COMPREHENSIVE SUMMARY OF INSTOR REPORTS

Transcription

1 COMPREHENSIVE SUMMARY OF INSTOR REPORTS Please note that the following chart provides a sampling of INSTOR reports to differentiate this registry s capabilities as a process improvement system. This list is by no means complete; INSTOR presents over 300 sophisticated real-time reports spanning six major categories. Utilized by Primary and Comprehensive Stroke Centers, INSTOR measures performance as it applies to both IV tpa and Endovascular Treatment (EVT), for inpatients as well as outpatients. STROKE REGISTRY CAPABILITIES GTWG INSTOR Demographics Population Overview 1. % of each stroke alert sub-type: Ischemic / TIA / mimic / SAH / ICH / IVH 2. % male or female 3. Age; minimum/median/maximum 4. % patients with diabetes 5. % patients transferred in Co-morbidities 1. % of emergency stroke alerts patients with a-fib 2. % of emergency stroke alerts patients with diabetes 3. % of emergency stroke alerts patients with coronary artery disease 4. % of emergency stroke alerts patients with hypertension 5. % of emergency stroke alerts patients with hypercholesterolemia 6. % of emergency stroke alerts patients with history of myocardial infarction 7. % of emergency stroke alerts patients with hypertension 8. % of emergency stroke alerts patients with history of smoking 9. % of patients with congestive heart failure Processes of Care Overview 1. % of patients treated with Intravenous tissue Plasminogen Activator (IV tpa) alone 2. % of patients treated with IV tpa + EVT

2 3. % of patients treated with EVT alone 4. % of all stroke alerts that received imaging within 25 minutes of patient arrival 5. % of all stroke alerts that had imaging read within 45 minutes 6. % of all stroke alerts with an National Institute Health Stroke Scale (NIHSS) score upon patient arrival 7. % of inpatient stroke alerts with a prospective NIHSS score Individual Patient Timelines (Running Bar Chart Format) All steps in the process of treatment of any 10 patients (sortable by date) 1. Process of care timelines for IV tpa patients 2. Process of care timelines for EVT patients Long-Term Trends (Monthly Median Times) Specific process intervals (door to CT, door to tpa, etc.) for any 24 month period (sortable by date) Stroke Alert Process Trends 1. Patient arrival to stroke alert 2. Patient arrival to CT 3. Patient arrival to CT read 4. Patient arrival to lab results IV tpa Process Trends 1. Imaging read to decision (IV tpa order) 2. Patient arrival to decision (IV tpa order) 3. Patient arrival to IV tpa started 4. Decision (tpa order) to tpa started Endovascular Process Trends 1. Patient arrival to patient on the table 2. On table to puncture 3. Patient arrival to puncture 4. Patient arrival to start of revascularization (catheter in brain) 5. Patient arrival to Thromboembolic Ischemia in Cerebral Infarction (TICI) 2a 6. Patient arrival to TICI 2b 7. Puncture to start of revascularization (catheter in brain) 8. Puncture to TICI 2a

3 9. Puncture to TICI 2b Personnel Response Trends 1. Patient arrival to stroke code responder (may be ED, stroke nurse, stroke coordinator, etc.) 2. Patient arrival to neurology arrival 3. Patient arrival to neurointerventionist arrival 4. Patient arrival to cath team arrival Detailed Current Trends Moving average trend line of 30 consecutive process intervals for each of the indicated steps (sortable by date) Process Trends for 30 Consecutive Stroke Alerts 1. Patient arrival to stroke alert 2. Patient arrival to CT/MRI 3. Patient arrival to CT/MRI read 4. CT/MRI done to CT/MRI read 5. Patient arrival to lab results Process Trends for 30 Consecutive IV tpa Patients 1. Patient arrival to decision (IV tpa order) 2. Patient arrival to IV tpa started 3. CT/MRI read to decision (IV tpa order) 4. Decision (tpa order) to IV tpa started Process Trends for 30 Consecutive Endovascular Patients 1. Patient arrival to patient on table 2. On table to puncture 3. Patient arrival to puncture 4. Patient arrival to start of revascularization (catheter in brain) 5. Patient arrival to TICI 2a 6. Patient arrival to TICI 2b 7. Puncture to start of revascularization (catheter in brain) 8. Puncture to TICI 2a 9. Puncture to TICI 2b Personnel Response Time for 30 Consecutive Cases 1. Patient arrival to stroke code nurse/stroke responder

