There is much talk about alignment in healthcare, not only with physicians, but with nurse practitioners in coordinating care. That was evident in the Joint Commission's review, Carter says. "It wasn't good enough to say, ‘We have a nurse educator.' We had to show what the practitioner did, and they made us prove we did what we said we were doing."
The Joint Commission review also showed that despite the hospital's progress, there were still lessons to be learned, with specific details of stroke care that will continue to be reviewed and evaluated. "They made us look at every process," Carter says. "Is this a necessary process? Or, is this just a historical process that we've done?"
As a result of the Joint Commission's detailed review, the San Diego hospital, for instance, evaluated its use of CAT scans. "We found small things contributing to delays (in care), such as the way the CAT scans were ordered," he says. Eventually, the hospital adjusted its electronic medical record [system] to improve "time and efficiency" in using CAT scans as well as other procedures, Carter adds.
While there are now 12 comprehensive stroke centers, Carter anticipates that there may eventually be dozens more, as well as more than 1,000 primary care stroke centers "when this all shakes out with the Joint Commission."
Unfortunately, not all stroke centers, despite their designation, work together as a team to provide stroke care. That should change, Carter says. All stroke centers need to better coordinate care for stroke patients, especially under emergency conditions. Carter equates such an effort as similar to trauma centers.
"When there's an auto accident, it's immediately known where to send the patient," Carter says, noting that EMS crews immediately decide what's necessary for an injured motorist, and what hospital is equipped to provide best treatment. That's been successful," Carter says. "The same should be done for a stroke patient."