stroke Center
1000 – 1200
Acute Stroke Ready Hospitals
Academic medical center, tertiary care facility
CSC
75 – 200
2012
Wide range of hospitals; standard stroke care; stroke unit; uses tPA
2003
Rural hospitals; basic care; drip and ship; use tele-technologies
July2015

5. 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
< Data as of 4/8/15 >

6. PSC vs. ASRH Primary Stroke Center Acute Stroke Ready Hospital
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

7. 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
As I mentioned earlier, ASRH candidates are rural hospitals, like most of you, with no designated stroke beds. A relationship with EMS is the key to rapid treatment for stroke patients therefore, communication, protocols and education between EMS and the ASRH are key components of the certification.

8. Advanced Certification Model
Quality & Safety of Care for Patients
Process
Clinical Practice Guidelines
Structure
Standards + program specific requirements
Outcome
Standardized Performance Measures

9. Structure: ASRH Requirements
Initial Assessment
Telemedicine
Transfer Protocol
Staff Education
Performance Measurement

10. ASRH Initial Assessment
Performed 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 to
Stroke expertise, including consultation for IV-thrombolytic therapy
CT/MRI, lab tests, ECG, and chest x-ray WHEN ORDERED. Results available within 45 minutes (60 minutes for MRI)

11. 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

12. ASRH Transfer Protocol(s)
Agreement with one PSC or CSC
Transfer IV-thrombolytic and neurosurgical patients
Patients should leave the hospital within 2 hours of ED arrival or when medically stable
Written protocol includes communication and feedback from receiving facility

13. 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

14. 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

15. Additional Requirements for ASRH
Topic
Standard Number
Relationship with EMS
DSPR.3, EP 4
Stroke team log
DSPM.3, EP 2a
Stroke registry
DSPM.3, EP 2b

16. Process: Clinical Practice Guidelines
Current evidence-based guidelines are embedded in the ASRH standing orders.
Evaluated thru patient tracer activity
Most 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
National Guideline Clearinghouse at

17. 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 clinical
Other two measures can be clinical, administrative, utilization, or satisfaction

18. 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:

19. Certification Logistics
Pre
Gap analysis to standards and guidelines; resolution of any gaps
Apply 4-6 months before desired review date
Data Collection
Visit
30 days advance notification of date
ASRH and PSC: One reviewer x one day
CSC: Two reviewers x two days
Post
Data collection and submission
Intracycle conference call 12 months after visit
Apply for recertification
Recertification visit occurs 2 years after initial visit
To be scheduled within 90 day window around anniversary date
7 days advance notice of date

21. 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 closely
Creates a loyal, cohesive clinical team
Provides an objective assessment of clinical excellence
Differentiates clinical care in the marketplace
Promotes achievement to referral sources

22. Contact Information
MJ Hampel, MPH, MBA Director, Clinical Services Certification The Joint Commission

23. 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.