New performance measure requirements for Acute Stroke Ready Hospital Certification
Effective July 1, 2021, the Door to Transfer to Another Hospital performance measure for The Joint Commission’s Acute Stroke Ready Hospital Certification —ASR-OP-2 — will be retired. ASR-OP-2 will be replaced with the Door to Transfer to Another Hospital — STK-OP-1 — measure that also is collected for Primary Stroke Center
ASR-OP-2 was one of two outpatient measures designed to evaluate the management of both ischemic and hemorrhagic stroke patients in hospitals and critical access hospitals that can quickly diagnose stroke, initiate IV thrombolytic therapy for eligible patients, and transfer the patient to a higher-level primary or comprehensive stroke center for advanced therapies and services when indicated. “Door In – Door Out” times for stroke patients transferred from the emergency department of an acute stroke ready hospital to a higher-level acute stroke center are reported for three stroke patient groups:
- Hemorrhagic stroke
- Ischemic stroke — IV thrombolytic (t-PA) therapy prior to transfer
- Ischemic stroke — no IV thrombolytic (t-PA) therapy prior to transfer
Primary stroke centers also report transfer times for stroke patients; however, the STK-OP-1 measure includes additional strata for ischemic stroke patients with large vessel occlusions (LVO) who may or may not be eligible for mechanical endovascular reperfusion therapy. Endovascular therapy is the standard of care for treatment of acute ischemic stroke due to LVO. Faster transfer times and rapid reperfusion with mechanical thrombectomy in ischemic strokes with LVO leads to significant reduction in morbidity and mortality.
Since both acute stroke ready hospitals and PSCs collect similar data, measure alignment makes sense and may promote the use of data for comparative evaluation across hospitals and certification programs. Recent revisions to the STK-OP-1 measure strata — also effective July 1, 2021 — were made to assist health care organizations and Joint Commission stroke reviewers to better assess organizational performance around “Door In – Door Out” times for different groups of stroke patients and identify opportunities for improvement. Revisions involved the stratum for ischemic stroke—IV thrombolytic (t-PA) therapy prior to transfer. Three strata were added to differentiate LVO patients who may or may not be eligible for mechanical endovascular reperfusion therapy following IV alteplase initiation from those ischemic stroke patients transferred post-IV alteplase initiation for other reasons.
The revised STK-OP-1 measure will be detailed in the Specifications Manual for Joint Commission National Quality Measures, future Version 2021B, and available around Feb. 1, 2021, at https://www.jointcommission.org/specifications_manual_joint_commission_national_quality_core_measures.aspx. Questions about these measures may be sent via the Performance Measurement Network Q&A Forum at https://manual.jointcommission.org.