| Question Description |
State name 2-letter code |
Year of inventory 4-digit |
Coverdell Hospital ID number |
What is your hospital's Rural-Urban Commuting Area (RUCA) code? |
Current hosptial size (number of licensed beds) |
total number of inpatient discharges (not including observation only, ED patients, ED transfers) in most recent calendar year |
total number of acute stroke discharges (primary diagnosis only; see list of ICD-9 and ICD-10 codes in the appendix) 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 a designated 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 subarachnoid hemorrhagic strokes (SAH)? |
If yes to (2b), does it include (select all that apply): |
Does your hospital admit most subarachnoid hemorrhagic (SAH) stroke patients? |
Protocol for emergency care of intracerebral hemorrhagic (ICH) strokes? |
If yes to (2c), does it include (select all that apply) |
Does your hospital admit most intracerebral hemorrhagic (ICH) stroke patients? |
Protocol for IV tPA (alteplase) |
Protocol for endovascular therapy |
Protocol for admission orders |
Protocol for dysphagia screening |
Discharge planning protocol |
Post-discharge follow-up care protocols |
Does your hospital have a neuro-intensive care unit? |
If yes to (3) 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 (5), does your hospital have neurosurgical services available 24/7 (may be on-site or at a remote location)? |
If never to (5a), 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 (select all that apply) |
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 a Coverdell-specific in-hospital data collection tool (e.g., GWTG, state-based system)? |
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? |
[Optional] To what extent has the interaction between the ED and EMS providers changed during the past calendar year, compared to the prior calendar year, with respect to communication |
[Optional] To what extent has the interaction between the ED and EMS providers changed during the past calendar year, compared to the prior calendar year, with respect to data exchange |
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? |
Do you follow-up with (select all that apply) |
Does your hospital utilize an inventory of community resources to make referrals for post-stroke needs? |
Does your hospital have a neurology residency or fellowship program |
Does your hospital have other residency or fellowship programs |
Is your hospital currently certified as a Joint Commission ASRH, PSC, CSC, TSC, or other similar organization such as DNV or HFAP? |
Does your state/county/region/locality have a stroke designation program? (select all that apply) |
If yes to (3), is your hospital current designated by that entity as a stroke center or stroke capable/ready hospital ? (select all that apply) |
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) |
Does your hospital provide stroke consultation services to other hospitals via telemedicine? |
[Optional] If yes to (5), 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? |
Did you participate in any QI activities offered through the State health department Coverdell program? |
If yes to (1), how many? |
[Optional] Has your stroke team implemented structured quality improvement strategies (e.g. PDSA (Plan-Do-Study-Act) cycles, small tests of change, lean, six-sigma) to improve
quality of care in the most recent calendar year? |
If yes to (2), describe problems addressed |
If yes to (2), briefly describe results |
If yes to (2), was this a helpful way to address the problem? |
If yes to (2), why or why not [was it or not a helpful way to address the problem]? |
If yes to (2), what challenges did you encounter? |
[Optional] As a result of participating in the registry the most recent calendar year, what stroke policies or system changes has your hospital implemented? |
Have you assessed the impact of any of these changes, for example, by examining changes in data/performance measures? |
[Optional] To what extent do you have buy-in from upper management (i.e. hospital CEO/board/upper management) to implement stroke QI initiatives? (select one best answer) |
[Optional] Do you have other QI initiatives that are not directly related to stroke care at your hospital? |
If yes to (5), are your stroke QI initiatives integrated with other QI initiatives in your hospital? |
If yes to (5), compared to other QI initiatives, how important/prioritized are QI initiatives around stroke? |
If yes to (5), how do you think other hospital QI initiatives affect your stroke QI initiatives? |
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 |
numeric |
Y/N |
Y/N |
Initial stabilization/Diagnostic imaging/Treatment/Labs |
Y/N |
Initial stabilization/Diagnostic imaging/Treatment/Labs |
We typically transfer SAH patients/We typically admit these patients/We admit or transfer depending on staff availability or other factors |
Y/N |
Initial stabilization/Diagnostic imaging/Treatment/Labs |
We typically transfer ICH patients/We typically admit these patients/We admit or transfer depending on staff availability or other factors |
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 |
Intra-arterial alteplase/Catheter-based reperfusion; mechanical thrombectomy |
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 |
Patients transported by EMS with final dx of stk with pre-notification/ Patients transported by EMS with final dx of stk w/o pre-notification/Patients with Pre-notification regardless of final dx/Unknown/Other |
Y/N |
substantial improvement/minimal improvements/no improvements/minimal decline/substantial decline |
substantial improvement/minimal improvements/no improvement/minimal decline/substantial decline |
Always/Sometimes/Rarely/Never |
Y/N |
1-7/8-14/15-21/22-30/>30 |
All patients discharged home/a sample of patients dischaged home/only cases that were treated with IV alteplase/only cases that were treated with IV alteplase and/or thrombectomy/other |
Y/N |
Y/N |
Y/N |
JC ASRH/JC PSC/DNV PSC/HFAP PSC/JC CSC/DNV CSC/JC TSC |
State designation/County regional local designation/No |
Stroke Center (state)/Stroke capable (state)/Stroke center (county regional)/Stroke capable (county regional) |
Y when neuro not avail/Y no neuro/N |
Telephone call/ interactive video; videoconference/Other |
Yes provide telestroke consul services and can receive patients that we provide consul on/Yes provide telestroke consul services but cannot receive patients/No do not provide telestroke consul services |
Telephone call/Interactive video; videoconference/other |
Y/N |
Pros/Retro/Comb |
MD/Stk Team/Med Records/QI/other hospital staff/outsourced/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 |
Y/N |
numeric |
Y/N |
alpha |
alpha |
Y/N |
alpha |
alpha |
alpha |
Y/N |
A great deal of support/a fair amount of support/little support/no support |
Y/N |
Y/N |
Much more important/a little more important/equally important/a little less important/a lot less important |
complement/hinder/do not affect |
Prof Dev/Networking/Enhance quality/Financial/Stroke designation/GWTG/Upper management/Benchmark/Recognition/Other |
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