4 2. Patient arrival to neurologist arrival 3. Patient arrival to neurointerventionist arrival 4. Patient arrival to cath team arrival Variances 1. Clinical and procedural a. Last 3 months symptomatic hemorrhages b. Last 6 months Iatrogenic complications c. Last 12 months deaths within 72 hours of EVT stroke therapy 2. Stroke alert Variances (last 3 months) a. Arrival to stroke alert > 20 minutes b. Arrival to CT > 60 minutes c. Arrival to CT read > 90 minutes d. CT done to CT read > 30 minutes 3. IV tpa Variances (last 3 months) a. CT read to tpa order (decision) > 20 minutes b. Arrival to tpa > 90 minutes c. Decision (tpa order) to tpa started > 20 minutes 4. Endovascular treatment Variances (last 6 months) a. Arrival to patient on the table > 150 minutes b. On the table to puncture > 30 minutes c. Arrival to Puncture time > 180 minutes d. Arrival to Start of revascularization > 210 minutes e. Arrival to TICI 2a > 260 minutes f. Puncture to start of revascularization > 40 minutes g. Puncture to TICI 2a > 90 minutes Clinical Outcomes (90-day mrs Standard Neurological Stacked Bar Chart Format) IV tpa Alone 1. Stacked bar chart 90-day modified Rankin Score (mrs) IV tpa (0-3 hrs.) 2. Median/minimum/maximum NIHSS score for IV tpa patients (0-3 hrs.)

5 3. Stacked bar chart 90-day mrs for IV tpa (3-4.5 hrs.) 4. Median/minimum/maximum NIHSS score for IV tpa patients (3-4.5 hrs.) 5. % of patients treated with IV tpa alone who had mrs 0-1 at 90 days 6. % of patients treated with IV tpa alone who had mrs 0-2 at 90 days 7. % of patients treated with IV tpa alone with 90-day mrs 0-1 and are diabetic 8. % of patients treated with IV tpa alone with 90-day mrs 0-1 and are NOT diabetic 9. % of patients treated with IV tpa alone who had a symptomatic intra-cerebral hemorrhage within 36 hrs. EVT (Endovascular) 1. Stacked bar chart 90-day mrs for IV tpa + EVT patients 2. Median/minimum/maximum NIHSS score for IV tpa + EVT patients 3. Stacked bar chart 90-day mrs for EVT alone 4. Median/minimum/maximum NIHSS score for EVT alone patients 5. % of patients treated by EVT (with or without IV tpa) that had mrs 0-1 at 90 days 6. % of patients treated by EVT (with or without IV tpa) that had mrs 0-2 at 90 days 7. % of patients treated with ANY endovascular therapy with mrs 0-2 and are diabetic 8. % of patients treated with ANY endovascular therapy with mrs 0-2 and are NOT diabetic 9. % of patients treated with EVT therapy and general anesthesia 10. % of patients treated with EVT therapy using general anesthesia with mrs 0-2 at 90 days 11. % of patients treated with EVT therapy NOT using general anesthesia with mrs 0-2 at 90 days 12. % of patients treated with EVT who had a post procedural symptomatic intra-cerebral 13. % of patients treated with endovascular therapy with peri-procedural complications within 6 hrs. 90-day mrs by Original Occlusion Site for Endovascular Patients (Risk-Adjusted Outcomes Analysis) 1. IV tpa + EVT 2. EVT alone 90-day mrs by THRIVE (Totaled Health Risk In Vascular Events) Score (Risk-Adjusted Outcomes Analysis) 1. IV tpa alone 2. IV tpa + EVT 3. EVT alone mrs by Original NIHSS Score (Risk-Adjusted Outcomes Analysis) 1. All patients

