Joint Commission Seeking Input on Thrombolytic Therapy by Jan. 1, 2008

The Joint Commission, in partnership with the American Stroke Association (ASA)—a division of the American Heart Association (AHA)—is proposing additional requirements to the Primary Stroke Center Certification regarding the use of IV thrombolytic therapy for the management of patients with acute ischemic stroke in critical access hospitals and hospitals.

Click to Read the Proposed Requirements and Complete the Survey:

Specifically, the proposed revisions focus on IV thrombolytic therapy administration to eligible patients and the organization’s infrastructure that supports the safe administration of IV thrombolytic therapy.

According to the ASA, stroke is the third leading cause of death in the United States.  Early diagnosis of ischemic stroke and treatment with IV thrombolytic therapy can significantly impact the quality of life for ischemic stroke patients. While the current requirements for the Primary Stroke Center Certification generally address thrombolytic therapy, The Joint Commission believes more specific requirements for IV thrombolytic therapy will strengthen stroke certification.

Under the proposed requirements, hospitals that want to be or are accredited stroke centers would be obligated to administer IV tissue plasminogen activator (tPA).
"Emergency physicians need to make their voice heard on this issue as there is a push to implement the administration of tPa in the ED regardless of the resources available to the physician," says Marilyn Bromley, RN, the director of ACEP’s Emergency Medicine Practice Department.

The proposed requirements would not allow emergency physicians to make decisions based on the stringent and science-based National Institute of Neurological Disorders and Stroke (NINDS) criteria, which is the foundation of ACEP’s policy on use of IV tPA for the management of acute stroke in the ED.

"The administration of tPa would have to be done under conditions that are not in keeping with our policy," Bromley explains. "I have some trepidation about the emergency physician being required to give tPa without the benefit of adequate resources and without regard to a criteria established using rigorous evidence-based standards. 

ACEP has provided The Joint Commission its clinical policy and Policy Resource Education Paper (PREP) on the issue—a resource Bromley says will be given significant consideration as TJC addresses this issue. 

"Our clinical policy and PREP will be heavily weighted by The Joint Commission because ACEP’s policies are based on science and developed with such rigor," she says. "The Joint Commission will also give serious consideration to the number and content of the responses from individual physicians.

ACEP members are strongly encouraged to read the proposed requirements and complete the online survey at

The deadline for completion is January 1, 2008.

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