Other Stroke Measures



IV tPA - Arrive by 2 Hour, Treat by 3 Hour

What are we measuring and why?

Ischemic stroke is a type of stroke where a blockage in the blood vessels of the brain causes damage to brain tissue. Tissue plasminogen activator (tPA) is a drug used to dissolve the blood clots that cause this blockage and restore normal blood flow. The medication should be administered within 4.5 hours of stroke symptoms.

It is estimated that 2 million nerve cells die for every minute that brain ischemia remains untreated. Therefore, reducing the time to treatment is a critical intervention in the management of acute stroke. MGH tracks the percentage of eligible ischemic stroke patients who received IV tPA within 3 hours, as well as the percent who are treated within 60 minutes of Emergency Department (ED) arrival. To qualify for IV tPA, patients must arrive to MGH within the first few hours of symptoms. The administration of tPA to carefully screened, eligible acute ischemic stroke patients has been shown to significantly improve patient outcomes.

MGH often performs Carotid Endarterectomy (CEA) procedures for patients with or at risk for ischemic stroke. The rates of stroke or death within the 30 days following CEA are displayed below, broken out by symptomatic and asymptomatic patients. All cases are reviewed by an independent neurologist and adjudicated by the Carotid Committee of the Vascular Center. Rates of 30-day death and complications for CEA patients at MGH are well below the 6% national upper limit.

How are we doing and how do we compare to best practice?

In 2016, 96% of eligible stroke patients at MGH were treated with tPA within 3 hours of the time that they were last known to be well. Performance exceeded the average rates for both nationwide academic hospitals and Massachusetts Primary Stroke Service (PSS) sites. MGH is also participating in Target: Stroke, a national campaign to operationalize 10 best practices aimed at reducing the time from patient arrival in the ED to the start of tPA treatment. MGH has surpassed the goal to treat at least 50% of tPA cases within 60 minutes of arrival and ranks among the top U.S. hospitals on this measure.

  • Current Scores
  • Scores Over Time
  • Higher values are better
86% 90% 96%

MGH and Comparison Aggregate Data: This Get With The Guidelines ® (GWTG) Aggregate Data report was generated using the IQVIA PMT ™ system.
Copy or distribution of the GWTG Aggregate Data is prohibited without the prior written consent of the American Heart Association and IQVIA.

MGH and GWTG Data Report: Sep 22, 2017

100 96 86 96 97 94 89 86 83 86 84 88 91 87 84 90 92 93

MGH and Comparison Aggregate Data: This Get With The Guidelines ® (GWTG) Aggregate Data report was generated using the IQVIA PMT ™ system.
Copy or distribution of the GWTG Aggregate Data is prohibited without the prior written consent of the American Heart Association and IQVIA.



What are we doing to improve?

Every moment counts, so MGH educates its staff and the community on how to identify and respond to stroke events in a timely manner. We have an improvement team dedicated to reducing the time from ED arrival to treatment with catheter-based acute stroke therapy.

What can you do?

It is important to learn the signs and symptoms of a stroke. According to the American Stroke Association, common signals include sudden numbness or weakness of the face, arms, or legs, especially on one side of the body; confusion or trouble speaking/understanding others; difficulty seeing in one or both eyes; trouble walking, dizziness, or loss of balance/coordination; or, a severe headache with no known cause.

If you think you might be having a stroke, call 911. Patients who arrive by ambulance get treated faster.

Useful Links

Massachusetts Department of Public Health Primary Stroke Service (PSS) data

 

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