6 2. IV tpa 3. Endovascular (with or without IV tpa) Procedural Outcomes Thromboembolic Ischemia in Cerebral Infarction (TICI) Score 1. Beginning TICI 2. Stacked Bar Chart Final TICI; all grades 3. % of patients treated with endovascular therapy with final TICI 2a or above 4. % of patients treated with endovascular therapy with final TICI 2b or above 5. % of patients treated with endovascular therapy with final TICI 3 (a or b) Complications 1. % of patients treated with IV tpa alone with symptomatic intra-cerebral hemorrhage within 36 hrs. 2. % of patients treated with both IV tpa and endovascular therapy with a symptomatic intracerebral 3. % of patients treated with endovascular therapy alone with a symptomatic intra-cerebral 4. % of patients treated with endovascular therapy with peri-procedural complications within 6 hrs. 5. % of patients treated with endovascular therapy that die within 72 hrs. 6. % of patients treated with IV tpa that die within 72 hrs. American Stroke Association Metrics for Ischemic Stroke 1. % of patients with ischemic stroke with documented NIHSS score 2. % of patients with stroke who receive tpa in appropriate time window (0-3 hrs.) 3. % of patients with stroke who receive tpa in appropriate time window (3-4.5 hrs.) 4. % of patients with stroke who receive tpa within 60 minutes 5. Median time to multimodal imaging (e.g., CTA, CT perfusion) 6. % of patients with ischemic stroke where EVT therapy is considered 7. % of patients treated with IV tpa with Sx bleeds 8. % of patients treated with EVT with Sx bleeds 9. % of patients treated with IV tpa or EVT with documented mrs at 90 days a. Stacked bar chart of 90-day mrs for IV tpa patients (0-3 hrs.) b. Stacked bar chart of 90-day mrs for IV tpa patients (3 4.5 hrs.) c. Stacked bar chart of 90-day mrs for IV tpa + EVT patients

7 d. Stacked bar chart of 90-day mrs for EVT alone patients Joint Commission Measures Concerning Acute Ischemic Stroke 1. % of patients with NIHSS score recorded on patient arrival h. Actual minimum/median/maximum NIHSS for all acute ischemic stroke alerts 2. % of patients who arrive by 2 hrs., are treated by 3 hrs. 3. % of patients who arrive by 3.5 hrs., are treated by 4.5 hrs. 4. % of patients with ANY mrs at 90 days a. Stacked bar chart 90-day mrs for IV tpa alone patients (0 to 3 hrs.) b. Stacked bar chart 90-day mrs for IV tpa alone patients (3 4.5 hrs.) c. Stacked bar chart 90-day mrs for IV tpa and EVT patients d. Stacked bar chart 90-day mrs for EVT alone patients 5. % of patients with stroke severity measurement on patient arrival 6. Actual measure of stroke severity (minimum/median/maximum) a. NIHSS for acute ischemic stroke b. Hunt and Hess scale for SAH c. ICH score for ICH 7. % of patients with ICH with treatment with a pro-coagulant reversal agent if needed 8. Median time to treatment with a pro-coagulant reversal agent 9. Median time to completion of INR reversal 10. % of patients treated with IV tpa alone with symptomatic intra-cerebral hemorrhage within 36 hrs. 11. % of patients treated with both IV tpa and endovascular therapy with a symptomatic intracerebral 12. % of patients treated with endovascular therapy alone with a symptomatic intra-cerebral 13. % of patients with SAH that receive nimodipine within 24 hrs. 14. Median time to recanalization therapy for EVT patients 15. % EVT treated patients with at least TICI 2b recanalization 16. Stacked bar chart of post treatment TICI score for EVT patients Multisociety Consensus Quality Improvement Guidelines for Intra-Arterial Treatment of Acute Ischemic Stroke

8 Inclusive of individual physician performance measures and the specific hospital measures that directly impact them Hospital Performance Guidelines % of all EVT patients have all required process and outcomes data entered into a national database, trial or registry 2. 80% of acute stroke patients being evaluated for revascularization should have a non-contrast head CT or MRI within 25 minutes from time of patient arrival 3. 80% of acute stroke patients being evaluated for revascularization should have a non-contrast head CT or MRI completed and interpreted within 45 minutes from time of patient arrival 4. If institutional protocols require non-invasive vascular and parenchymal imaging (CTA/CTP or MRA/MRI) prior to intervention, 80% of all EVT patients should undergo these studies 5. 75% of patients treated with endovascular therapy should have a door to puncture time < 2 hrs. Individual Physician Performance Guidelines Only INSTOR is capable of measuring performance of individual physicians 1. 50% of patients treated with endovascular therapy by each specific physician should have a time from puncture to start of revascularization of < 45 minutes 2. 60% of patients treated by each specific physician should have TIMI 2 or TICI 2-3 recanalization at procedure completion 3. At least 30% of patients treated by endovascular methods by each specific MD should have an mrs 0-2 at 90 days 4. post EVT symptomatic hemorrhages of patients treated by each specific MD are tracked and reviewed; 12 % is threshold 5. 90% of EVT stroke patients should have a CT/MRI within 36 hrs. post treatment 6. All deaths within 72 hrs. of patients treated by each specific physician are documented