As most vascular surgeons know, the number of mechanical thrombectomy procedures performed in the U.S. has steadily increased over the last few years. In response to this trend, The Joint Commission recently announced its decision to reinstate the individual mechanical thrombectomy volume eligibility requirement for its thrombectomy-capable stroke center (TSC) and comprehensive stroke center (CSC) certification programs.
As of February 1, all primary neurointerventionists—those health care professionals who routinely take calls to perform emergency mechanical thrombectomy—at facilities applying for TSC or CSC certification or recertification must meet the original volume criteria by having had 15 mechanical thrombectomies performed in the last 12 months, or 30 in the last 24 months.
Beginning August 1, revised volume criteria also will be effective for all physicians who perform mechanical thrombectomy at a hospital applying for TSC or CSC certification. In evaluating the number of mechanical thrombectomies performed, procedures performed at hospitals other than the one applying for certification may be included in the physician’s or primary neurointerventionist’s total.
Debating the data
When the individual physician procedural volume and training eligibility requirements for mechanical thrombectomies in the TSC and CSC certification programs originally were implemented, The Joint Commission heard some concerns from its accredited institutions that requiring individual physicians to perform 15 mechanical thrombectomies per year was too demanding. Therefore, in October 2018, The Joint Commission suspended the requirements in order to review relevant data and have conversations with both stakeholders and an expert panel on the appropriateness of those eligibility requirements.
During those discussions, The Joint Commission’s Technical Advisory Panel (TAP) considered studies from the last few years on mechanical thrombectomy procedural volumes and noted that the number of mechanical thrombectomies increased dramatically in both 2017 and 2018. These data addressed the concerns that the original requirement (15 mechanical thrombectomies per year for individual physicians) was too high, therefore supporting reinstatement of the original individual physician volume requirement.
As additional data become available, however, The Joint Commission will continue to review the results with TAP members and revise the individual physician volume eligibility requirement as appropriate.
The TAP also addressed whether the individual physician mechanical thrombectomy volume requirement should apply to all physicians who perform mechanical thrombectomy at a stroke center or if it should be restricted to primary neurointerventionists (those health care professionals who take calls to perform emergency mechanical thrombectomy).
Most TAP members supported a proposed requirement to extend applicability to any physician who performs mechanical thrombectomy. However, several panel members emphasized the need to give stroke centers enough time to adjust their staffing levels and call schedules to ensure that all physicians who perform mechanical thrombectomy can meet the volume requirement.
In these meetings, participants expressed strong support for reestablishing training requirements; however, it was agreed that stakeholders and the stroke TAP members needed to discuss the issue further before finalizing revised requirements. The Joint Commission plans to announce any additional changes after further review.
Acknowledgment
The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.
