Abstract P297: The Accuracy of the Comprehensive Stroke Performance CSTK-5b Measure Rates

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Pradeep Panuganti ◽  
Cassandra Forrest ◽  
Shahid M Nimjee ◽  
Ciaran Powers ◽  
Sharon Heaton ◽  
...  
Keyword(s):  
Failure Rate ◽  
Reperfusion Therapy ◽  
Joint Commission ◽  
Annual Data ◽  
Point Change ◽  
True Rate ◽  
Symptomatic Intracerebral Hemorrhage ◽  
National Quality ◽  
Comprehensive Stroke Center ◽  
The Joint Commission

Introduction: Symptomatic intracerebral hemorrhage (ICH) is a feared complication of reperfusion therapy in acute ischemic stroke. The Joint Commission (JC) national quality measure Comprehensive Stroke (CSTK-5b) reflects the rate of symptomatic ICH after mechanical thrombectomy (MT) and is used as a marker of comprehensive stroke center (CSC) performance. We sought to determine the accuracy of the CSKT-5b as determined by vascular neurologists. Methods: We reviewed the CSTK-5b failures in our JC certified CSC program for the years 2018 and 2019. Our CSC abstractors follow the instructions from the Joint Commission National Quality Measures manual without deviation and do not allow for clinician over-ride or adjudication (consistent with manual instructions). All CSKT-5b failures were reviewed by study neurologists to determine the true CSTK-5b rate. Data was collected on National Institute of Health Stroke Scale (NIHSS), symptomatic ICH, and neuroimaging results. European Cooperative Acute Stroke Study (ECASS) definitions were used and included hemorrhagic infarction (HI) (grade 1 or 2) and parenchymal hematoma (PH) (grade 1 or 2). Results: Among 361 MT patients for the 2 year period, the CSTK-5b failure rate reported to JC was 34/250 (13.6%), whereas the true rate was 21/250 (8.4%). Among the 13 cases that were miscoded, the ECASS grading included 1 HI-1, 7 HI-2, 1 PH-1, and 4 subarachnoid hemorrhage, and all had a 4 point change in NIHSS that was determined to be clinically unrelated to ICH. Comparing annual data, the 2018 CSTK-5b failure rate was 14/111 (12.6%) whereas the true CSTK-5b failure rate was 7/111 (6.3%). In 2019, the CSTK 5b failure rate was 20/139 (14.4%), whereas the true CSTK-5b failure rate was 14/139 (10.1%). Conclusions: Non-physician abstractors relying on instructions from the JC manual over-estimate the rate of CSKT-5b measure failure. The determination of symptomatic ICH after MT is complex and requires clinical knowledge for accuracy.

Abstract WP435: Post Procedural Monitoring Tool Improves the Joint Commission Comprehensive Stroke Center Standard Compliance

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Denise Gaffney ◽  
Lorina Punsalang ◽  
Alvina Mkrtumyan ◽  
Raeesa Dhanji ◽  
David McCartney ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Electronic Monitoring ◽  
Vital Signs ◽  
Joint Commission ◽  
Monitoring Tool ◽  
Post Intervention ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Iv Tpa ◽  
The Joint Commission

Background: The Joint Commission (TJC) Comprehensive Stroke Center standard requires monitoring of patients after IV tPA administration, diagnostic angiography, aneurysm coiling, carotid angioplasty and stenting, mechanical endovascular reperfusion (MER) and carotid endarterectomy. Meeting 100% compliance of the standard is challenging. In 2018, monitoring and documentation were among the TJC’s top ten cited survey findings. Purpose: To determine if an electronic tool can improve documentation compliance and reduce delays in monitoring of vital signs, and neurologic, pedal pulse and skin site assessments. Methods: The initiative was implemented in 2018 with the objective for all patients to have 100% of their post procedural monitoring completed. A documentation tool was created and introduced to nursing units via annual stroke education updates. The tool was added to an online nursing resource SharePoint website and application, which was accessible to all nurses within the hospital. The procedure end time was entered in the tool, which automatically calculated the documentation times. Data was compared 12 months pre and post intervention. Analysis and reporting of data were conducted monthly via the program’s quality oversight committee. Data was analyzed using T-Test. Results: In post-IV tPA patients, more patients had 100% complete documentation (79% post vs. 29% pre-implementation; p=0.006). For all post neuro-interventional radiology procedures, more patients had 100% complete documentation (68% post vs. 17% pre-implementation; p<0.001). For post carotid endarterectomy revascularization, there was a trend toward more patients with 100% complete documentation (83% vs 38%; p=0.07). Conclusion: Utilization of an electronic monitoring tool for post procedural documentation adherence can improve the percentage of patients who have 100% completed assessments and help meet the TJC standard.

A Neglected Principle of Liturgical Revision

1920 ◽  
Vol 13 (4) ◽  
pp. 390-401
Author(s):  
Robert Pierce Casey
Keyword(s):  
Joint Commission ◽  
Episcopal Church ◽  
Book Of Common Prayer ◽  
History Of ◽  
Common Prayer ◽  
The Joint Commission

The Second Report of the Joint Commission on the Book of Common Prayer is an interesting document, not only for the history of liturgy in the American Church but also in showing, perhaps more by implication than by direct statement, the lines along which thought in the Episcopal Church is at present moving.

Preparing for the Joint Commission Unannounced Visit

2008 ◽  
Vol 23 (3) ◽  
pp. E10
Author(s):  
Tula Epling ◽  
Ligaya Jimenez ◽  
Agnes Sibayan ◽  
Lillian Bailey
Keyword(s):  
Joint Commission ◽  
The Joint Commission

Clarification of FDA and The Joint Commission reporting requirements for US tissue recipient adverse reactions

2007 ◽  
Vol 9 (1) ◽  
pp. 67-68 ◽  
Author(s):  
Tina Khoie ◽  
Craig E. Zinderman ◽  
Ruth Solomon ◽  
Robert P. Wise ◽  
Karen C. Lee ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Joint Commission ◽  
Reporting Requirements ◽  
The Joint Commission

The Joint Commission on Correctional Manpower and Training

1968 ◽  
Vol 10 (2) ◽  
pp. 282-301
Author(s):  
Barbara A. Kay
Keyword(s):  
Joint Commission ◽  
And Training ◽  
The Joint Commission
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