Tammy Mobley Axsom was treated for a stroke in 2019 at IU Health Bloomington. She said she remembers being treated quickly and thoroughly, and without the resources the hospital had, she probably wouldn’t have survived. In Aug. 2022, IU Health Bloomington said they chose not to renew its stroke certification this year — a certification they've held since 2007. Axsom said she now worries patients won’t be treated right away.
After the hospital did not renew its certification, what has since ensued is confusion amongst residents about the hospital’s quality of care and a IU Health public statement criticizing another local Bloomington paper for its coverage.
Brian Shockney, president of IU Health South Central Region, told the IDS obtaining stroke certification is voluntary. The hospital didn’t lose the certification, but rather, made the choice to not renew it, Shockney said. He said this was because of high levels of patients in the midst of the pandemic as well as going through the process of moving into a new hospital.
“We made a conscious decision that recertification wasn’t something we had the resources nor the time to do at that point,” Shockney said.
But, other healthcare professionals outside IU Health say the lapse in certification could impact treatment times and locations.
What does it mean to receive this stroke certification?
The certification previously allowed the hospital to be named a Primary Stroke Center, a title given to hospitals with healthcare professionals specially trained in stroke care and with facilities to distribute faster treatment and individualized care. PSCs can provide more advanced diagnostic assessments using high-tech imaging.
Stroke certifications are administered by The Joint Commission, a national nonprofit that evaluates healthcare organizations. Founded in 1951, the organization is the nation’s oldest and largest standard-setting, accrediting body in healthcare, according to its website.
To earn certification, healthcare organizations undergo on-site surveys every two years to examine whether the organization meets certification standards. For PSCs — the certification IU Health Bloomington had before it lapsed — these standards measure elements such as time between arrival at the emergency room and beginning of treatment, the types of treatment stroke patients receive and assessment for rehabilitation services.
Why did IU Health not re-certify?
Dealing with a patient surge after moving into the new hospital, IU Health Bloomington decided it would be best not to allocate extra time to recertification, Shockney said.
The Joint Commission’s website said healthcare organizations should pursue the stroke certification. The stroke certification assists in establishing a consistent approach to care and demonstrates a commitment to a higher standard of service, according to its website.
Shockney said IU Health Bloomington is already ranked as a high-performing hospital for stroke care and continues to meet certification standards, even without being certified this year. He said having the certification itself, because it is voluntary, doesn’t prove anything.
IU Health Bloomington is ranked by U.S. News as high-performing in 5 categories of treatment --- stroke, heart attack, kidney failure, maternity care and chronic obstructive pulmonary disease.
The hospital also holds Gold Plus Target Stroke Honor Roll Elite status with the American Heart Association for stroke treatment.
“Patients can come to us for their care as they did before without any doubt they’re going to get the best, and excellent, care,” Shockney said.
Before the hospital chose not to re-certify, it was given an extension.
IU Health Bloomington spokesperson Samantha Kirby said the hospital was given its most recent certification in 2019, prior to the COVID-19 pandemic. The hospital was due for recertification in the fall of 2021, but it was approved for an extension due to the pandemic.
When the extension expired, the hospital decided not to seek recertification at that time. The recertification process meant IU Health Bloomington would have to submit an application with the data they collect and pay the Joint Commission to come in for an external review, Shockney said.
“We determined there wasn’t a need to really stress the team more with that kind of survey,” Cindy Herrington, Chief Nursing Officer of IU Health South Central Region, said. “The taxing of the team during that time was just not necessary — we continued with the same excellence.”
What are other local healthcare professionals saying?
Experts in stroke care in Indiana told the IDS they feel stroke certification is reassuring for the community and expressed the importance of having stroke-certified hospitals.
“I believe the hospital is responsible for explaining to the Bloomington community why the decision was made to not renew their stroke certification and describe what stroke care will look like going forward,“ Susan Savastuk, a former Stroke Program Coordinator at IU Health Bloomington who retired in 2015, said in an email.
Savastuk, while working for IU Health Bloomington, was tasked with facilitating the Joint Committee’s certification of the hospital, helping prepare everyone in the program to answer questions and demonstrate the hospital’s abilities.
