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Question: If the patient enters the ED as a potential or actual TIA or hemorrhagic stroke patient, are the ED physicians required to document why the patient did not have IV thrombolytics initiated?

If the patient enters the ED as a potential or actual TIA or hemorrhagic stroke patient, are the ED physicians required to document why the patient did not have IV thrombolytics initiated? Do they have to explicitly state patient did not receive thrombolytic therapy due to further risk of bleeding, for example?

Answer:

STK-4: Thrombolytic Therapy is for ischemic stroke patients only as identified by the ICD-9-CM Principal Diagnosis Code assigned to the patient at discharge (See Appendix A, Table 8.1 of the national specifications manual – link below). The principal diagnosis code represents the condition which after careful study occasioned the patient’s admission to the hospital. The principal diagnosis code is not assigned until discharge. Although the admitting diagnosis and principal diagnosis are often times the same diagnosis, a diagnosis other than the admitting diagnosis may be assigned as the principal diagnosis at the time of the patient's discharge from the hospital.

Patients assigned an ICD-9-CM Principal Diagnosis Code for hemorrhagic stroke, code 430 or 431 (appendix A, Table 8.2), are NOT included in STK-4. Patients assigned a principal diagnosis code for ischemic stroke at discharge who did not receive IV t-PA, must have a documented "Reason for Not Initiating IV Thrombolytic" in the medical record in order to exclude the case from the measure population (i.e., reason documented by the MD/APN/PA or pharmacist within the timeframe for thrombolytic administration and linked with t-PA).

In the event that the admitting diagnosis/initial impression in ED is hemorrhage but the principal diagnosis assigned at discharge is ischemic, the case will be in the STK-4 denominator and not the numerator, unless a documented reason is documented in the medical record within the timeframe for thrombolytic administration, e.g., ED physician documents, "Possible brain hemmorrhage. Will not give t-PA."

http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures/

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK, STK 4
File:

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