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Stroke Center Certification: "The physicians were the ones ..."

By Dr. David C. Pate, News and Community
November 1, 2012

What does it take to get The Joint Commission’s Disease-Specific Care Certification as an Advanced Primary Stroke Center?

 Physician leadership. Education. Buy-in, improvement, and rehearsal. And lots of each.

 “The physicians were the ones who drove it,” said Sarah Walker, the neuroscience coordinator of the ortho/neuro service line for St. Luke’s Treasure Valley who coordinated the effort. “We absolutely have the physicians to thank. The physicians were the ones who said, ‘This is important.’”

 Here’s the difference it makes: In data year 2011, Treasure Valley overall stroke imperfect care was 23.72 percent, meaning that we provided perfect care slightly more than 76 percent of the time. Because of our efforts to improve our stroke treatment, in data year 2012, we were at 16.62 percent, meaning perfect care more than 83 percent of the time.

 “We have seen significant improvement,” Walker said.

In September, St. Luke’s Treasure Valley passed its Primary Stroke Center certification survey with no official survey findings.

No findings is what you want. It’s a good thing, a very good thing. It means The Joint Commission didn’t find any specific areas for improvement. And this is meaningful to us because this was the first attempt by any of our St. Luke’s sites at obtaining disease-specific certification.

It’s all the more remarkable because stroke wasn’t one of our areas of focus until fairly recently.

Dr. Jim Torres, an ED physician for 20 years who is our stroke medical director, would be the first to say he wasn’t particularly interested in stroke until he was tapped by Dr. Bart Hill, now St. Luke’s Health System chief quality officer, to represent St. Luke’s with the American Heart Association.

 “I saw that we had a need,” Dr. Torres said. “We didn’t have any organized stroke care in the ED or in the hospital … My first goal was to get everything organized in the ED.”

 The Joint Commission spent time in the Treasure Valley Sept. 18 and 19, hearing Dr. Torres, Sarah, and Treasure Valley Chief Operating Officer Kathy Moore present information about our services, programs, and quality metrics.

The reviewer toured the Boise and Meridian sites, interviewing staff members, reviewing stroke processes and staff knowledge in the EDs, medical imaging, and the stroke-designated units, and studying charts, data, and performance improvement metrics. The Joint Commission also evaluated our HR, learning services, and medical staff processes.

And while the visit was only two days, the work that was the subject of the visit goes back more than four years, with the effort accelerating in early 2011.

To improve our stroke care, Dr. Torres tapped national experts and worked closely with other ED physicians and St. Luke’s neurologists and interventional neuro-radiologists.

When the board of directors and Treasure Valley Chief Executive Officer Chris Roth made stroke certification a priority, resources were available but lots of work remained to be done.

The stroke team worked to standardize care, create processes and protocols where needed, and engage in continuous process improvement, from the first contact with emergency medical services to follow-up in our stroke clinic and at home.

Education was critical to the success of the group’s work. Dozens of St. Luke’s physicians and staff members needed to understand why stroke treatment was a priority and would improve patient care, and how to best proceed with care.

 All the work paid off. The Joint Commission certification reviewer was impressed with staff and provider knowledge and engagement and the overall consistency of our care for stroke patients.

 Specific strengths mentioned? Stroke patient identification in the Emergency Department, collaborative stroke follow-up, patient education materials, and our transient ischemic attack observation center, something not many other health care facilities have established. 

Joint Commission certification recognizes those organizations that continuously provide safe, high-quality care, treatment, and services, at the same time identifying opportunities for improvement in processes.

At St. Luke’s, the certification process, like the awards we have been garnering, is a means to remind us to keep working, perfecting, and transforming.

 We use the certification process as an improvement tool. It’s a seal of quality that says we provide evidence-based care and are willing to be accountable for that, and that we’re committed to continual process improvement. We’ll be back for re-certification in two years, and those two years are an opportunity for us to get even better.

 Next up: Magic Valley. Dr. Torres and many others already are working to prepare St. Luke’s Magic Valley for the certification process.

Our recent successful certification was a team effort, as Sarah eloquently points out. 

“I want to commend nursing and all other staff. They have done this,” she said. “They’re the ones that have carried it out and have stepped up to the plate to make it happen.

 “It couldn’t have happened without the whole team at the table.”

 Congratulations to Dr. Torres, Sarah, all the physicians, nurses, therapists, technologists, and everyone involved in the Treasure Valley in making our stroke care the best it can be. By showing the surveyors your excellence, they saw the “better care” part of our Triple Aim strategy in action. 

 You are saving lives, reducing morbidity, and providing a tremendous service to all those in our community. From all of us in the St. Luke’s family, and from the patients and their families who benefit from this wonderful care, thank you!

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.