Metrics for Measuring Quality of Care in Comprehensive Stroke Centers: Detailed Follow-Up to Brain Attack Coalition Comprehensive Stroke Center Recommendations: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Perspective:

The following are important core metrics for care of patients with stroke:

1. Any patient presenting with a stroke or a transient ischemic attack with residual deficit at presentation should have the National Institutes of Health Stroke Scale (NIHSS) score documented. NIHSS should be obtained by a certified examiner.

2. The percentage of ischemic stroke patients eligible for intravenous thrombolysis who receive it within the appropriate time window should be tracked.

3. Patients with ischemic stroke who receive intravenous thrombolysis and are treated within 60 minutes of presentation should be tracked.

4. Patients seen within 6 hours of onset of an ischemic stroke should either have an endovascular recanalization procedure performed or documentation that it was considered and deemed not to be appropriate or possible. Median time from arrival to start of endovascular treatment should be reported.

5. The percentage of patients treated with thrombolysis or endovascular procedures who develop symptomatic intracranial bleeding should be tracked.

6. All patients treated with thrombolysis or endovascular treatment should have a modified Rankin scale score documented at 90 days.

7. The 30-day incidence of stroke or death in patients undergoing carotid endarterectomy or stenting should be reported. The 30-day incidence of stroke or death in patients undergoing intracranial stenting should also be tracked.

8. In patients with subarachnoid hemorrhage (SAH) or intracranial bleeding, initial symptom severity should be documented. In patients with ruptured aneurysm, median time from admission to start of a surgical or endovascular procedure to obliterate the aneurysm needs to be documented.

9. The percentage of patients with documented aneurysmal SAH for whom nimodipine treatment is started within 24 hours of diagnosis and for whom such treatment is continued until 21 days after the hemorrhage or until discharge should be documented.

10. Median number of days from admission to completion of assessment for rehabilitative services unless patient is medically unstable or deemed not to need such services should be documented.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Vascular Medicine

Keywords: Subarachnoid Hemorrhage, Stroke, Follow-Up Studies, Atherosclerosis, Ischemic Attack, Transient, Endarterectomy, Carotid, Peripheral Vascular Diseases, Incidence, Intracranial Hemorrhages, Aneurysm, Ruptured, National Institutes of Health (U.S.), Cardiovascular Nursing, United States, Brain


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