STROKE DESIGNATED HOSPITAL Data TSA-E

NOTE: Submit ONLY 1 survey for your hospital and ONLY if your hospital is not participating in American Heart Association Get With the Guidelines Stroke Program.

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 their regions to complete this 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 hospital.

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 “0” with an explanation of the
barriers and suggestions for future data collection.

EXCLUSION CRITERIA:
Exclude inpatient strokes and exclude patients admitted for the sole purpose of a scheduled
procedure.

* 1. Name of hospital agency:

* 2. Does your hospital agency currently participate in American Heart Association Get With the Guidelines Stroke Program?

* 3. From January to March 2014, how many patients received IV fibrinolytics (tPA)?

(INCLUSION: Total number of patients ≥ 18 years who were discharged with a final clinical diagnosis related to stroke, including TIA, Acute Ischemic Stroke (ICD9 Codes 433-436) who received IV tPA)
(EXCLUSION CRITERIA: inpatient strokes and patients admitted for the sole purpose of a scheduled
procedure)

* 4. From April to June 2014, how many patients received IV fibrinolytics (tPA)?

(INCLUSION: Total number of patients ≥ 18 years who were discharged with a final clinical diagnosis related to stroke, including TIA, Acute Ischemic Stroke (ICD9 Codes 433-436) who received IV tPA)
(EXCLUSION CRITERIA: inpatient strokes and patients admitted for the sole purpose of a scheduled
procedure)

* 5. From January to March 2014, how many patients received endovascular treatments?

(INCLUSION: Total number of patients ≥ 18 years who were discharged with a final clinical
diagnosis related to stroke, including TIA, Acute Ischemic Stroke, SAH, ICH (ICD9 Codes 430-436) who received IA tPA or other endovascular treatments)
(EXCLUSION CRITERIA: inpatient strokes and patients admitted for the sole purpose of a scheduled
procedure)

* 6. From April to June 2014, how many patients received endovascular treatments?

(INCLUSION: Total number of patients ≥ 18 years who were discharged with a final clinical
diagnosis related to stroke, including TIA, Acute Ischemic Stroke, SAH, ICH (ICD9 Codes 430-436) who received IA tPA or other endovascular treatments)
(EXCLUSION CRITERIA: inpatient strokes and patients admitted for the sole purpose of a scheduled
procedure)

* 7. From January to March 2014, what is total number of acute stroke admissions?

(INCLUSION: Total number of patients ≥ 18 years who were discharged with a final clinical
diagnosis related to stroke, including TIA, Acute Ischemic Stroke, SAH, ICH (ICD9 Codes 430-436))
(EXCLUSION CRITERIA: inpatient strokes and patients admitted for the sole purpose of a scheduled
procedure)

* 8. From April to June 2014, what is total number of acute stroke admissions?

(INCLUSION: Total number of patients ≥ 18 years who were discharged with a final clinical
diagnosis related to stroke, including TIA, Acute Ischemic Stroke, SAH, ICH (ICD9 Codes 430-436))
(EXCLUSION CRITERIA: inpatient strokes and patients admitted for the sole purpose of a scheduled
procedure)

* 9. Is your hospital agency PCI-capable?

(Definition of PCI-capable: A hospital that has the equipment, expertise and facilities to administer percutaneous coronary intervention (PCI), a mechanical means of treating heart attack patients. Although PCI is the preferred means of treating STEMI patients, only 25% of hospitals in the U.S. are equipped to do so. These PCI-capable hospitals are called STEMI-receiving hospitals because they are well equipped to receive and treat STEMI patients)

* 10. If you were not able to collect data and provide a response for any of the above data
points, please identify which data point and provide an explanation of the barriers and
suggestions for future data collection.

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