ASC Stroke Data Management & Registry Reporting 2 — Questions and Answers
Question 1: When performing chart abstraction for GWTG-Stroke, which patient population is EXCLUDED from IV alteplase eligibility measures?
- Patients with NIHSS score of 0 at arrival who had transient symptoms (Correct answer)
- Patients who arrived within 3 hours of symptom onset
- Patients with confirmed ischemic stroke who received alteplase
- Patients transferred from another acute care facility
Correct answer: Patients with NIHSS score of 0 at arrival who had transient symptoms
Patients who present with a resolved neurological deficit (NIHSS=0 at arrival) are typically excluded from alteplase eligibility measures because the treatment indication may not apply.
Question 2: A stroke coordinator identifies that 12 out of 80 eligible ischemic stroke patients did not receive antithrombotic therapy by the end of hospital day two. What is the compliance rate for this measure?
- 75%
- 80%
- 85% (Correct answer)
- 90%
Correct answer: 85%
(80-12)/80 = 68/80 = 85%, which is the percentage of eligible patients who received antithrombotic therapy within two days of admission.
Question 3: Which data element is required in stroke registries to document why an eligible patient did NOT receive IV alteplase?
- Attending physician specialty
- Contraindication or reason for non-treatment (Correct answer)
- Patient insurance status
- Time of neurology consult
Correct answer: Contraindication or reason for non-treatment
Documenting a specific contraindication or reason for non-treatment is required to properly exclude patients from the alteplase measure denominator and avoid penalizing centers for appropriate clinical decisions.
Question 4: In stroke data abstraction, 'last known well' (LKW) time is used primarily to determine eligibility for which intervention?
- Carotid endarterectomy scheduling
- IV alteplase and endovascular thrombectomy time windows (Correct answer)
- Anticoagulation initiation
- Statin therapy initiation
Correct answer: IV alteplase and endovascular thrombectomy time windows
LKW time is the reference point for calculating onset-to-door and onset-to-treatment times, which determine eligibility for IV alteplase (≤4.5 hours) and endovascular thrombectomy (≤24 hours for selected patients).
Question 5: A stroke coordinator is reviewing GWTG-Stroke data and notices the center's DTN median is 68 minutes. What is the recommended target to meet AHA/ASA guidelines?
- ≤30 minutes
- ≤45 minutes
- ≤60 minutes (Correct answer)
- ≤90 minutes
Correct answer: ≤60 minutes
The AHA/ASA guideline target for door-to-needle time is ≤60 minutes for at least 50% of IV alteplase-treated ischemic stroke patients, and high-performing centers aim for ≤45 minutes.
Question 6: During a GWTG-Stroke data validation audit, which action best ensures data accuracy for submitted stroke cases?
- Submitting all cases without secondary review
- Reconciling registry entries against original medical record source documents (Correct answer)
- Relying solely on nursing flowsheet documentation
- Extracting data only from physician discharge summaries
Correct answer: Reconciling registry entries against original medical record source documents
Reconciling submitted registry data against the original medical record source documents (nursing notes, ED records, radiology reports) is the gold standard for data validation and accuracy.
Question 7: Which GWTG-Stroke achievement award recognizes consistent top performance on all stroke quality measures over a 24-month period?
- Silver Plus Quality Achievement Award
- Gold Plus Quality Achievement Award (Correct answer)
- Target: Stroke Elite Plus Honor Roll
- Stroke Champion Designation
Correct answer: Gold Plus Quality Achievement Award
The GWTG-Stroke Gold Plus Quality Achievement Award recognizes hospitals that achieve 85% or higher compliance on all stroke measures for at least 24 consecutive months.
ASC Stroke Data Management & Registry Reporting 2
When performing chart abstraction for GWTG-Stroke, which patient population is EXCLUDED from IV alteplase eligibility measures?