Stroke care delivery before vs after JCAHO stroke center certification

Abstract

In 2004, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began certifying primary stroke centers.1 Certification requires adoption of guidelines,2 including standardized performance measures. The University of California Irvine Medical Center (UCIMC) was in the initial group of five hospitals certified, in January 2004. UCIMC is the only Level 1 trauma center and the only university medical center in Orange County, California, the fifth most populous US county.3 The hospital has 462 beds, a 7-bed neuroscience intensive care unit, and a 15-bed intermediate stroke care unit. In this report, we describe trends in stroke care delivery for the 1.5 years after JCAHO stroke center certification at UCIMC, compared with the previous 2.5 years. With JCAHO stroke center certification, the process of stroke care delivery changed at many levels. Before certification, neither a stroke team nor a stroke care unit was present at our center. Stroke care was generally administered according to the judgment of each physician, e.g., during acute evaluation, acute therapy selection, diagnostic workup, and prevention. After certification, numerous aspects of stroke care were standardized. Examples include an integrated response to emergency department brain attack codes, use of specific …