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  • Stroke patients can’t ask for a second opinion: a multi-specialty response to The Joint Commission’s recent suspension of individual stroke surgeon training and volume standards

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Editor’s column
Stroke patients can’t ask for a second opinion: a multi-specialty response to The Joint Commission’s recent suspension of individual stroke surgeon training and volume standards
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  1. Adam S Arthur1,
  2. J Mocco2,
  3. Italo Linfante3,
  4. David Fiorella4,
  5. M Shazam Hussain5,
  6. Tudor G Jovin6,
  7. Raul Nogueira7,
  8. Clemens Schirmer8,
  9. John D Barr9,
  10. Phillip M Meyers10,
  11. Reade De Leacy11,
  12. Felipe C Albuquerque12
  1. 1 University of Tennessee Health Sciences Center, Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
  2. 2 Department of Neurosurgery, Mount Sinai Hospital, New York, USA
  3. 3 Miami Cardiac and Vascular Institute, Baptist Hospital, Florida International University, Miami, Florida, USA
  4. 4 Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
  5. 5 Cerebrovascular Center Cleveland Clinic, Cleveland Clinic, Cleveland, Ohio, USA
  6. 6 Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  7. 7 Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  8. 8 Department of Neurosurgery, Neuroscience Institute, Geisinger, Wilkes-Barre, Pennsylvania, USA
  9. 9 Departments of Radiology and Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
  10. 10 Departments of Radiology and Neurological Surgery, Columbia University, New York, USA
  11. 11 Departments of Neurosurgery and Radiology, Mount Sinai Hospital, New York, USA
  12. 12 Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  1. Correspondence to Dr Adam S Arthur, UT Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee 38120, USA; aarthur{at}semmes-murphey.com

https://doi.org/10.1136/neurintsurg-2018-014536

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    If you were considering surgery on your brain to stave off a devastating stroke, you might ask about the training of the surgeon. You might ask how many times they had done the procedure. Unfortunately, patients with emergent large vessel occlusion strokes (ELVO) often cannot ask these important questions. Even if they could, they lack the time to consider their options. They depend on the healthcare system to bring them to a surgeon who gives them the best chance.

    On September 17 2018, The Joint Commission (TJC) announced the suspension of individual physician training and volume requirements for acute ischemic stroke thrombectomy at hospitals certified as Comprehensive Stroke Centers (CSC) and Thrombectomy-Capable Stroke Centers (TCC). TJC decided to remove its previously established requirement for both an individual thrombectomy volume minimum and for physician-specific certification to perform acute stroke thrombectomy. These requirements were established based on multiple discussions of TJC’s own technical advisory panel (TAP). No discussion was held with the TAP before the suspension of training and volume requirements for individual physicians.

    Why have individual requirements?

    Initial evidence to support these requirements can be found in the multi-specialty recommendations for training by the Committee for Advanced Subspecialty Training (CAST).1 These recommendations emphasize the importance of training and experience for achieving optimal outcomes. As essential elements, the CAST recommendations include: cognitive training in the clinical neurosciences; critical procedural neuroendovascular training; and annual performance of a minimum of thrombectomies and other neuroendovascular procedures. These recommendations are based on a large body of evidence published in peer-reviewed literature consistently demonstrating that standards of training and case volumes for both physician operators and treating medical centers significantly influence procedural outcomes and should be requirements to ensure high-quality care for patients.2–6 The physician volume requirement is further supported by the same 2016 Centers for Medicare and Medicaid Services (CMS) …

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