Performance Measurement Network

Question: How to abstact Last Known Well when there is too much information?

This is follow up to a prior question: "Date Last Known Well";.

Patient is admitted on 6/16 and the attending physician documented the following: "Patient woke up at 5:30 AM and had nasal congestion. She took Sudafed. She went back to sleep and woke up at 8:30 AM and noted numbness of the entire left side of her body." Is this 'Yes' or 'No' for Last Known Well? If Yes, would my Time of Last Known Well be the earliest, i.e. 0530?

In addition, the ED doctor documented,"She is not a TPA candidate because the symptoms began at at least 8:30 this morning and possibly earlier since she woke with the symptoms". So is this a 'Yes' for Last Known Well with a time of 8:30, since nasal congestion is not a warning sign or symptom of stroke?

Answer:

Physician documentation that the patient was "not a t-PA candidate" is a Reason for Not Initiating IV Thrombolytic and the case should be excluded. See algorithm STK-4 to follow the logic below:

1. If "No" is selected for Last Known Well, the case is excluded. "Documentation that "symptoms began at at least 8:30 this morning and possibly earlier since she woke with the symptoms" supports that the exact Time Last Known Well is unknown. "No" for Last Known Well could be selected in this scenario.

2. If "Yes" is selected for Last Known Well with 0830 as the Time Last Known Well and the Arrival Date and Time (not provided) is > 2 hrs, the case will be excluded.

3. If the Arrival Date and Time minus Date and Time Last Known Well (0830) is less than or equal to 2 hrs, the next decision will be IV Thrombolytic Initiation. If "No" is selected for IV Thrombolytic Initiation (assuming that t-PA was not administered since the patient was "not a t-PA candidate"), and "Yes" selected for Reason for Not Initiating IV Thrombolytic,then the case will be excluded.

Last Known Well is a difficult data element to abstract. In thinking through the options available based on the documentation provided, the end result is the same. (Also the same if you use 0530 as TLKW).

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

Copyright © by the contributing authors. All material on this collaboration platform is the property of the contributing authors.
Ideas, requests, problems regarding Performance Measurement Network? Send feedback