Accreditations, Certifications, & Designations in the Stroke System of Care

Transcription

1 Texas Stroke Institute Saving Lives, One Stroke at a Time Accreditations, Certifications, & Designations in the Stroke System of Care Tanzila Shams, MD MHA Member, SVIN Stroke Neurologist, Texas Stroke Institute HCA North Texas Division, Dallas-Fort Worth, TX

2 None Disclosures

3 Texas Stroke Institute Saving Lives, One Stroke at a Time Overview 1 Accreditation vs. Certification 2 Stroke Certification 3 Stroke Designation 4 EMS Stroke Triaging Plan

4 Accreditation

5 Accreditation: What does it mean? Accreditation is a comprehensive evaluation of the overall quality and safety of an organization. Accreditation is reserved to recognize the evaluation of a set of standards across an entire organization. Source: TJC ( Last accessed: November 1 st, 2014

6 Certification: What does it mean? Certification demonstrates commitment to excellence in providing disease-specific services in a comprehensive manner. Certification standards evaluate the scope of a specific disease or service, and a program s effectiveness in using clinical guidelines and performance measurement to improve care. Disease-specific Stroke Disease-specific Chest Pain Service-specific Stroke Rehab Source: TJC ( Last accessed: November 1 st, 2014

7 Stroke Certification

8 National Initiative: Target Stroke 2003 AHA/ASA recognized opportunity to assist hospitals and healthcare professionals Improve Stroke Specific Quality of Care Get with The Guidelines Hospitals 1.9 million patients

9 From: Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative JAMA. 2014;311(16): doi: /jama Figure Legend: Time Trend in the Proportion of Patients with Door-to-Needle Times for Tissue Plasminogen Activator (tpa) of 60 Minutes or Less During the Preintervention and Postintervention Periods of Target: StrokeThe total number of patients included was (perquarter mean of 1695 patients; median, 1705; interquartile range, ; and range, ). The slopes and intercepts of the regression lines were obtained from the unadjusted segmented regression model for trend rate on door-to-needle time of 60 minutes of less. The rate of increase in patients with door-to-needle Copyright 2014 times American of 60 minutes Medical or less was 6.20% (95% CI, 5.58%-6.78%) per each Date 4 quarters of download: postintervention 11/4/2014 for Target: Stroke vs 1.36% Association. (95% CI, All rights 1.04%-1.67%) reserved. per each 4 quarters preintervention for Target: Stroke (P <.001 for comparison of the 2 slopes).

10 How can we join the ranks as a system wide initiative in improving stroke outcomes?

11 Unmet need for Stroke Center Certification

12 1522 Stroke Centers have grown in the US 1387 certified Primary Stroke Centers and 135 certified Comprehensive Stroke Centers Source: JCAHO ( ; DNV ( HFAP ( & State Department of Public Health websites Last accessed: November 1 st, 2014

13 Stroke Designation

14 Levels of Stroke Center Certification and Designation Several States designate stroke hospitals based on level of care provided to assist EMS in triaging to the appropriate facility 0 to 1 hour Level 3 Stroke Support Facility/ Stroke Ready 0 to 3 hours Level 2 Primary Stroke Center > 3 hours Level 1 Comprehensive Stroke Center

15 Timeline of Stroke Designation: Primary Stroke Center legislation or non-legislative policy 20 States that have enacted or pending legislations, or nonlegislative administrative policies in place Source: CDC: A Summary of Primary Stroke Center Policy in the United States Updated: 2010

16 EMS Stroke Triaging Plan

17 Stroke Designation has led to development of EMS stroke triaging plans Geographic reach of Air ambulance/ems in one Trauma Regional Advisory Council (RAC) in Texas

18 Case Study: State of Texas Stroke Legislation State-wide Stroke Plan Task: Governor s Emergency Trauma Advisory Council (GETAC) Regional Stroke Plans Task: Trauma Regional Advisory Councils (RAC s) Each RAC works with EMS, members of the RAC, and hospitals within the RAC s counties Region, specific EMS Stroke Triaging Plan developed

19 EMS stroke triaging plans are crucial in time sensitive diseases like brain attacks Geographic Access to stroke patients within a county or region: Air vs. land ambulance Up to date Capabilities of hospitals providing stroke care: Level 1, 2 vs. Level 3 Nearest and most appropriate hospital for the stroke patient in the ambulance Time vs. Need to bypass a hospital

20 Summary

21 Types of Stroke Certification: We will review in today s workshop Stroke Rehab Comprehensive Stroke Center (Level 1) Carotid Stenting Primary Stroke Center (Level 2) Stroke Ready Hospital (Level 3)

22 Texas Stroke Institute Saving Lives, One Stroke at a Time Thank You Any Questions?