Endovascular treatment and imaging measure bundle

Measure purpose: Ensure patients who receive endovascular treatment receive optimal care and imaging. 

The numerator: All patients receiving endovascular treatment who received all 6 treatment components:

1. Non-contrast brain CT or MRI performed and interpreted within 45 minutes of arrival or in-hospital stroke or for patients transferred receipt of imaging (e.g., disc or via remote server/dicom viewer).
2. Non-contrast brain imaging report or stroke team review directly addresses hemorrhage, mass, acute infarction.
3. Documented causative intracranial large vessel (artery) occlusion (LVO) on vascular imaging.
4. Groin puncture within 90 minutes of ED or transfer arrival.
5. Final Thrombolysis in Cerebral Infarction (TICI) score documented.
6. Time to final TICI score documented. 

is divided by

the denominator: all patients aged 18 years and older who received endovascular treatment.

Exclusions are removed from the denominator:

For component 4 only:

• In-hospital stroke events

Key Phrases

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

Component 1:

• MRI results reviewed within 45 minutes of arrival
• Non-contrast CT results reviewed within 45 minutes of arrival
• Transfer images reviewed

Component 2:

• Hemorrhage noted (followed by appropriate clinical details)
• Mass present (followed by appropriate clinical details)
• Acute infarction documented (followed by appropriate clinical details)

Component 3:

• Causative LVO noted in imaging (followed by appropriate clinical details)

Component 4:

• Groin puncture occurred within 90 minutes of arrival

Component 5:

• Final TICI (followed by numerical/letter score)

Component 6:

• Time to final TICI score was (followed by time interval)

Measure Calculation Example

This measure utilizes an all-or-none calculation strategy. For a more comprehensive explanation of how measure bundles are calculated please view this 17-minute webinar (download).

Dr. Ocampo provides endovascular care to 5 patients (A, B, C, D, and E) aged 18 years and older between January 1 and December 31. This is the denominator.

• All five patients A, B, C, D, and E had non-contrast brain CT or MRI performed and interpreted within 45 minutes of arrival.
• Four patients A, B, D, and E had documentation the stroke team review of the imaging report directly addresses hemorrhage, mass, acute infarction. C did not.
• All five patients A, B, C, D, and E had documentation of causative LVO on vascular imaging.
• Four patients A, B, C, and E had documentation groin puncture occurred within 90 minutes of arrival.
• All five patients A, B, C, D, and E had final TICI score documented.
• Four patients A, B, C, and D had time to final TICI score documented. E did not.

Dr. Ocampo's performance rate is 60% for this measure. 3 patients (A, B, D) met the bundle/5 patients in the denominator.