Explanation of Outcomes Terms
DVT Prophylaxis by End of Admission Day Two
Deep venous thrombosis (DVT) is a blood clot that can form deep in the leg or arm when someone is unable to get out of bed. People who've had a stroke may have difficulty moving or walking, so it is important to reduce their risk of DVT. Evidence-based medicine has found that stroke patients should receive therapy to prevent DVT by the end of the second day of their hospital stay.
Antithrombotic at Discharge
According to the American Heart/American Stroke Association, 23 percent of strokes are recurrent – meaning the stroke happens to someone who has had a stroke before. It is important for people who've had a stroke to be on the correct medicines to prevent recurrent stroke. Antithrombotic medications, such as aspirin or Plavix, reduce the risk of recurrent stroke by making the platelets in the blood less likely to stick together and form a clot. It is important to prescribe antithrombotic treatment at discharge for people who have had a stroke.
Anticoagulation at Discharge for Patients with Atrial Fibrillation/Flutter
Atrial fibrillation and atrial flutter are irregular heart rhythms that prevent blood from flowing smoothly through the heart and increase the risk of blood clots. These blood clots can travel to the brain and cause a stroke. According to the National Stroke Association, people with atrial fibrillation are five times more likely to have a stroke. Anticoagulant medications make the blood less likely to clot, which reduces the risk of another stroke. An anticoagulant should be prescribed at discharge.
tPA-Eligible Patients Who Arrive Within Two Hours of Symptoms and are Treated Within Three Hours
Tissue plasminogen activator (tPA) is the only medication that can be used to open a blood vessel in the brain that is blocked by a blood clot, which is the cause of most strokes. If a person having this type of stroke arrives at the hospital within two hours of their first stroke symptom, doctors can often reopen the blocked vessel and save some of the brain tissue. This results in less brain damage and less disability. If a person waits too long to get medical attention, all of the brain tissue affected by the blocked blood vessel may already be dead. Reopening the vessel then will not lessen the damage from the stroke, and is very likely to cause bleeding in the brain. For this reason, tPA must be given within two to three hours of the first signs of stroke.
Antithrombotic Therapy by End of Admission Day Two
It is important for people who have had a stroke to receive antithrombotic medication quickly to keep the stroke-causing clot from growing. A clot sitting in a blood vessel will attract platelets, the part of the blood that forms a clot. Antithrombotic medications make platelets in the blood less likely to stick together and form a clot. For this reason, antithrombotics should be given by the end of the patient's second day in the hospital.
Statin Therapy at Discharge
Having a high level of bad cholesterol in the blood is a major risk factor for stroke. Bad cholesterol (LDL) in the blood forms plaque deposits on the walls of arteries. These plaque deposits narrow the opening of the artery, making it hard for blood to flow through. Clots can form on the plaque deposits and block blood flow, causing a stroke. Particles of clot and plaque can also break off from that site and travel to other sites, causing additional strokes. Statin medications reduce the amount of LDL in the blood. Stroke patients should be prescribed a statin medication at discharge.
Patient Received Written Stroke Education
This percentage represents stroke patients who received appropriate education in writing during their hospital stay. People who have had a stroke are at risk for having another stroke (called a recurrent stroke). Stroke patients should be given information on how to manage any conditions they have that increase their risk for stroke, including high blood pressure, high cholesterol, and diabetes. They should be told how to lead a healthier lifestyle to reduce the risk of a recurrent stroke. Smoking doubles the risk of stroke. People who smoke should be given information on how to quit when they leave the hospital. Stroke patients and their families also need education on how to recognize a stroke as soon as it happens and call 911 to ensure rapid treatment.
Patient is Assessed for Rehabilitation
Most people who experience a stroke need some combination of physical, occupational, and speech therapy during and after their hospital stay. Some patients need to transition from the hospital to an intensive inpatient rehabilitation center before they can return home. Others can return home and travel to an outpatient center for therapy or receive services in their home. Stroke patients should be properly evaluated for the type and level of therapy they need before they are discharged. This will help them return to the highest level of function possible.
Patient Received All Standards of Care
This represents the number of stroke patients who received care that met all of the measures mentioned above. This is also referred to as "defect-free care."
Total Number of Patients to Receive tPA
At Memorial Health University Medical Center, we track the number of patients that receive the clot-busting drug tissue plasminogen activator (tPA) in our facility each year. It is the only medication that can be used to open a blood vessel in the brain blocked by a clot, which is the cause of most strokes.
|Complication||Peers (Other Certified Primary Stroke Centers)||2016 Total||2015 Total||2014 Total||2013 Total|
|DVT Prophylaxis by End of Day Two||97.8%||97.7%||96.1%||96.0%||95.3%|
|Antithrombotic at Discharge||98.9%||99.4%||99.1%||99.5%||99.7%|
|Anticoagulation at Discharge for Atrial Fibrillation/Flutter||96.4%||100%||96.7%||100%||100%|
|tPA-Eligible Patients Treated Within Three Hours||86%||100%||96.1%||95.3%||84.4%|
|Antithrombotic by End of Day Two||97.8%||95.4%||97.1%||98.2%||99.3%|
|Statin Therapy at Discharge||97.5%||99.5%||98.3%||97.8%||98.2%|
|Received Written Stroke Education||95.9%||100%||99.7%||100%||100%|
|Assessed for Rehabilitation||98.9%||100%||99.8%||99.8%||99.8%|
|Received All Standards of Care||93.1%||94.1%||92.8%||93.0%||93.3%|
|Number of People to Receive tPA||Not Available||109||112||85||72|