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The Northeast Cerebrovascular Consortium (NECC) was established in 2006, to examine regional disparities and recommend strategies to improve stroke care based on the Stroke Systems of Care Model. Strategies for each of the stroke system components were identified through workgroups, and specific recommendations were published in May 2009. (Stroke. 2009;40:1793.)
As part of the NECC's efforts to improve upon stroke recognition, diagnosis and treatment measures, the Community Engagement Workgroup is looking to establish a baseline of stroke symptom onset and
documentation procedures among several GWTG-Stroke hospitals within the eight NECC states (CT, MA, ME, NH, NJ, NY, RI, VT).
The following survey is short, and SHOULD TAKE NO LONGER THAN 10 MINUTES to complete. It will assist the group in identifying gaps and opportunities surrounding the accurate establishment of patient symptom onset time, including provider education, data collection, documentation and analyses, etc. In addition, this information will ultimately help inform community outreach messaging, to increase stroke symptom recognition, decrease patient delay, and increase use of 911.
Please note: All survey responses are confidential, and will only be reported in aggregate form.
Many thanks for your assistance with this important initiative!
1. Your Contact Info
2. Documentation of stroke symptom onset time is most often extracted from:
Please indicate by order of frequency 1 = most frequent
4 = least frequent
1. NECC - Stroke Symptom Onset Survey
Name:
Title:
Your Specific Role: (example QI Coordinator, Stroke Coordinator, ED Nurse)
Organization:
Address:
Phone:
email:
EMD Records EMS run/trip sheet
Medical Record (includes admission sheet, physician, ED,
inpatient documentation, etc.)
Direct personal account from patient
or family
Source:
Other (please specify)
3. Do you document the name and contact information of any witnesses?
4. If "yes", where is the information captured? (please check ALL that apply)
5. Do you have a documented protocol for establishing stroke symptom onset time?
6. What is your process for verifying the time of symptom onset? (Please specify the criteria used to document time of onset if unknown).
Example: Compare onset time documented on EMS run report (when available), with time documented in ED triage log (source: pre-notification by EMS). Confirm with time reported verbally by patient and/or witness upon patient arrival to ED.
n No
m l k j n Yes
m l k j
Comments:
Medical chart
g f e d c
EMS run/trip sheet (paper or electronic)
g f e d c
Other (please specify)
g f e d c
n No
m l k j
Yes (If yes, and you are able to share, please email to [email protected])
n m l k j
Page 3 7. If unknown, which of the following sources do you probe in order to establish symptom onset? (please check ALL that apply)
8. At what point do you stop probing for an accurate onset time?
9. At what point do you document that the time of onset is unknown?
Example: When stroke is known to have occured while patient was sleeping,
"last known well" is bedtime, so "symptom onset" has to be documented as
"unknown".
Patient
g f e d c
Witness/family member
g f e d c
EMS team
g f e d c
Neurologist
g f e d c
ED physician
g f e d c
No further attempts are made
g f e d c
Other (please specify)
Symptom onset known to be over 3 hours
n m l k j
Symptom onset known to be over 6 hours
n m l k j
Symptom onset known to be over 12 hours
n m l k j
Symptom onset known to be over 24 hours
n m l k j
Other
n m l k j
Comments:
10. At your facility, who is ultimately responsible for confirming symptom onset time? PLEASE CHOOSE ONLY ONE
11. How many local EMS services transport stroke patients to your facility?
12. In your best estimate, what percentage of these transporting services CONSISTENTLY provide prior notification that a stroke patient is enroute?
13. Where is prior notification from EMS documented? (please check ALL that apply)
Please choose one Number of EMS
Transport Services
Please choose one Percentage of Services
that Pre-Notify
Stroke Team/Neurology
n m l k j
Admitting Physician
n m l k j
ED Physician
n m l k j
ED Nursing Notes
n m l k j
EMS/EMD
n m l k j
Other (please specify)
Comments
Patient record/Medical chart
g f e d c
Triage log
g f e d c
EMS run/trip sheet
g f e d c
Verbal - not consistently documented
g f e d c
Other (please specify)
Page 5 15. Is there a formal feedback mechanism between your facility and EMS to help capture more accurate stroke symptom onset time?
Example: Regular chart reviews with EMS providers to report back stroke patient outcomes and identify opportunities for improvement
16. Do you use the GWTG "Comments" field to capture any other additional information to help determine the onset time?
n No
m l k j
Yes, please briefly describe below
n m l k j
n No
m l k j
Yes, please specify below
n m l k j