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%
2020: 99.2%
YTD 2021: 99.6%

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%
2020: 100%
YTD 2021: 99.3%

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%
2021: 100%
YTD 2021: 99.5%

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%
2020: 100%
YTD 2021: 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%
2020: 97.9%
YTD 2021: 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%
2020: 99.4%
YTD 2021: 100%

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%
2020: 99.7%
YTD 2021: 95.3%

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%
2020: 97.6%
YTD 2021: 93.7%

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%
2020: 100%
YTD 2021: 99.6%

Outcomes data:

Percentage of patients discharged to home and inpatient rehabilitation:

  • 2021 YTD Home: 46%
  • 2021 YTD Rehab: 26%

Total Types of Strokes Treated Annually:

  • 2020 Acute Ischemic Stroke: 446
  • 2020 Intracerebral Hemorrhage Stroke: 93
  • 2020 Subarachnoid Hemorrhagic Stroke: 33
  • 2020 Trans Ischemic Attacks: 53
  • 2021 YTD Acute Ischemic Stroke: 309
  • 2021 YTD Intracerebral Hemorrhage Stroke: 54
  • 2021 YTD Subarachnoid Hemorrhagic Stroke: 30
  • 2021 YTD Trans Ischemic Attacks: 37

Procedure totals and outcomes

2021 YTD

  • Total Carotid Endarterectomies (CEA) - 5
  • Asymptomatic CEA - 0
  • Symptomatic CEA - 5
  • Total Carotid Arterial Stents (CAS) - 14
  • Asymptomatic CAS - 0
  • Symptomatic CAS - 14
  • Embo/Coils - 36 ([2]-30 day mortality-post procedure)
  • EVD – 25
  • VP - 9
  • Diagnostic Caths - 171
  • Thrombectomies - 60 (4 Hemorrhagic Conversions; [0] deaths)
  • Decompressive Hemicrani - 8 (0 Complications; [0] 30-day mortality-post procedure)

2020

  • Total Carotid Endarterectomies (CEA) - 3 - No complications
  • Asymptomatic CEA - 0
  • Symptomatic CEA - 3
  • Total Carotid Arterial Stents (CAS) - 24
  • Asymptomatic CAS - 0
  • Symptomatic CAS - 24
  • Embo/Coils - 49 ([1]-30-day mortality-post procedure)
  • EVD - 26
  • VP - 50
  • Diagnostic Caths - 235 - No complications
  • Thrombectomies - 84 (14 Hemorrhagic Conversions; [0] 30-day mortality-post procedure)
  • Decompressive hemicrani - 22

Other

Tulane Health System has demonstrated for three years running that we are able to treat, on average, a patient in less than 36 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.