| Question Description |
State name 2-letter code |
Year of inventory 4-digit |
Coverdell Hospital ID number |
Number of licensed beds |
total number of inpatient discharges in most recent calendar year |
total number of acute stroke discharges (see list of ICD9 and ICD10 codes) in most recent calendar year |
[Optional] Total number of acute ischemic stroke discharges in the most recent calendar year |
[Optional] Total number of TIA discharges in the most recent calendar year |
[Optional] Total number of subarachnoid hemorrhagic stroke discharges in the most recent calendar year |
[Optional] Total number of intracerebral hemorrhagic stroke discharges in the most recent calendar year |
[Optional] Total number of stroke (type unspecified) discharges in the most recent calendar year |
Does your hospital have an acute stroke team? |
Written protocol for emergency care of ischemic stroke? |
If yes to (2a), does it include (select all that apply): |
Written protocol for emergency care of hemorrhagic stroke? |
If yes to (2b), does it include (select all that apply): |
Protocol for alteplase (IV tPA) |
Protocol for endovascular therapy |
Protocol for admission orders |
Protocol for dysphagia screening |
Discharge planning protocol |
Post-discharge follow-up care protocols |
Does hospital provide stroke-specific or neurointensive care unit? |
Does your hospital have a neurointensivist to manage care for stroke patients? |
Do all stroke patients receive continuous ECG monitoring for at least 24 hours during admission? |
Does your hospital have neurosurgical services on-staff? |
If yes to (6), does your hospital have neurosurgical services available 24/7 (may be on-site or at a remote location)? |
If never to (6a), does your hospital have neurosurgical services available within 2 hours of patient arrival (may be on-site or at a remote location)? |
Does your hospital have stroke neurointerventional capabilities? |
Does your hospital provide neurointerventional treatment for stroke (capability to give intra-arterial tPA or use of catheter-based neurointerventional reperfusion)? |
Is there a written plan for receiving patients with suspected stroke via EMS |
Does pre-notification by EMS regarding a suspected stroke case lead to activation of the stroke team? |
Does EMS notification lead to activation of written stroke care protocol |
Does your hospital enter EMS run sheets into the Coverdell in-hospital record? |
Do you have a formal process for data feedback to EMS agencies? |
If yes to (5), how is the feedback provided to EMS agencies? (select all that apply) |
If yes to (5), for what patient population is feedback provided? (select all that apply) |
Does your hospital have an EMS coordinator? |
Do you utilize a transition of care summary with stroke patients during discharge? |
Does your hospital conduct post-discharge follow-up on patients discharged to home? |
If yes to (2), how long after discharge does this follow-up typically take place? |
Does your hospital have a neurology residency or fellowship program |
Does your hospital have other residency or fellowship programs |
Is your hospital certified as a Joint Commission ASRH, PSC, CSC, or other similar organization such as DNV or HFAP? |
If yes, year of most recent certification or recertification |
Does your state/county/region/locality have a stroke designation program? (select all that apply) |
If yes to (3), is your hospital designated by that entity as a stroke center or stroke capable/ready hospital ? (select all that apply) |
If designated in 3a, what is the date of the most recent certification? |
Does your hospital receive stroke consultation services from another hospital via telemedicine? |
[Optional] If yes to (4), what mode does the telemedicine consult take place? (select all that apply) |
[Optional] Does your hospital provide community education on stroke signs and symptoms and importance of calling 911? |
What process is used for case identification? (select one best answer) |
Who is responsible for data abstraction? (select all that apply) |
What process is used for data abstraction? (select one best answer) |
Does your hospital sample cases to abstract for data that is submitted to Coverdell? |
If yes to (4), please briefly describe your sampling method (e.g. following The Joint Commission's requirements), including the percentage of cases that are sampled |
What electronic health record system does your hospital use for stroke care? |
Who receives data reports on your stroke quality of care? (select all that apply) |
How many systematic quality improvement interventions were implemented by hospital staff as a result of quality of care data reports? |
[Optional] In the most recent calendar year, have you run additional analyses (beyond what was required for reporting) on your hospital's own stroke data? |
[Optional] If yes to (3), in the most recent calendar year, how frequently have you run and used the analyses generated? (select one best answer) |
[Optional] In the most recent calendar year, what reports did you run? (select all that apply) |
[Optional] How do you use these analyses/reports |
[Optional] If no to (3), what is the main reason you do not run your own analyses? (select one best answer) |
[Optional] In this past year, approximately how many presentations (either using state-provided reports or data reports you have run internally) were made? |
[Optional] What were the topics of the presentations? |
[Optional] To whom were presentations made (including abstracts presented at meetings)? (select all that apply) |
[Optional] Are dadta presentations a standing agenda item during your "Stroke Team Meetings"? |
[Optional] What other data or information do you need (that current data reports/queries are not providing) in order to help you plan QI efforts at your hospital? |
Did you participate in any QI activities offered through the State health department Coverdell program? |
If yes to (1), how many? |
What reasons or incentives are most important in your hospital's decision to participate in (if new) or continue to participate in the Coverdell Stroke Registry? (select the 3 most important reasons) |
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|
| Allowed response |
alpha |
yyyy |
alpha |
numeric |
numeric |
numeric |
numeric |
numeric |
numeric |
numeric |
numeric |
Y/N |
Y/N |
Initial stabilization/Diagnostic imaging/Treatment/Labs |
Y/N |
Initial stabilization/Diagnostic imaging/Treatment/Labs |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
Always/Sometimes/Never |
Always/Sometimes/Never |
Y/N |
Y/N |
Y/N |
Always/Sometimes/Never/No pre-notification |
Always/Sometimes/Never/No pre-notification |
Always/Sometimes/Rarely/Never |
Y/N |
Fax/Email/Phone/In-person/Other |
Final dx stk pre-notification/Pre-notification/Unknown/Other |
Y/N |
Always/Sometimes/Rarely/Never |
Y/N |
1-7/8-14/15-21/22-30/>30 |
Y/N |
Y/N |
JC ASRH/JC PSC/DNV PSC/HFAP PSC/JC CSC/DNV CSC |
Year (yyyy) |
State designation/County regional local designation/No |
Stroke Center (state)/Stroke capable (state)/Stroke center (county regional)/Stroke capable (county regional) |
Date (mm/dd/yyyy) |
Y when neuro not avail/Y no neuro/N |
Telephone/Video/Other |
Y/N |
Pros/Retro/Comb |
MD/Stk Team/Med Records/QI/Other |
Concurrent/Retro/Equal |
Y/N |
alpha |
Allscripts/Centricity/Cerner/CPSI/eClinicalWorks/Epic/McKesson/Meditech/NextGen/Other |
CEO/Board/CNO/StkTeam/MD/Chief Med/Other |
numeric |
Y/N |
Weekly/Monthly/Less than monthly/1-2 times |
Pre-programmed/Additional beyond |
Inform QI/Report to management/Other |
Not sure how/Not sure what needed/Lack of time/Lack of interest/All provided/Other |
None/1/2-4/5-12/>12 |
Alpha |
Stk Team/Grand Rounds/CEO/Board/Regional Mtg/National Mtg |
Y/N |
Alpha |
Y/N |
numeric |
Prof Dev/Networking/Enhance quality/Financial/Stroke designation/GWTG/Upper management/Benchmark/Recognition/Other |
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