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Intravenous fibrinolytic treatment measure bundle

Measure bundle purpose: Ensure patients receive optimal fibrinolytic treatment.

The numerator has five components, all of which must be met:

  1. NIH Stroke Scale (NIHSS) documented
  2. IV fibrinolytic treatment eligibility assessment documented
  3. IV fibrinolytic treatment documented
  4. IV fibrinolytic treatment initiated within 60 minutes from presentation
  5. Non-contrast brain CT or MRI interpreted within 45 minutes from presentation

is divided by

the denominator: all acute ischemic stroke (AIS) patients aged 18 years and older presenting within 4.5 hours of Last Known Well time (LKW).

Exclusions are removed from the denominator:

For component 4 only, the following exclusions are removed:

  • Patients presenting after 3.5 hours from LKW
  • Patients who already received treatment (e.g., transfer)

Key Phrases

Examples of key phrases you could use to meet the measure include:

  • NIHSS followed by numerical score
  • Fibrinolytic treatment options assessed
  • IV fibrinolytic treatment administered
  • IV fibrinolytic treatment initiated within (numerical time) minutes of presentation
  • CT/MRI interpreted within (numerical time) minutes of presentation

Measure Calculation Example

This measure utilizes an all-or-none calculation strategy.  For a more comprehensive explanation of how measure bundles are calculated please view this 17-minute webinar (download).

Dr. Zhang sees 5 patients (A, B, C, D, and E) between January 1 and December 31 that were diagnosed with AIS within 4.5 hours of LKW.

  • All five patients A, B, C, D, and E had NIHSS documented.
  • Four patients A, B, D, and E had eligibility assessment documented. C did not.
  • All five patients A, B, C, D, and E had fibrinolytic treatment documented.
  • Four patients A, B, C, and E had treatment initiated within 60 minutes. D met exclusion and is removed from the denominator for this component.
  • Four patients A, B, C, and D had CT or MRI interpreted within 45 minutes. E did not.

Dr. Zhang's performance rate is 60% for this measure. 3 patients (A, B, D) met the bundle/5 patients (D removed from component 4) in the denominator.