How are we doing at providing the best care for patients having a Stroke?
The Comprehensive Stroke Center at Hartford Hospital monitors rates for timely and effective stroke care, comparing them against other hospitals in Connecticut. Note: Higher percentages are better.
| Performance Measure |
Hartford Hospital
|
State Average |
| Percent of ischemic or hemorrhagic stroke patients evaluated for rehabilitation services. |
100%
|
99.5%
|
| Percent of ischemic or hemorrhagic stroke patients or caregivers who received written educational materials about stroke care and prevention during the hospital stay |
99.0%
|
95.9%
|
| Percent of ischemic stroke patients needing medicine to lower cholesterol who were given a prescription for this medication before discharge. |
99.1%
|
99.3%
|
| Percent of ischemic stroke patients who received medicine known to prevent complications caused by blood clots within 2 days of arriving at the hospital. |
98.0%
|
96.8%
|
| Percent of ischemic stroke patients who got medicine to break up a clot within 3 hours after symptoms started. |
92.9%
|
92.5%
|
| Percent of ischemic stroke patients with a type of irregular heartbeat who were given a prescription for a blood thinner at discharge. |
98.9%
|
97.6%
|
| Percent of ischemic stroke patients who received a prescription for medicine known to prevent complications caused by blood clots before discharge. |
99.8%
|
99.9%
|
| Percent of ischemic or hemorrhagic stroke patients who received treatment to keep blood clots from forming anywhere in the body within 2 days of arriving at the hospital. |
96.0%
|
97.1%
|
Additional publicly reported data can be found on the American Heart Association’s public reporting website.
The Comprehensive Stroke Center at Hartford Hospital monitors complications related to several interventions for patients with acute ischemic stroke. Of the patients at Hartford Hospital treated by IV with the clot-dissolver tPA in FY2023, only 2.7% of patients had complications from receiving IV tPA, compared to the national average complication rate of 6%.
The preferred goal for the rate of complications after carotid endarterectomies (CEA) and carotid arterial stenting (CAS) is to have an aggregate complication rate of less than six percent.
- For 2022, the aggregate complication rate was only 0.6%.
Diagnostic (cerebral) catheter angiography is a common procedure to evaluate the blood vessels in the brain and neck. It is used to determine if any of the blood vessels are narrowed due to plaque or to see if the patient has other blood vessel abnormalities like an aneurysm or AVM. The preferred goal is to have a peri-procedure stroke and death rate less than one percent.
- For FY2023, the peri-procedure stroke or death rate for diagnostic (cerebral) catheter angiography was 0%.
- Additionally, it is preferred to have a less than 2% aggregate serious complication rate. For FY2023, the aggregate serious complication rate was only 0.2%.
Timely Stroke Care
Administration of powerful clot busting medications to carefully screened and eligible patients has been shown to be beneficial to patients with acute ischemic stroke by improving their long-term outcome. Many studies have confirmed the benefit of giving this medicine to break up blood clots to patients within 3 hours of symptom onset.
Additional blood clots can create complications over the length of the hospital stay or even after discharge. Medications like aspirin, clopidogrel or aspirin with dipyridamole can prevent additional blood clots from forming and should be given within 2 days of arriving at the hospital.
It is important to provide protection from forming clots anywhere in the body after stroke. Up to a third of patients who have moderately severe strokes can develop deep vein thrombosis which can interrupt their rehabilitation and delay recovery. It is most important to protect against this to improve outcome.
Effective Stroke Care
After having a stroke, patients should receive a prescription to continue the medications started at the hospital. Antithrombotic medications, either antiplatelets like aspirin or anticoagulants like warfarin, have been shown to reduce complications after stroke, stroke recurrence and even death. It is important to take your medications as prescribed.
Some patients may have irregular heartbeats like atrial fibrillation or atrial flutter. These patients need specific anticoagulants to manage this important risk factor for stroke. A prescription for this medication should be given at discharge. It is very important to take this medication as prescribed.
Elevated blood lipid levels or cholesterol is a well-documented risk factor for stroke and heart disease. Patients that have atherosclerosis or plaque in their blood vessels or have an LDL greater than 100 mg/dl should be given a prescription for a statin or cholesterol lowering medication at discharge. Taking this medication as prescribed can help prevent a stroke or heart attack.
After stroke, patients and families should receive education about the event (e.g. cause, treatment and risk factors), their medications and lifestyle changes to prevent another stroke. Patients should be given information on the warning signs and symptoms of a stroke and know to call 911 if they happen again. Information about any follow-up appointments should be given to the patient in writing.
Stroke rehabilitation should begin as soon as possible after stroke. A priority of care should be to evaluate what type of rehabilitation the patient needs to enhance their mobility and self-care. The primary goal of rehabilitation is to prevent complications, minimize impairments and maximize function.
References:
rev. 11.3.23