Abstract W P271: Reasons Why rt-PA Was Not Given: Physician Documentation vs. Chart Abstraction
Introduction: Joint Commission primary stroke center (PSC) certification requires explicit physician documentation as to why rt-PA is not given to an ischemic stroke patient who presents within two hours of onset. We hypothesized that many reasons for non-treatment could be inferred from the medical record even if physician documentation was absent, and we sought to evaluate this within a large, biracial population in a region containing four PSC and eleven non-PSC hospitals.
Methods: All ischemic stroke patients ≥20 years of age who presented to an emergency department within two hours of onset in 2010 and resided in the Greater Cincinnati/Northern Kentucky (GCNK) region were included. For each case, medical records from the acute hospitalization were retrospectively abstracted by research nurses, who recorded physician-documented reasons for non-treatment and recorded at least one exclusion criterion applicable to the patient. Chi-square test was used to compare physician documentation rates between PSC and non-PSC hospitals.
Results: There were 374 patients included in this analysis. Mean age was 69.8 (SD 15.0), 50.8% were female, and 19.8% were black. Of the 374, 96 (25.7%) were treated with rt-PA. Of the 278 patients who were not treated, 82 presented to PSCs and 196 presented to non-PSCs. At PSCs, physicians documented exclusion criteria 58.5% of the time, while nurses abstracted exclusion criteria in 92.7%. At non-PSCs, the rate of physician documentation was 43.9% and that of nurse abstraction was 94.5%. Rate of physician documentation was statistically significantly higher at PSCs than non-PSCs (p=0.03).
Discussion: Within our population, we found that physicians documented the rationale for non-treatment with rt-PA less than half of the time. However, study nurses were able to abstract exclusion criteria from the chart in 94% of cases. Physician documentation, though still poor, was better at primary stroke centers than other hospitals. Allowing objective rt-PA exclusions to be abstracted from the medical record may allow a more accurate understanding of reasons for non-treatment at the hospital level.
Author Disclosures: B. Eckerle: None. J. Khoury: None. K. Alwell: None. C. Moomaw: None. B. Kissela: None. M. Flaherty: None. D. Woo: None. O. Adeoye: None. S. Ferioli: None. F. de los Rios la Rosa: None. S. Martini: None. J. Mackey: None. D. Kleindorfer: None.
- © 2015 by American Heart Association, Inc.