The fourth level of stroke center certification is a collaboration with the American Heart Association/American Stroke Association, and identifies hospitals that meet standards for performing mechanical endovascular thrombectomies.
The Joint Commission has created a Thrombectomy-Capable Stroke Center (TSC) certification.
David Baker, MD, executive vice president for Health Care Quality Evaluation at The Joint Commission, said the new certification program was developed after surveys showed that one-third of certified primary stroke centers routinely performed endovascular thrombectomies.
"Multiple studies have proven EVT treatment to be effective in saving lives and lowering disability from stroke, particularly if performed within six hours of the last time the patient was known to be well," says Baker.
"This certification was developed in response to a revolutionary technology and trying to make sure that everyone has good access to that technology in a timeframe that is going to achieve optimal outcomes," he said.
Baker spoke with HealthLeaders Media about the new TSC certification. The following is an edited transcript.
HLM: What hospitals should consider this certification program?
Baker: Right now, one third of our primary stroke centers are doing mechanical thrombectomies. We are looking for the strongest hospitals in that group; the ones that are able to do high-quality thrombectomies and post-procedure care. They've got substantial volume with strong experience. Importantly for us, this was originally developed to address areas where there wasn’t good access to a comprehensive stroke center.
HLM: What are the advantages to mechanical thrombectomies?
Baker: In 2015 three landmark studies showed that for patients that have the worst strokes, basically clots in one of the big blood vessels in the neck or the brain, a very large part of the brain is affected by this and the patients will be devastated by this.
These studies showed, and I am not overstating this, some of the most dramatic improvements that we have seen with any therapy. So, if you can get somebody to a hospital who can do this procedure -- they put a catheter into the large vessel, and they remove that blood clot so it restores blood flow to that area of the brain that is affected -- if you look at the numbers of people who were able to regain almost complete function, it's a vast improvement.
HLM: What should hospitals look at internally when deciding to pursue this?
Baker: This is probably something that would be taken up by hospitals that are already doing these procedures. They are going to have to make sure they can provide 24/7 coverage. Ideally, there should be a working relationship with EMS so that they know that if they gear up and can do this with 24/7/365 coverage and the costs associated with that, that they are going to get the volume of patients.
The calculation is how many patients are we seeing? How many more patients would we see if we got this designation, and will our emergency transport system recognized that? Particularly in some of these rural areas, if there was something there it would get a lot of traffic.
HLM: How does this accelerate access to proper care?
Baker: Again, two-thirds of the primary stroke centers are not doing mechanical thrombectomies. So you're EMS and you’ve got three primary stroke centers that you could go to but you don't know which one is capable of doing the mechanical thrombectomy. You go to the closest center, they evaluate the patients and then they have to transfer the patient to presumably a comprehensive stroke center to do the procedure. That is a huge delay that dramatically affects how much function a patient can regain.
This certification tells EMS who is capable of doing this. The hard part is in the field for EMS to determine who has one of these large vessel occlusions? Who has a clot in a major artery? There are a few rules that they can use and they need to learn how to use them. But, if EMS can identify those patients in the field, instead of going 90 minutes to a comprehensive stroke center I can go 20 minutes to a TSC and know that the patient is going to get good care.
HLM: How do you measure ROI for this certification?
Baker: That's going to depend on the local situation. You have to look at all the different aspects, the 24/7 coverage, the imaging procedures, and technology that is required and then be able to do your own estimate of ‘OK if we think we are going to get 15 or 20 cases per year brought in by EMS is it going to make sense?’
HLM: How long does the certification process take?
Baker: There is huge variability. There are some that thought they would be ready for survey within a month or two. Others it's taken them three or four months. It all depends upon what the baseline state is, so that is a difficult question to answer.
John Commins is the news editor for HealthLeaders.