Quality improvement: stroke plan-do-study-act for primary stroke center certification.

The 10-year aftermath of Shortell and colleagues' landmark intensive care unit study has resulted in healthcare institutions increasingly strategizing themselves into disease-specific niches. Specialization has evolved to the point at which The Joint Commission will certify exceptional disease programs. One such certification has been developed for stroke. The processes essential to attain stroke certification are detailed, complex, and outlined in this article.