Performance Measurement Network

Question: Date Last Known Well


This question has follow-up question(s): How to abstact Last Known Well when there is too much information?

1. If ER documentation states "numbness/weakness over past few days- 3 times since 2 days ago", should we subtract 2 days from arrival date to determine LKW date? Or should we use UTD? Please provide parameters for when to use UTD selection.

2. If there is conflicting documentation as to date LKW, such as one MD documents symptoms began 2 days prior, another states symptoms began 3 days prior, how should we answer this data element?

Answer:

The data element definitions for Date Last Known Well and Time Last Known Well currently in effect (stroke implementation guide, version 2.a) list a heirarchy to use when multiple times are documented. With Version 3.0a of the specifications manual, the heirarchy will be deleted. Use the earliest date/time documented time regardless of author.

**Date Last Known Well, Version 3.0a**

When a date and time cannot be determined or an invalid date and time documented, select "UTD".

When an actual date is not documented but there is reference to the date described in the medical record (e.g., today, tonight, this evening, and this morning, 2 days ago), assume that the Date Last Known Well is the same as the date for that timeframe preceding hospital arrival. The Date Last Known Well and the Arrival Date may be the same date or a different date.

**Time Lat Known Well Version 3.0a**

If the time last known well is documented as being a specific number of hours prior to arrival (e.g., felt left side go numb 2 hours ago) rather than a specific time, subtract that number from the time of ED arrival and enter that time as the time last known well.

If the time last known well is noted to be a range of time prior to ED arrival (e.g., felt left side go numb 2 – 3 hours ago), assume the maximum time from the range (e.g., 3 hours), and subtract that number of hours from the time of arrival to compute the time last known well.

If there are multiple times of last known well documented, use the earliest time recorded.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK, Date Last Known Well,
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