Process for Achieving Certification

 

Process for Achieving Primary Stroke Center Certification

 

In 2003, the leadership of University Health System, Inc., charged a planning task force of medical staff, nurses and managers to develop the Brain and Spine Institute. The steering committee was lead by a neurologist, Dr. John H. Dougherty, and a neurosurgeon, Dr. William S. Reid. The Brain & Spine Institute’s vision is to be a beacon of hope for those with disorders of the brain and spine. One means of accomplishing this goal was to develop a Stroke Center and achieve certification from the Joint Commission (JCAHO) for that center.

Why a Stroke Center at the University of Tennessee Medical Center? There continues to be growth in the 40- to 65-year-old population in the 21-county region served by UT Medical Center, susceptible to cerebrovascular disease. This population needs access to comprehensive services addressing stroke and/or TIA.

The objectives of the Stroke Center include a coordinated, multidisciplinary, evidenced-based approach to stroke care; organized performance review and improvement; Integration of regional Emergency Medical Services (EMS); and increased community awareness of stroke warning signs, risk factors and risk factor reduction.

To that end, a multi-disciplinary Stroke Steering Committee was developed. Dr. Kent Hutson, neuro-radiologist, serves as the medical director. Dr. Michelle Brewer, neurologist, serves as the neurology consultant. Jennifer Henry, RN, is the Stroke Coordinator. The team includes the following disciplines.

• Neurology
• Neurosurgery
• Radiology
• Interventional Neuroradiology
• Emergency Medicine
• Critical Care Medicine
• Hospital-based Medicine
• Nursing
• Nursing Education
• Laboratory Services
• Physical Medicine
• Physical Therapy
• Occupational Therapy
• Speech Language Pathology
• Case Management
• EMS
• Home Care Services
• Respiratory Care
• Pharmacy
• Marketing
• Community Outreach
• Cardiovascular & Pulmonary Rehabilitation
• Performance Improvement

This team is charged with ongoing development of the Stroke Program and evaluation of outcomes.

The features of the Stroke Center include 24-hour access to neurology, neurosurgery and neuroimaging. This means a CT scanner in the Emergency Department and rapid laboratory response for a timely diagnosis. There also is operating room availability, critical care beds and a designated unit for acute care.

Community education is a key component in our region and is crucial to improving outcomes. Many individuals do not know the warning signs of stroke and the importance of calling 911 right away in order to get to the emergency room within three hours of symptom onset. Partnering with Heart Lung Vascular Institute, Marketing and Public Information and Network Development, more than 7,000 people have received printed information and/or counseling regarding recognition of stroke warning signs and risk factor reduction since May 2005. The medical center also assisted Emergency and Trauma Services at their annual symposium for Emergency Medical System personnel by training staff in stroke assessment.

Once the Stroke Center was organized and functioning, the Joint Commission was invited to review the program. This review resulted in a certification as a Primary Stroke Center and recognition of meeting the high standards required to achieve this designation. UT Medical Center is proud to be the first in the region to achieve this status and looks forward to serving its community through the Stroke Center.

Click here for more information on stroke warning signs, stroke prevention and  stroke services.