As mechanical thrombectomy science evolved over the past decade, the neurointerventional (NIR) suite became a critical area for patient care and a focus of regulatory review for stroke certification.When assisting programs in seeking successful certification visits, we’ve noted a few common themes in need of attention in the NIR suite to ensure successful certification tracers. 

• Staffing: There tends to be variation in how NIR suites are staffed across the nation in terms of number of staff, credentials of staff and roles of each staff member in the suite.  This is often more pronounced in organizations when the NIR suite is maintained separately from the cardiac catheterization suite.  Leadership should be aware of the differences and articulate how their model of staffing ensures patient safety while in the NIR suite.  Differences between how cardiac intervention cases and stroke intervention cases are staffed should be explored by leadership and easily explained if asked.  
• Educational competencies: NIR suite leadership may manage education and competency assessment from several perspectives.  Companies with knowledge about devices frequently host educational talks or in-services for staff.  Content covered and attendance at in-services should be noted by NIR leadership and documented in staff files.  Information from device experts should be put

  

  into context for NIR staff by practitioners (e.g., physicians, advanced practice providers, stroke coordinators, lead technologists) so all staff are knowledgeable about how devices will be used in procedures at the organization.  Another great approach to NIR staff education is focusing on what staff should anticipate if an unexpected complication occurs during the case.  Discussion or even simulated cases of managing complications during procedures can help all room staff anticipate what is needed during a stressful event.  Finally, any staff managing patients with critical care needs in the NIR suite should have documented education and competencies related to critical care stroke management. 
• Knowledge of performance improvement data: NIR staff should have knowledge of the program’s performance data and how they fit into the puzzle of fast and safe care.  This includes knowledge about the time from door to thrombolysis and mechanical thrombectomy times (first pass of device, recanalization time) and outcomes (TICI scores).  Staff should be articulate about how they ensure processes are followed to minimize delay and ensure safety.  Data should be readily available for staff, and they should be able to explain the information and why it matters to patient care.  
• Management of critically ill patients: Some patients receiving care in the NIR suite are critically ill, such as patients with subarachnoid hemorrhage in the suite for intra-arterial management of cerebral vasospasm.  Roles and responsibilities of all staff in the room related to management of critical care needs including the external ventricular drain (EVD), intracranial pressure monitoring and management, vasopressors for blood pressure management, and mechanical ventilation should be clear. Documentation of frequent vital sign assessment, EVD monitoring and mechanical ventilation should also be clear in the medical record for patient tracers. Many traditional templates for the NIR or cardiac catheterization lab in electronic health records do not offer a place for documentation of these parameters and require editing to ensure complete documentation of monitoring.

Having an organized approach to these key areas will help to ensure a smooth certification review for your stroke program and will minimize the risk of findings on your next certification review.  Most importantly, it will ensure you are providing the best care for your patients.   

And as always, Stroke Challenges has several free resources including blogs on various stroke topics.  We also offer both e-books and on-demand webinar training on topics including how to put your best foot forward during your stroke program opening presentation for certification, mastering your data tracer and several helpful on-demand data management presentations and workshops.  Visit our website to see all that we offer!

STROKE CHALLENGES, CO-FOUNDERS

Sarah Livesay, DNP, APRN, ACNP-BC, ACNS-BC

Debbie Hill, BS, FAHA

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