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.

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 2017: 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 2017: 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 2017: 100%

STK-4:  Initiation of IV tPA within 3 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 3 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 2017: 100%

STK-5:  Antithrombotic Therapy started by end of hospital day #2

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

Rationale:  studies show that administering antithrombotics within 2 days of stroke reduces morbidity and mortality.
National Performance Goal: 85%
Q1 2017: 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 2017: 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 2017: 100%

STK-10: Rehab must be considered for all patients

  • Pt must be assessed for Rehab Services

Rationale:  two-thirds of people that suffer strokes every year survive, leaving approx 40% with some form of functional impairment.  These patients require some form of rehab.
National Performance Goal: 85%
Q1 2017: 100%

Outcomes Data:

70% of our stroke patients go home or to Inpatient Rehab at discharge in Q1 2017

Procedure Totals & Outcomes

2017 (Q1 & Q2)

  • Total Carotid Endartectomies (CEA)-0
  • Total Carotid Arterial Stents (CAS)-11
  • Asymptomatic CEA- 0
  • Symptomatic CEA-0
  • Asymptomatic CAS-5
  • Symptomatic CAS-6
  • Clippings: 3 (2 Hemorrhagic Conversion, 1 MCA infarct)
  • Coils- 24
  • EVD/VP - 12
  • Diagnostic Caths, 72
  • Thrombectomies - 27 (5 Hemorrhagic Conversions, 1 death)
  • Decompressive hemicrani - 3

2016

  • Total Carotid Endartectomies (CEA)-5 - No complications
  • Total Carotid Arterial Stents (CAS)-25 - 2 “AE” complications neuro worsening/abnormal H&H
  • Asymptomatic CEA- 2
  • Symptomatic CEA-3
  • Asymptomatic CAS-15
  • Symptomatic CAS-10
  • Clippings: 5 - no complications
  • Coils- 37
  • EVD/VP -41 (3 complications, infection related)
  • Diagnostic Caths, 103 (4 complications)
  • Thrombectomies 44
  • Decompressive hemicrani - 14
  • 2 in hospital deaths not related to procedures

Other:

Tulane demonstrated for 2 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 over 60 minutes.

The average time it takes from hospital arrival to speak to a stroke doctor during an acute stroke emergency is less than 3 minutes.