Performance Measurement Network

Question: Last Known Well

ED physician documents that the patient woke to go to bathroom 1 1/2 hours ago. Would the date/time last known well be EXCLUDED because the patient woke with symptoms, or is timing to be calculated using 1 1/2 hours subtracted from arrival time?

Answer:

To abstract the Date and Time Last Known Well, use all documentation available in the medical record. Last Known Well should be the time that the patient was last known to be at there baseline state of health / usual state of health. When the stroke is witnessed, Date and Time Last Known Well and time of symptom onset are synonymous; however, the stroke is likely not to be witnessed.

If the patient went to bed at 21:00 and was fine (i.e., usual state of health at that time)and awoke at 07:00 with signs/symptoms of stroke, the stroke may have occurred anytime during the 10 hour period, unless the patient can report differently. Abstraction guidelines instruct to use 21:00 as Time Last Known Well in this type of patient scenario.

If the patient went to bed at 21:00 and awoke at 07:00 with signs/symptoms of stroke which resolved in 5 minutes and returned 30 minutes later, for example, the Time Last Known Well may be determined as 07:35.

Date / Time Last Known Well can be difficult to abstract because of conflicting documentation/multiple dates and times dcoumented. Use the abstraction guidelines provided in the data element definitions to make the best call. Ultimately, the physician needs to decide whether or not IV t-PA is appropriate for the patient or document a reason for not initiating therapy.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK, STK-04, STK4
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