"There's a significant proportion of stroke patients who have a really large blood clot in the brain, or they have a brain bleed or a stroke that is so severe that it either [triggers] a coma or seizure," Hemmen explains.
"They need to come to a place where, at the door, all options are on the table. If you need to go to a surgery right away; if you need to go to the cath lab to remove the large blood clot right away or you go to the intensive care unit where a specialized physician who is trained in the neurology of intensive care looks after your brain function."
The UC San Diego Medical Center team's multidisciplinary programs often target the elderly. Four in 10 of its stroke patients are over the age of 80, Hemmen says. An estimated 7 million Americans have had some form of stroke, the fourth-leading cause of death in the U.S.
Treating patients is one thing. Awaiting the Joint Commission's decision on certification is something else. And, Carter admits, that's a little scary. When his organization went through the process, he wondered if it would work out. "They put us through the wringer and made me respect the process more. I think we were confident, but yeah, we were a little nervous."
The Joint Commission, for instance, examined each record of patients with a hemorrhagic stroke. Carter says. "They pored through the charts very carefully and made sure our reports matched up with what their reviews had," Carter says. "That's a level of rigor and detail that you typically would not necessarily get. I thought it was pretty impressive."
The Joint Commission didn't stop strictly at the end result of clinical aspects of care, but it delved into how they got to those outcomes—through the "emphases on team work and process," he adds. The commission made it clear that, for comprehensive care, a successful hospitalization is not the only endgame, Carter says.
"They very much wanted to understand that we educated the patient for discharge, and made sure that patients understood the implications of their strokes and the implication of downstream medical care and the monitoring they would need. They were rigorous and made us prove what we said we were going to do."