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Revised Certification Eligibility Criteria for Comprehensive Stroke Centers (CSC)

July 12, 2012

The Joint Commission has developed a new Disease-Specific Care Advanced Certification Program for Comprehensive Stroke Centers (CSC) in collaboration with the American Heart Association and the American Stroke Association. The CSC requirements are rigorous and will require additional technology and resources when compared to Advanced Certification for Primary Stroke Centers (PSC).

Organizations seeking certification as a Comprehensive Stroke Center must meet all of the general eligibility requirements for Disease-Specific Care certification:

  • The program is in the United States, or operated by the US government or under a charter of the US Congress.
  • The program is provided within a Joint Commission accredited organization.
  • The program must have served a designated minimum number of patients (for CSC volume requirements, see below).
  • The program uses a standardized method of delivering clinical care based on clinical practice guidelines and/or evidence-based practice.
  • The program uses performance measurement to improve its performance over time.

All standards and requirements for Primary Stroke Center certification are incorporated into the Comprehensive Stroke Center requirements. In addition, eligibility for Comprehensive Stroke Centers includes all of the following requirements:

  1. Volume of cases:
    When applying for Comprehensive Stroke Center Certification, the organization will need to provide data on the volume eligibility criteria for the preceding year starting from the time of the organization’s application. During subsequent recertification for Comprehensive Stroke Center Certification, the volume data from the preceding 2 years based on the date of initial certification, will be required. 

    The Comprehensive Stroke Center:
    • Demonstrates that care is provided to 20 or more patients per year with a diagnosis of subarachnoid hemorrhage.
    • Demonstrates that 10 or more craniotomies for aneurysm clipping procedures are performed per year.
    • The Comprehensive Stroke Center demonstrates that 15 or more endovascular coiling procedures for an aneurysm are performed per year.
    •  (NEW) The CSC demonstrates that 15 or more endovascular coiling or surgical clipping procedures for aneurysm are performed per year.
    • The CSC will administer IV tPA to 25 eligible patients per year.
      • Note 1:  Providing IV tPA to an average of 25 eligible patients over a two year period is acceptable.
      • Note 2:  IV tPA administered in the following situations can be counted in the requirement of 25 administrations per year:
        • IV tPA ordered and monitored by the CSC via telemedicine with administration occurring at another hospital.
        • IV tPA administered by another hospital which then transferred the patient to the comprehensive stroke center.
  2. Advanced Imaging Capabilities:

    The hospital will be able to provide:
    • Carotid duplex ultrasound 
    • Catheter angiography available on-site 24 hours a day, 7 days a week
    • CT angiography available on-site 24 hours a day, 7 days a week
    • Extracranial ultrasonography
    • MR angiography-MRA available on-site 24 hours a day, 7 days a week
    • MRI, including diffusion weighted MRI, available on-site 24 hours a day, 7 days a week
    • Transcranial Doppler
    • Transesophageal Echocardiography
    • Transthoracic Echocardiography
  3. Post hospital care coordination for patients.

  4. Dedicated neuro-intensive care unit (ICU) beds for complex stroke patients:
    • The hospital will have dedicated neuro-intensive care unit (ICU) beds for complex stroke patients, that include staff and licensed independent practitioners with the expertise and experience to provide neuro-critical care 24 hours a day, 7 days a week.
  5. Peer review process:
    • The hospital will have a peer review process to review and monitor the care provided to patients with ischemic stroke, subarachnoid hemorrhage and administration of tPA.
  6. Participation in stroke research:
    • The CSC will participate in IRB-approved, patient-centered stroke research.
  7. Performance measures:
    • Initially, CSCs will be required to collect all of the standardized performance measures for Primary Stroke Centers. Additional CSC-specific performance measures are in development.

More details on CSC certification will be found in the final Comprehensive Stroke Center certification standards.