Stroke and Neurovascular Reports

The Joint Commission Measures

The Joint Commission uses 10 clinical performance measures for stroke care. Below is a listing of each of the 10 measures and a description. Listed below the descriptions are charts depicting how Froedtert & the Medical College of Wisconsin perform compared with all hospitals and compared with other The Joint Commission-certified stroke centers.

Measures to Prevent Another Stroke

Discharged on antithrombotics — the patient is discharged with medication that prevents the formation of blood clots.
Patients with atrial fibrillation receiving anticoagulation therapy — about 15 percent of strokes occur in people with atrial fibrillation (abnormal heart rhythm). During atrial fibrillation, the atria (two upper chambers of the heart) quiver instead of beating normally. Blood does not pump completely out of the atria and may pool and clot. If a piece of a blood clot leaves the heart and becomes lodged in a brain artery, a stroke results. Anticoagulation therapy involves prescribing blood thinning medication that prevents the formation of blood clots.
Lipid profile — an elevated serum lipid level is a risk factor for coronary artery disease. Elevated lipid levels are also related to the incidence of stroke. The reduction of LDL cholesterol, through lifestyle modification and medication, for the prevention of stroke and other vascular events is recommended for patients with coronary artery disease.

A lipid profile blood test is recommended for all stroke patients. A lipid profile usually includes total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and low-density lipoprotein (LDL) cholesterol.
Stroke education — providing education about stroke for patients and care providers
Smoking cessation — smoking is a risk factor for a stroke. Before discharge, stroke patients who smoke should receive counseling and information on ways to quit smoking.
Antithrombotic medication within 48 hours of hospitalization — patients recovering from a mild stroke or who have had a recent transient ischemic attack (TIA or “mini” stroke) are at high risk of having another stroke. Antithrombotic drugs, which prevent the formation of blood clots, should be given with 48 hours of symptom onset in acute ischemic stroke patients who meet certain guidelines for these drugs. Antiplatelet therapy is also recommended for most patients w/TIAs.

Emergency Measures
Tissue plasminogen activator (tPA) considered — tPA is a clot-dissolving drug approved by the FDA to treat ischemic stroke (blood clots in the brain) in the first three hours after the start of symptoms. The sooner tPA or other appropriate treatment is begun, the better the chances for recovery.

Note: The chart below compares Froedtert & the Medical College of Wisconsin data for “tPA considered” and “tPA administered” with other hospitals.

Measures to Prevent Complications
DVT prophylaxis (prevention of leg vein blood clots) — deep vein thrombosis (DVT) involves the formation of a clot in the veins in the lower leg and the thigh. This clot may interfere with circulation and may break off and travel through the blood vessels and cause another stroke. Patients experiencing stroke that involves a partially or totally paralyzed leg are at increased risk of developing DVT. DVT prevention is recommended for at-risk patients to reduce the risk of another stroke. Preventive measures include the use of blood thinning medications, compression stockings and pneumatic (air) compression of the legs.
Screen for dysphagia — a stroke can affect many body functions, including the ability to swallow. Stroke patients are at particular risk of aspiration (choking) because of dysphagia (difficulty swallowing). All stroke patients should be checked for their ability to swallow.
Rehabilitation plan considered — before discharge, stroke patients should be assessed or receive rehabilitation services to enhance their recovery and minimize functional disabilities.

Note: The chart below shows how the Froedtert & the Medical College Stroke & Neurovascular Program compared to other hospitals in the country.

“All hospitals” are those participating in Get with the Guidelines-Stroke (GWTG-Stroke) developed by the American Stroke Association. GWTG-Stroke is the American Stroke Association’s process for continuous quality improvement of acute stroke treatment and ischemic stroke prevention. The program helps hospitals collect and analyze stroke data, and provides a way for physicians and hospital staff to monitor their performance. GWTG-Stroke focuses on care team protocols to ensure that patients are treated and discharged appropriately.
“Midwest hospitals” are those participating hospitals in the Midwest region that participate with Get with the Guidelines-Stroke.

In all cases in the chart above, the higher percentage is preferred.

The above information addresses the Institute of Medicine’s aim for health care that is effective.

FAST — When Minutes Count

Minutes count when responding to a stroke. That’s just one reason why the Froedtert & the Medical College Acute Stroke Team (FAST) is available 24 hours a day, seven days a week. This acute response team provides stroke patients with rapid access to diagnosis and treatment.

Stroke neurologists, critical care neurologists, neurosurgeons, interventional neurologists, emergency medicine physicians and nurse specialists work around the clock to beat stroke.

Clot-Busting Drugs

Studies have shown that thrombolytic drugs, or clot-busters, effectively stop strokes and improve patient outcomes if specialists trained in giving the drugs are immediately available. All FAST doctors are trained to administer clot-busters and have been successfully using them since their approval in 1996. Some of these miracle drugs need to be administered intravenously within the first three hours of the onset of symptoms. It’s just another reason to act fast when stroke symptoms occur.

Tissue plasminogen activator (tPA) considered (a JCAHO measure for stroke care) — tPA is a clot-dissolving drug approved by the FDA to treat ischemic stroke (blood clots in the brain) in the first three hours after the start of symptoms. The sooner tPA or other appropriate treatment is begun, the better the chances for recovery.

Note: The chart below compares Froedtert & the Medical College of Wisconsin data for “tPA considered” and “tPA administered” with other hospitals.

The chart below compares the time to tPA for Froedtert & the Medical College of Wisconsin with other hospitals. This is a measure of how quickly the stroke team reacts.