ASC Quality Improvement & Program Management 3 — Questions and Answers
Question 1: A stroke coordinator is tasked with reducing 30-day readmission rates. Which intervention has the STRONGEST evidence base for achieving this goal?
- Increasing stroke unit bed capacity
- Implementing structured transitional care with follow-up phone calls (Correct answer)
- Requiring all patients to attend inpatient group education sessions
- Extending average inpatient length of stay by 24 hours
Correct answer: Implementing structured transitional care with follow-up phone calls
Structured transitional care programs with post-discharge follow-up calls have strong evidence for reducing 30-day readmissions.
Question 2: Which statistical tool is MOST useful for identifying which steps in the stroke care process contribute most to delays in DTN time?
- Pareto chart (Correct answer)
- Control chart
- Scatter plot
- Histogram
Correct answer: Pareto chart
A Pareto chart identifies the vital few contributors (80/20 rule) responsible for the majority of a problem, such as DTN delays.
Question 3: Under the CMS Hospital Inpatient Quality Reporting program, stroke-related measures are reported using which patient population code?
- AMI (Acute Myocardial Infarction)
- STK (Stroke) (Correct answer)
- VTE (Venous Thromboembolism)
- SCIP (Surgical Care Improvement Project)
Correct answer: STK (Stroke)
CMS uses the STK measure set to track stroke-specific quality indicators for inpatient quality reporting.
Question 4: A stroke coordinator reviews data showing a sudden shift in the control chart for tPA rates. This finding most likely indicates:
- Normal random variation in the process
- A special cause variation requiring investigation (Correct answer)
- A seasonal pattern in stroke presentations
- Measurement error that should be ignored
Correct answer: A special cause variation requiring investigation
A sudden shift on a control chart signals special cause variation, which requires investigation to identify a systematic change in the process.
Question 5: The stroke program coordinator is developing a new telestroke protocol. Which stakeholder group is MOST critical to include in the protocol design committee?
- Hospital finance and billing staff
- Emergency physicians, neurologists, and nursing leadership (Correct answer)
- Marketing and public relations team
- Facilities management and IT security
Correct answer: Emergency physicians, neurologists, and nursing leadership
Emergency physicians, neurologists, and nursing leadership are the frontline stakeholders whose buy-in and expertise are essential for an effective telestroke protocol.
Question 6: Which measure is included in the AHA Target: Stroke initiative's set of best practice strategies?
- Rapid triage with pre-notification by EMS (Correct answer)
- Mandatory CT angiography for all ischemic strokes
- Routine use of hypothermia after ischemic stroke
- Daily aspirin for all acute stroke patients within 24 hours
Correct answer: Rapid triage with pre-notification by EMS
EMS pre-notification is one of the core Target: Stroke strategies shown to reduce in-hospital delays and improve DTN times.
Question 7: A stroke program wants to improve its AF detection rates in cryptogenic stroke patients. What is the MOST evidence-based monitoring approach to implement?
- 12-lead ECG on admission only
- 24-hour Holter monitor for all ischemic stroke patients
- Prolonged cardiac monitoring (at least 30 days) for selected patients (Correct answer)
- Telemetry monitoring limited to the first 48 hours
Correct answer: Prolonged cardiac monitoring (at least 30 days) for selected patients
Prolonged cardiac monitoring (≥30 days) with implantable loop recorders significantly increases AF detection in cryptogenic stroke patients.
ASC Quality Improvement & Program Management 3
A stroke coordinator is tasked with reducing 30-day readmission rates.
Which intervention has the STRONGEST evidence base for achieving this goal?