These quality metrics are some of the requirements a hospital has to meet to become a certified stroke center. Compliance with these metrics has proven better outcomes for stroke patients based on scientific research.

CSTK-1: NIHSS in 12 hours

National Performance Goal: 85%
Q1 2019: 98%

STK-1: DVT Prophylaxis

  • Ischemic and hemorrhagic stroke patients must receive VTE prophylaxis the day of/day after admission

Rationale: stroke patients are at an increased risk of developing a DVT as opposed to other patients. A DVT (Deep Vein Thrombosis) is a blood clot.
National Performance Goal: 85%
Q1 2019: 99%

STK-2: Antithrombotics prescribed at discharge

  • Discharged on Antithrombotic

Rationale: data suggests patients that take daily antithrombotic after a stroke reduces morbidity and mortality.
National Performance Goal: 85%
Q1 2019: 100%

STK-3: Anticoagulation for patients diagnosed with A-fib or A-flutter

  • Patient must be discharged on anticoagulant if presents with afib/aflutter

Rationale: these are risk factors for stroke. Prescribing an anticoagulant at discharge helps prevent recurrence of stroke. If patient is ineligible for anticoagulation therapy, a reason must be documented why.
National Performance Goal: 85%
Q1 2019: 100%

STK-4: Initiation of IV tPA within 3.5 hours of “last seen well” for eligible patients

  • tPA must be given within the applicable timeframe (if indicated)

Rationale: t-PA administration in eligible patients is most effective if used within three hours of symptom onset. t-PA is a medication that helps break up the clot to restore blood flow to the brain. It is the only FDA-approved medication available to treat an acute ischemic stroke.
National Performance Goal: 85%
Q1 2019: 100%

STK-5: Antithrombotic therapy started by end of hospital day no. 2

  • Antithrombotics must be given by the end of hospital day 2 or documented contraindication provided

Rationale: studies show that administering antithrombotics within two days of stroke reduces morbidity and mortality.
National Performance Goal: 85%
Q1 2019: 98%

STK-6: Patients should have an LDL level drawn within 48 hours of admission. Patients with LDL >100 should be discharged home on Statin therapy

  • LDL level must be drawn for all strokes within 48 hours of arrival

Rationale: Patients with LDL > 100 mg/dL should be prescribed a Statin at discharge to reduce the recurrence of stroke. High cholesterol is a risk factor for stroke.
National Performance Goal: 85%
Q1 2019: 100%

STK-8: Patients or family members must be provided with stroke education.

  • Stroke education

Rationale: Patients with strokes must be educated on risk factors, activation of EMS, the importance of follow-up after discharge, medications they have been prescribed, and warning symptoms/signs of stroke. Early activation of EMS and proper treatment of stroke significantly increases life spans of patients with stroke. Appropriate education is imperative to the reduction of morbidity and mortality.
National Performance Goal: 85%
Q1 2019: 100%

STK-10: Rehab must be considered for all patients

  • Patient must be assessed for rehab services

Rationale: two-thirds of people that suffer strokes every year survive, leaving approximately 40% with some form of functional impairment. These patients require some form of rehab.
National Performance Goal: 85%
Q1 2019: 100%

Outcomes data:

70% of our stroke patients go home or to inpatient rehab at discharge in Q1 2019

30-day inpatient mortality rate: (4/2018-4/2019)

  • Acute Ischemic Stroke: 5.3%
  • Intracerebral Hemorrhage Stroke: 18.8%
  • Subarachnoid Hemorrhagic Stroke: 3%

Procedure totals and outcomes

2018

  • Total Carotid Endartectomies (CEA) - 1
  • Asymptomatic CEA - 0
  • Symptomatic CEA - 1
  • Total Carotid Arterial Stents (CAS) - 28
  • Asymptomatic CAS - 5
  • Symptomatic CAS - 23
  • Clippings - 11 (No Complications)
  • Coils - 69 ([5]-30 day mortality-post procedure)
  • EVD/VP - 32
  • Diagnostic Caths - 130
  • Thrombectomies - 109 (20 Hemorrhagic Conversions; [9] deaths)
  • Decompressive Hemicrani - 13 (2 Complications; [4] 30-day mortality-post procedure)

2017

  • Total Carotid Endartectomies (CEA) - 5 - No complications
  • Asymptomatic CEA - 0
  • Symptomatic CEA - 4
  • Total Carotid Arterial Stents (CAS) - 23 (2 “AE” complications neuro worsening/abnormal H&H)
  • Asymptomatic CAS - 5
  • Symptomatic CAS - 19
  • Clippings - 5 - No complications
  • Embo/Coils - 49 ([1]-30-day mortality-post procedure)
  • EVD/VP - 31 (1 complications, infection related)
  • Diagnostic Caths - 132 - No complications
  • Thrombectomies - 88 (22 Hemorrhagic Conversions; [4] 30-day mortality-post procedure)
  • Decompressive hemicrani - 21 ([2] inpatient deaths not related to procedures)

Other

Tulane Health System has demonstrated for three years running that we are able to treat, on average, a patient in less than 45 minutes with IV tpa. This has earned Tulane’s stroke program the highest award given by the American Heart Association/American Stroke Association for stroke care. The average time reported to the AHA/ASA is more than 60 minutes.

The average time it takes from hospital arrival to speak to a stroke doctor during an acute stroke emergency is less than three minutes.