Obtaining A Stroke Certificate: Launching Your Medical Career

Stroke certification is a comprehensive portfolio of stroke-focused certifications, available to hospitals nationwide. It is a way to verify that an organization's stroke care programs are meeting or exceeding standards of care in the delivery of quality stroke care. There are various types of stroke certifications, including basic and advanced certifications, with the latter being more demanding. Stroke certification can benefit patients and hospitals by improving efficiency, reducing morbidity and mortality rates, and increasing patient satisfaction. It also allows hospitals to stand out from their competitors and access valuable resources and support. Additionally, there are specific stroke certifications for physical and occupational therapists, such as the Certified Stroke Rehabilitation Specialist (CSRS™) course, which provides in-depth, hands-on training in stroke rehabilitation.

Comprehensive Stroke Center (CSC) certification

To successfully achieve this level of certification, hospitals must coordinate significant resources and services into an organized program. This includes coordinating teams across the continuum of care, from emergency response to long-term rehabilitation. CSC certification recognizes hospitals that excel in stroke care and are dedicated to raising the bar for their organization's performance. It is the highest level of certification for hospitals treating complex stroke cases.

There are several benefits to pursuing CSC certification. Firstly, it designates excellence in the care of stroke patients and demonstrates a commitment to a higher standard of clinical service. Secondly, it helps create a loyal and cohesive clinical team, reducing variation and the risk of error. Thirdly, it provides a framework to improve patient outcomes and enhances the facility's ability to attract top-level talent. Finally, it strengthens community confidence and can potentially increase patient volumes due to EMS routing protocols.

To obtain CSC certification, hospitals must meet certain requirements and adopt standardized performance measures. They must also submit monthly data to the certifying organization, such as The Joint Commission, for ongoing evaluation and improvement. The process typically involves understanding the certification standards and supporting documents, conducting a gap analysis, and developing a business plan and timeline for certification.

Overall, CSC certification is a challenging but rewarding process that recognizes hospitals for their excellence in stroke care and their commitment to continuous improvement.

Thrombectomy-Capable Stroke Center (TSC) certification

The benefits of pursuing TSC certification are numerous. Firstly, it designates your hospital for providing excellent care to stroke patients. Secondly, it helps to create a loyal and cohesive clinical team by establishing a consistent approach to care, thereby reducing variations and the risk of errors. Thirdly, it demonstrates your hospital's commitment to a higher standard of clinical service. Additionally, TSC certification provides a framework to improve patient outcomes, enhances your facility's ability to attract top-level talent, and strengthens community confidence in the quality and safety of your hospital's care, treatment, and services.

To achieve TSC certification, your hospital must meet rigorous standards for performing endovascular thrombectomy and providing post-procedural care. This includes adopting standardised performance measures and submitting monthly data to the Joint Commission. The Joint Commission, in collaboration with the American Heart Association and American Stroke Association, offers a comprehensive portfolio of stroke-focused certifications available to all hospitals nationwide.

In addition to the benefits outlined above, certification can also provide a competitive edge in the marketplace, supporting marketing, contracting, and reimbursement. It is worth noting that the implementation of a stroke-center program has been associated with a decline in the average cost of treating stroke patients and a lower average length of stay.

Primary Stroke Center (PSC) certification

Standards and Requirements:

• Hospitals seeking PSC certification must establish a dedicated stroke-focused program with qualified medical professionals specifically trained in stroke care.
• They should provide individualised care tailored to meet the unique needs of stroke patients, involving them in their hospital care.
• Post-discharge patient self-care coordination is essential, ensuring a streamlined flow of patient information while protecting patient rights, security, and privacy.
• PSC-seeking hospitals must collect and maintain data on their stroke-treatment performance and hospital team performance, utilising this data to continuously enhance the quality of care.
• Additionally, PSC-certified hospitals are required to adopt standardised performance measures, submitting monthly data to the accrediting organisation.

Benefits of PSC Certification:

• PSC certification designates excellence in stroke patient care, creating a loyal and cohesive clinical team.
• It assists organisations in establishing a consistent, standardised approach to stroke care, reducing variations and the risk of errors.
• The certification demonstrates a hospital's commitment to a higher standard of clinical service and improved patient outcomes.
• PSC-certified hospitals can attract top-level talent, enhance their reputation, and strengthen community confidence in the quality and safety of their care.
• The certification provides a competitive edge in the marketplace, supporting marketing, contracting, and reimbursement.
• Overall, PSC certification improves stroke patient care, enhances operational efficiency, and can lead to reduced morbidity and mortality rates.

Steps to Attain PSC Certification:

• Contact the relevant accrediting organisation, such as The Joint Commission, to express interest and inquire about the specific requirements and process for PSC certification.
• Ensure your hospital meets the core requirements outlined in the Disease-Specific Care Manual, including standards, clinical practice guidelines, and performance measurement.
• Implement a dedicated stroke-focused program with qualified and trained medical staff.
• Establish protocols for stroke patient triage, treatment, and potential transfer, in collaboration with local Emergency Medical Services (EMS).
• Collect and submit the required performance data to the accrediting organisation.
• Continuously evaluate and improve the quality of care based on the collected data.

