Acute stroke endovascular treatment measure bundle

Measure bundle purpose: Ensure patients receive optimal endovascular treatment evaluation and management.

The numerator has two components, both of which must be met:

1. Documentation of NIHSS on presentation or prior to initiation of endovascular therapy if administered
2. Documentation of eligibility for endovascular treatment using a defined inclusion and exclusion criteria AND Documentation of treatment decision within 1 hour of presentation to include the following details:
   1. If not eligible, documentation of appropriate exclusion criteria must be done
   2. If eligible, documentation of referral for endovascular treatment must be done (referral to an outside endovascular treatment center is acceptable)

is divided by 

The denominator: all acute ischemic stroke patients aged 18 years and older presenting within 6 hours from Last Known Well time (LKW).

There are no exclusions for this measure. 

Key Phrases

Examples of key phrases you could use to meet the measure include:

Component 1:

• NIHSS (followed by numerical score)

Component 2:

• Pt not appropriate candidate for endovascular treatment (followed by appropriate exclusion criteria)
• Pt appropriate candidate for endovascular treatment (followed by appropriate inclusion criteria)
• Time to referral for treatment within 60 minutes of presentation
• Treatment decision reached within 60 minutes of presentation

Measure Calculation Example

Dr. Sokolov treated 100 patients between January 1 and December 31 with a diagnosis of acute ischemic stroke within 6 hours from LKW. This is the denominator.

Of the 100 patients, Dr. Sokolov documented NIHSS score on presentation or prior to initiation of treatment for 97 patients. Of these 97 patients, Dr. Sokolov documented eligibility for endovascular treatment with inclusion and exclusion criteria for 87 patients. Of these 87 patients, Dr. Sokolov documented treatment decision within 60 minutes of presentation with appropriate exclusion criteria or referral for endovascular treatment for 56 patients. This is the numerator. 

Quality of patient care = 56/100. Dr. Sokolov has a score of 56% for this measure.