STROKE DESIGNATED HOSPITAL Data TSA-E

The purpose of data collection among the Regional Advisory Councils (RACs) is to enhance surveillance of the stroke and
STEMI systems of care in Texas. RACs will collect and report data to the Health Promotion and Chronic Disease Prevention Section (HPCDPS) of DSHS and HPCDPS will analyze the data and report results of the analyses to RACs and the Texas Council on Cardiovascular Disease and Stroke. DSHS is asking RAC leadership, RAC Chairs or RAC Directors and, if applicable, Stroke Committee Chairs and Cardiac Committee Chairs, to work with key stakeholders such as Emergency Medical Services (EMS) and hospitals in region to complete survey.

If you are not able to complete the survey, we ask that you forward the original survey link to the appropriate person in your facility.

NOTE: Please only submit one survey for your individual facility.

NOTE Stroke portion: Submit ONLY if NOT participating in American Heart Association Get With the Guidelines Stroke Program.

Information must be entered into every area to move forward to the next question. If possible, please provide the most accurate and complete data.
If there is a data point for which you cannot feasibly report data, you may report “NA". At the end of each page,there is a comment box where you can provide an explanation of the barriers and suggestions for future data collection.

DUE DATE: November 30, 2014 and should ONLY include 2014 Quarter 3 data (July through September 2014).

If you have any questions about taking the survey, please contact Jennifer Gardner at 817-607-7013 or jgardner@ncttrac.org.
Thank you in advance for your time!

* 1. Name of Hospital facility:

* 2. Your Name:

* 3. Your Email:

T