By following these steps and meeting the required standards, hospitals can attain PSC certification, elevating their stroke care capabilities and improving patient outcomes.

Acute Stroke Ready Hospital (ASRH) certification

ASRH certification offers a range of benefits to certified hospitals and their patients. Here are the top reasons to pursue ASRH certification:

• Excellence in Patient Care: ASRH certification designates a hospital's excellence in providing specialised care for stroke patients, ensuring they receive the best possible treatment.
• Improved Clinical Service: It demonstrates a hospital's commitment to a higher standard of clinical service, reducing variations and the risk of errors, ultimately improving patient outcomes.
• Enhanced Team Dynamics: ASRH certification helps create a loyal and cohesive clinical team, fostering a consistent approach to care across different departments and teams.
• Market Differentiation: Certified hospitals can stand out from competitors, gaining a competitive edge in the marketplace. This supports their marketing, contracting, and reimbursement efforts.
• Attracting Top Talent: ASRH certification enhances the facility's ability to attract top-level talent, including experienced healthcare professionals and experts in the field.
• Community Confidence: It strengthens community confidence in the quality and safety of the hospital's care, treatment, and services, fulfilling a crucial community need.
• Increased Patient Volumes: The potential increase in patient volumes is due to EMS routing protocols, ensuring that more individuals in need of stroke care can access it.
• Improved Efficiencies: Certified hospitals can provide improved efficiencies, reduced morbidity and mortality rates, and enhanced long-term outcomes for stroke patients.
• Cost-Effectiveness: Implementing a stroke-center program has been associated with a decline in the average cost of treating stroke patients, positively impacting healthcare economics.
• Support and Resources: Once certified, hospitals gain access to valuable resources, including an online community, education, quality improvement consultants, and marketing toolkits, to continuously enhance their stroke care programmes.

To achieve ASRH certification, hospitals must meet the core requirements outlined in the Disease-Specific Care Manual, including standards, clinical practice guidelines, and performance measurement. Joint Commission-certified ASRHs and organisations seeking initial certification are required to adopt standardised performance measures and submit monthly data to The Joint Commission.

National Institutes of Health Stroke Scale (NIHSS) certification

The National Institutes of Health Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke and aid in planning post-acute care. It was designed for the National Institute of Neurological Disorders and Stroke (NINDS) Recombinant Tissue Plasminogen Activator (rt-PA) Acute Stroke Trial and was first published by neurologist Dr. Patrick Lyden and colleagues in 2001. The NIHSS is composed of 11 items, each scoring a specific ability between 0 and 4. The individual scores are summed to calculate a patient's total NIHSS score, which can range from 0 to 42. A score of 0 indicates normal function, while a higher score indicates some level of impairment.

When administering the NIHSS, the examiner should not coach or help the patient with the assigned task. However, the examiner may demonstrate the commands to patients who are unable to comprehend verbal instructions. The examiner can also physically help the patient get into position to begin the test, but no further assistance should be provided. The examiner should score the patient's first effort, and repeated attempts should not affect the score, except in the language assessment, where the patient's best effort should be scored.

The 11 items on the NIHSS assess the following abilities:

• Level of Consciousness (LOC): Tests the patient's responsiveness, ability to answer questions, and follow verbal commands to perform simple tasks.
• Horizontal Eye Movement: Assesses the patient's ability to track a pen or finger from side to side with their eyes, testing motor ability and gaze towards the hemisphere opposite of injury.
• Visual Field Test: Assesses the patient's vision in each visual field by testing each eye individually and asking the patient to indicate how many fingers are presented in each quadrant.
• Facial Palsy: Inspects the symmetry of facial expressions by instructing the patient to show their teeth, squeeze their eyes closed, and raise their eyebrows.
• Motor Arm Assessment: Evaluates the patient's ability to hold their arm in a specific position for 10 seconds without drifting or falling.
• Motor Leg Assessment: Similar to the motor arm assessment, this item evaluates the patient's ability to hold their leg in a specific position for 5 seconds.
• Ataxia: Tests the patient's ability to touch their finger to the examiner's finger and then move it back to their nose, repeating this movement for each hand.
• Sensory Testing: Performed via pinpricks in the proximal portion of all four limbs, assessing the patient's ability to feel the pinpricks and if there is a difference in sensation between sides.
• Language Skills: Evaluates the patient's ability to explain a scenario depicted in a figure, read a list of sentences, and name objects.
• Dysarthria: Assesses the patient's articulation and clarity of speech by asking them to read a list of words.
• Extinction and Inattention (formerly known as neglect): Tests the patient's ability to identify which side of their body is being touched when their eyes are closed, as well as their ability to track moving fingers in front of their eyes.

The NIHSS has been validated as a tool for assessing stroke severity and predicting patient outcomes. A baseline NIHSS score greater than 16 indicates a strong probability of patient death, while a score of less than 6 indicates a strong probability of a good recovery. The NIHSS is widely used in clinical research and treatment planning, particularly for determining eligibility for acute treatments such as thrombolysis.

Frequently asked questions