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Stroke Care

A stroke, sometimes called a "brain attack," occurs when blood flow to the brain is interrupted. When a stroke occurs, brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function. There are two major kinds of stroke:

  • An ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel or artery in the brain.
  • A hemorrhagic stroke is caused by a blood vessel in the brain that breaks and bleeds into the brain.

Strokes can cause a loss of the ability to speak, memory problems, or paralysis on one side of the body. Getting the right care at the right time can help reduce the risk of complications and another stroke. These measures show some of the standards of stroke care that hospitals should follow, for adults who have had a stroke.

Hospital Discharges 7/1/2013 through 6/30/2014

Ischemic Stroke Patients Who Got Medicine To Break Up A Blood Clot Within 3 Hours After Symptoms Started

Billings Clinic 94%
State of Montana Avg 80%
United States Avg 76%

Patients with ischemic stroke should get medicine called tissue plasminogen activator, or t-PA, to break up a blood clot within 3 hours after their symptoms start. T-PA is a kind of thrombolytic therapy.

Research shows that hospitals that give t-PA within 3 hours after symptoms start can limit the damage and disability caused by an ischemic stroke.

This measure shows the percentage of patients admitted with ischemic stroke who arrived in the emergency department (ED) within 2 hours of the onset of their symptoms and who got t-PA within three hours after the onset of their symptoms.

Ischemic Stroke Patients Who Received Medicine Known To Prevent Complications Caused By Blood Clots Within 2 Days Of Arriving At The Hospital

Billings Clinic 100%
State of Montana Avg 99%
United States Avg 98%

Ischemic stroke patients should get medicine known to reduce death, disability and the risk of another stroke (known as Antithrombotic Therapy) while in the hospital.

Research shows that hospitals should start this medicine within 2 days of arriving at the hospital to prevent and treat clots and reduce the risk of complications from the stroke.

Serious complications caused by strokes include changes in thinking and memory; muscle, joint, and nerve problems; or difficulty swallowing or eating; or blood clots.

This measure shows the percentage of patients admitted with an ischemic stroke who got antithrombotic therapy started within 2 days of arriving at the hospital.

Ischemic or Hemorrhagic Stroke Patients Who Received Treatment To Keep Blood Clots From Forming Anywhere In The Body Within 2 Days of Arriving At The Hospital

Billings Clinic 94%
State of Montana Avg 95%
United States Avg 96%

Patients admitted to the hospital with ischemic stroke or hemorrhagic stroke are at increased risk of developing new blood clots in their veins that break off and travel to other parts of the body, like the brain or lung (also called Venous thromboembolism).

Research shows that hospitals should begin treatment to prevent new blood clots on the day of or day after these patients are arrived at the hospital.

Treatment can include medicine, medical devices, or tightly fitting stockings designed to keep blood from clotting.

This measure shows the percentage of patients admitted with an ischemic stroke or hemorrhagic stroke who either received treatment to prevent blood clots on the day of or day after arrival at the hospital or had paperwork in their chart to explain why they had not received this treatment.

Ischemic Stroke Patients Who Received A Prescription for Medicine Known To Prevent Complications Caused By Blood Clots Before Discharge

Billings Clinic 100%
State of Montana Avg 100%
United States Avg 99%

Patients admitted with an ischemic stroke are at risk for developing complications like another stroke even after discharge. These patients should get a prescription at discharge for a blood thinner that prevents complications like another stroke (called Antithrombotic Therapy.)

Serious complications caused by strokes include changes in thinking and memory; muscle, joint, and nerve problems; or difficulty swallowing or eating; or blood clots.

This measure shows the percentage of patients who were admitted with an ischemic stroke who were given a prescription for an antithrombotic before they were discharged from the hospital.

Ischemic Stroke Patients With A Type of Irregular Heartbeat Who Were Given A Prescription for A Blood Thinner At Discharge

Billings Clinic 100%
State of Montana Avg 99%
United States Avg 96%

Patients admitted with an ischemic stroke who have an irregular heartbeat (also called atrial fibrillation or atrial flutter) are at greater risk of having another stroke.

Research suggests that medicine that thins the blood (called an anticoagulant) reduces the chance of another stroke in these patients.

This measure shows the percentage of patients admitted with ischemic stroke and an irregular heartbeat (atrial fibrillation/atrial flutter) who were prescribed an anticoagulant before they were discharged from the hospital.

Ischemic Stroke Patients Needing Medicine To Lower Cholesterol, Who Were Given A Prescription for This Medicine Before Discharge

Billings Clinic 99%
State of Montana Avg 95%
United States Avg 96%

Cholesterol is a fat (also called a lipid) that the body needs to work properly. Levels of bad cholesterol (LDL) that are too high can increase the chance of stroke, heart disease, and other problems. Medicines called statins can help lower LDL cholesterol levels.

In patients with ischemic stroke who have high cholesterol, taking statins can help lower the chance of another stroke.

This measure shows the percentage of patients admitted with an ischemic stroke who got a prescription for a statin before they were discharged from the hospital.

Patients who shouldn’t take statins are not included in this measure.

Ischemic or Hemorrhagic Stroke Patients or Caregivers Who Received Written Educational Materials About Stroke Care and Prevention During The Hospital Stay

Billings Clinic 98%
State of Montana Avg 92%
United States Avg 92%

Educating patients with ischemic stroke and hemorrhagic stroke and their caregivers about stroke care and prevention helps patients live healthier lives and reduces health care costs.

During the hospital stay, hospital staff should give stroke patients and caregivers written information on:

  • How to activate the hospital emergency system
  • The importance of doing follow-up after being released from the hospital
  • Medicines prescribed at discharge
  • What increases the chance of stroke
  • Warning signs and symptoms of stroke

This measure shows the percentage of patients with an ischemic stroke or a hemorrhagic stroke or their caregivers who received written information about these topics during their hospital stay.

Ischemic or Hemorrhagic Stroke Patients Who Were Evaluated for Rehabilitation Services

Billings Clinic 100%
State of Montana Avg 98%
United States Avg 98%

Many ischemic stroke or hemorrhagic stroke patients will experience moderate or severe disability, including problems with physical, speech and mental functions. Stroke rehabilitation can help patients relearn those lost skills and regain independence. Once the stroke symptoms and related problems are under control, the hospital appropriate health care professionals should review the status of the patient and begin rehabilitation as soon as possible. Appropriate health care professionals include physicians, physical therapists, occupational therapists, speech and language therapists, and/or neuropsychologist. The earlier the patient starts rehabilitation, the better the recovery process.

Patients who need stroke rehabilitation may begin while they are still at the hospital and continue in a rehabilitation setting that is right for the patient. These options include inpatient rehabilitation units (either stand-alone or part of a hospital/clinic), outpatient units (usually part of a hospital/clinic), nursing home, or home-based programs.

This measure shows the percentage of patients admitted with an ischemic stroke or a hemorrhagic stroke who were evaluated for their need for rehabilitation services.

The percentage includes only patients whose history and condition indicate the treatment is appropriate. Talk to your doctor if you have questions about your treatment.

For more information about heart health, check:

Related Quality Information

For help in making good decisions about your care, compare Billings Clinic to other Health Care Organizations by visiting Hospital Compare or HealthGrades.

Consumer Reports Ranks Hospital Safety. See how Billings Clinic fares in the Nation in the Consumer Reports Article.

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