Savastuk said having the certification allowed the hospital to advertise they are stroke-certified. It also meant emergency services knew to bring patients to IU Health Bloomington if they needed stroke care since Monroe Hospital is not stroke-certified.
“They knew we would have measures that we looked at, and we would get things done quickly and see the patient,” Savastuk said. “Everybody was under the same standard.”
Savastuk recalled tracking treatment time meticulously during her time working at the hospital She said the stroke team would measure every element of care: the time it took emergency services to get to a patient’s home, the time it took to get the patient into an ambulance, time to be seen by a physician and time to be started on important stroke treatment.
Research shows that time is one of the most important factors in stroke care. 85 percent of all strokes in the U.S. are ischemic strokes. The most common life-saving treatment for these types of strokes is tissue plasminogen activator, which is given to stroke patients to break up blood clots and restore blood flow to the brain. TPA is widely known as being most effective if administered within three hours after symptoms of a stroke arise.
Savastuk said that during her time at IU Health Bloomington, initial treatment times kept improving until the “door-to-needle" time — the time from when a patient entered the emergency room doors to the start time of TPA — was down to 60 minutes or less.
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With Monroe County Hospital not being stroke-certified, Savastuk said she’s worried there’s no known “stroke champion” in the area.
Eskenazi Health in Indianapolis is certified as a Primary Stroke Center. Stroke Program Manager Michelle Glidden said having a stroke certification brings in a certain level of expertise because they are held to a higher standard of care. Stroke-certified hospitals also attract physicians who are passionate about stroke care.
“The research shows that the patients that go to a stroke center versus any hospital, their care is better and their outcomes are better,” Glidden said.
Glidden said more patients treated at certified stroke centers are prepared for rehabilitation and are sent home earlier rather than needing longer-term care.
The closest stroke-certified facilities to Bloomington are in Indianapolis. Glidden said she thinks the lapse of stroke certification puts residents around Bloomington at a disadvantage. She cited a 2018 law and said she’d be interested to see whether EMS services choose to take stroke patients to closer non-stroke-certified hospitals or if they choose to airlift patients to certified hospitals.
What happened with the Herald-Times?
The Herald-Times published an article Aug. 26 titled “‘IU Health Bloomington has lost a stroke certification. What that means for patients.”
The article provided details about IU Health’s neurology team and comments from local neurologists, including one who formerly served as the hospital’s medical director for the stroke neurology team. The neurologist, Dr. Ronnie Goswami, told the H-T he was concerned about what the loss of the certification could mean for the speed at which patients receive care. Goswami also told the H-T the lack of certification could mean some patients would need to be transferred to other facilities, and that he thinks the certification loss is a blow to IU Health Bloomington’s reputation.
An IU Health spokeswoman told the Herald-Times in the article that the hospital remains committed to excellent stroke care and “continues to be a leading edge provider of stroke care.”
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On Aug. 29, IU Health Bloomington posted a press release written by Shockney to its Facebook page. The press release criticized the Herald-Times' reporting, stating the headline of the Herald-Times article was “irresponsible and harmful” to patients seeking care.
In the press release, Shockney said healthcare organizations have been faced with significant challenges over the past two-and-a-half years, which has required continual evaluation of voluntary and non-required certifications and programs that shift caregivers away from the bedside and add to costs.
Shockney said in the release that the claim that some patients may have to be transferred is untrue, and that IU Health has continued to invest in its neurology program by increasing the number of providers over the past five years and recruiting new neurologists.
However, the Herald-Times published another story Sept. 12, stating the IU Health Bloomington communications team refused to name its staff neurologists or say which of them are accepting patients and when.
In an interview with the IDS prior to the second Herald-Times article, Shockney called the Herald-Times' reporting “erroneous” and said the article “shocked all of us.” Herrington said the article brought unworthy attention that the hospital didn’t deserve. Herrington also said the hospital recently hired a new stroke coordinator.
Boris Ladwig, the reporter at the Herald-Times who wrote both articles, told the IDS in an email that “the stories and the reporting speak for themselves.”