Compliance of Joint Commission stroke measures shows significant reduction of complications and reduced recurrence risk
By Thomas Habiger, M.D.

Planning for St. John’s Stroke Center began in May 1998 with a multi-disciplinary team. The vision for the Stroke Center was to integrate comprehensive care through a multidisciplinary team servicing a single site. The focus of the Stroke Center was to provide the highest quality care possible for the stroke patient, to provide this care at the lowest cost, and to provide stroke education to the public.

The Stroke Team Active Responders (STAR) are called to rapidly respond and treat acute stroke, including  providing thrombolytic therapy with t-PA. Available 24 hours a day, seven days a week. This team consists of four St. John’s neurologists and four Stroke Center Coordinators and a neurointerventionalist for intrarterial t-PA.  The STAR team responds to both ETC and in-house interventions.

St. John’s Stroke Center was one of 17 multi-hospital specialty centers in the United States participating in the American Academy of Neurology’s (AAN) and the American Stroke Association’s, Stroke Practice Improvement Network (SPIN). 

The overall objective was to develop and implement a model of a national stroke performance improvement network sponsored by a professional society.  St. John’s Stroke Center was one of 6 hospitals randomized to perform stroke benchmarking for SPIN in the areas of bedside dysphagia screening, DVT prophylaxis, A-fib and Coumadin compliance, t-PA within one hour of ETC arrival. 

St. John’s Stroke Center was one of 33 hospitals in the United States participating as a pilot-test site for The Joint Commission Disease-Specific Care (DSC) Stroke Pilot Measure Project from Oct. 1, 2004 through Sept. 30, 2005. 

The project goal was to evaluate a standardized set of performance measures for stroke inpatient care that have great potential for improving the quality of stroke care.  Measures collected were DVT prophylaxis, discharged on antithrombotics, patients with Atrial Fibrillation receiving anticoagulation therapy, Tissue Plasminogen Activator (t-PA) considered, antithrombotic medication within 48 hours of hospitalization, lipid profile, screen for dysphagia, stroke education, smoking cessation, and a plan for rehabilitation was considered.

The performance measures collected for SPIN and JCAHO’s Disease-Specific Care Stroke Pilot Measure Project have been incorporated into the American Stroke Association stroke database registry, Get With The Guidelines (GWTG)-Stroke.

Consistent compliance of using standard treatment protocols for these core measures has shown significant reductions of the complications of stroke and a reduced risk of a recurrent stroke, which is greatest in the subsequent three months. Using stroke order sets from St. John’s Internet incorporates the appropriate treatments for the core measures and improves compliance, resulting in improved outcomes. 

The accompanying sheet outlining the acute stroke core measures is placed on the inpatient chart to help remind the treating team of appropriate goals. I would also ask any St. John’s admitting doctor to briefly review this sheet to familiarize yourself with the core measures.

In February of 2004, St. John’s Stroke Center became one of the first eight stroke centers in the nation to achieve Primary Stroke Center Certification from the Joint Commission Disease-Specific Care Program by JCAHO. This certification is indicative of our program’s compliance with consensus-based national standards; effective use of established clinical practice guidelines to manage and optimize care; and performance measurement and improvement activities.

St. John’s Stroke Center has met many of the goals that were originally set in 1998. As changes occur in the medical field, our focus is then redefined and refined to meet the changes. 

We continue to provide the highest quality care possible for the stroke patient by participating in clinical research trials including IMS III, which is a NIH sponsored trial of IV t-PA compared to combination IV and IA t-PA. We continue to provide this care in an attempt to prevent an individual from having a physically, financially and emotionally devastating stroke.

I recently received a letter from a patient we treated with t-PA several years ago which I would like to share with you:

Dear Dr. Habiger,

You may not remember me, but I met you in St. John’s ER on March 23, 2000. I was a freshman at SMS, now Missouri State University, and I had a stroke. On that day you saved my life and I am now getting married! I am sending you this invitation as a THANK YOU from my family and myself for all that you did for me. I am currently a kindergarten teacher in the St. Louis area and I am doing wonderful! Because of everything you did for me, all of my dreams are coming true. Thank you so much again and I will never forget what you have done for me.

Sincerely,
B