Comprehensive Stroke Center Certification Stroke Boot Camp Georgann

Comprehensive Stroke Center Certification Stroke Boot Camp Georgann Adams RN, MSN, ACNS-BC CNRN, SCRN, CCRN Stroke Program Coordinator, IU Health Methodist Hospital 5/24/2021 1

Objectives • Discuss the requirements of The Joint Commission’s Comprehensive Stroke Center Certification (CSC) • Discuss components of the onsite visit that are unique to a CSC 5/24/2021 2

Disclosures • No disclosures or conflicts of interest 5/24/2021 3

• Comprehensive statewide healthcare system with 18 hospitals in Indiana • IUH Methodist was the first to become certified in Indiana as a Joint Commission Comprehensive Stroke Center in 2014 treating over 800 complex stroke patients a year. • In addition to the CSC we have 3 other Primary Stroke Centers in the system and hoping to add another in 2015 4 5/24/2021 4

• • Approximately 85 centers that are currently certified Revised standards in July 2014 Started reporting 8 CSC measures in Jan 2015 Definition of a CSC • A facility or system with the necessary • personnel • infrastructure • expertise • With programs to diagnose and treat stroke patients • Who require a high intensity of medical and surgical care, specialized tests, or interventional therapies 5/24/2021 5

A Comprehensive Stroke Center • Act as a resource center for other facilities in their region • providing expertise about managing particular cases • offering guidance for triage of patients • making diagnostic tests or treatments available to patients treated initially at a PSC • an educational resource for other hospitals and health care professionals in a city or region. 5/24/2021 6

• Care Across the Continuum

• Acute Stroke Treatment Team with 24/7/365 activation and rapid emergency response • Relationship/support of Emergency medicine and pre-hospital paramedic community • Interventional Neuroradiology part of stroke team • Written care protocols • • Acute management Secondary Prevention Rehabilitation Risk Factor modification • Dedicated Stroke Units • Access to neurosurgical services 24/7/365 • STAT access to neuroimaging and laboratory services 24/7/365 • Demonstrated support of the medical organization • Stroke Registry supporting quality management • Team and staff education • Community education program/marketing 8

Indiana University Health Methodist Hospital Stroke Team 5/24/2021 9

Stroke Team Committee • People • Departments • • • MD’s • ED • Neurologists • Neurosurgeons • Interventional Neuro Radiologists • Internal Medicine • RN’s • MSW • Technologists • Rehabilitation Therapists • OT/PT/SLP ED Radiology Case Management Administration Nursing Research Clinical Education Rehabilitation 10

CSC Survey • Pre survey conference call • Eligibility requirements “CSC Requirements Assessed at Application” • DSPM volume requirements • DSPR Advanced Imaging Capabilities • DSDF 5, 6 DSSE 1, 3 Post hospital Care coordination • DSPR Dedicated neuro-intensive care beds for complex strokes • DSPR 5 Research and written research protocol • DSPR Interdisciplinary program level review and peer review • DSPM Performance measures • Onsite agenda • CSC reviewer are highly trained and may include a stroke neurologist

• Meets disease specific care requirements ( PSC) • Volumes • 20 SAH • 15 aneurysmal clippings ablations/ year • 25 rt. PA administrations to eligible acute ischemic stroke patients/in 2 year • • • Advanced imaging capacity 24/7 ( MRI, MRA, CTA, transcranial doppler, TEE, ) After hospital care coordination Peer review mechanism Participation in IRB, patient–centered stroke research Collection of 8 comprehensive standard performance measures 5/24/2021 12

600 500 479 2014 Volumes • Ischemic Stroke: 479 • Subarachnoid Hemorrhage (SAH): 133 – CSC Requirement: Care is provided to 20 SAH or more per year • Intracerebral Hemorrhage (ICH): 127 • Carotid Endarterectomy (CEA): 131 400 300 200 133 127 131 SAH ICH CEA 100 0 AIS 5/24/2021 13

2014 Treatment Volumes • Treatment for Aneurysm: 130 – CSC Requirement: 15 or more coils or clips per year – Coiling: 84 – Clipping: 46 • IR for ischemic stroke: 24 • IV t. PA: 89 – CSC Requirement: Administer IV t. PA to 25 pts per year – EMTC: 55 – In-house: 7 – Drip & Ship: 27 140 120 100 80 60 40 20 0 Aneurysm IR IV t. PA

Agenda Template • Opening conference and orientation to the program • Emergency Department review – 2 reviewers • Individual tracers reviewers conduct separately ( morning and afternoon sessions) • Advanced imaging • Acute comprehensive stroke care • • • • Day 2 Daily briefing • Individual tracer review • Similar to day 1 • System tracer- Data use, research, PI. Conducted by both reviewer • PI methodology • Volumes of procedures and intervention • Clipping and coiling mortality rates • Complication rates • Public reporting • Stroke performance measures • Follow up phone calls • Interdisciplinary program review and peer review process • use of stroke registry • Patient satisfaction • CSC research • Review of stroke log • Education, competence assessment and Credentialing process • Review of personnel files • Community education • Issues resolution • Exit conference Emergency care Informed consent Preop evaluation IR suite CT/ MRI Procedures and intervention ICU care Medical Care Nursing Care Post Acute Care • • • Social work Therapy( speech, OT, PT) Transfer/ Discharge Follow up call Closed record review Summary session at end of first day • Address any special issues for resolution

CSC Survey Visit 5/24/2021 16

• Performance Measures 5/24/2021 17

Questions • What benchmarks are you using • Current challenges • Process for multiple stroke alert patients • Patient family assessments • Cognition/ Respite/ transition of care communication

Competence Tracers • Physician and APN • Credentialing and privileging • Education requirements • Clinical Services and Allied Health • Expanded to imaging areas • Rehab staff and RRT

Education • • Medical directors/ Physicians Emergency Department Neuro ICU Stroke Units Interventional Radiology Stroke Team RRT Other departments and support staff

Helpful Hints • Review active inpatient census • Encourage additional staff • Request team availability • IT staff experts • Identify strong escorts and communication across the system • Team meetings and prep with champions • Review institutional initiatives and review weak areas (individual care plans, education, falls)

Core team drive the process • Everyone needs to be able to describe how we provide care, algorithms, outcomes and availability of experts • Continuous Journey • Attend national, local and web education offerings and meetings to network and continuously learn!

Identify Barriers • Internal • External • Conflicting priorities • Limited resources

Group Dedication • • Engaged leaders Physicians Administrator Clinical nursing staff Rehabilitation Pharmacy Research Quality