Stroke Systems of Care Framework: Resources

Resources that support partnership development or coalition building with hospitals, EMS agencies, and post-hospital organizations.

• Coweta Cares: Post-Hospital Stroke Care [PDF – 998 KB]
  Use this PPT presentation to learn about the community paramedicine program in Coweta County, Georgia.
• Michigan Stroke Initiative
  This website was developed by  a coalition of experts and dedicated to the Michigan Stroke Initiative that addresses the burden of stroke in the state.
• Building Blocks of a Stroke Program [PDF – 2.46 MB]
  Hospitals can use this toolkit to help build a stroke program at their site. It includes Brain Attack Coalition’s recommendations for basic stroke care, guidance from HA, tips for self-assessment, and use case examples.
• Wisconsin Stroke Coalition
  Share this home page for the Wisconsin State Coalition, which is dedicated to reducing the burden of stroke, improving patient outcomes, and supporting a healthy population.
• Coverdell Stroke Care Partner Agreement Template [PDF – 105 KB]
  Use this PDF template of the Coverdell Stroke Care Partner Agreement for State of Wisconsin partners to sign on to participate in the Coverdell program or adapt to use in your own partnerships.
• Coverdell Stroke Champion Agreement [PDF – 114 KB]
  Use this PDF template for the Coverdell Stroke Champion Agreement for State of Wisconsin hospitals to sign on as champions or adapt to use in your own partnerships.
• Wisconsin Coverdell Stroke Program Hospital Participation Guide [PDF – 1.47 MB]
  Use this Hospital Participation Guide from the Wisconsin Coverdell Stroke Program to implement strategies into your hospital’s stroke program.
• Enhancing Communication and Teamwork to Reduce Door-to-Needle Time [PDF – 704 KB]
  Incorporate lessons learned from this success story highlighting a hospital’s investigation into their alteplase administration process for quality improvement and resulting reduction in door-to-needle times for stroke patients.
• Teamwork Leads to Positive Patient Outcomes at Ascension All Saints [PDF – 520 KB]
  Incorporate lessons learned from this success story highlighting an area EMS’s new protocol and stroke alert checklist to improve stroke care among different teams.

Resources that support (1) systematizing data collection (inclusive of data use agreements, data elements, and performance measures); and (2) using data to inform quality improvement plans, tools, and education OR using data to improve coordination and quality of stroke care.

• Steps to Take for Accurate Documentation of Last Known Well [PDF – 255 KB]
  Abstracting an Accurate Last Known Well [PDF – 1 MB]
  Use these resources, published by the Wisconsin Coverdell Stroke Program, to help improve the documentation of the “Last Known Well (LKW)” time at your hospital. The acronym “LKW” refers to the date and time a patient was last known to be without any signs and symptoms of a stroke. Correctly identifying a patient’s LKW time is critical for determining if they can receive certain time-sensitive treatments for stroke.
• 2018 Georgia Data Summary [PDF – 289 KB]
  Use this summary of stroke data collected by the Georgia Coverdell Acute Stroke Registry for 2018, highlighting EMS pre-notification that led to successful patient outcomes in Georgia.
• The Michigan Stroke Experience: Burden, Healthcare Utilization, and Falls [PDF – 111 KB]
  Read this newsletter from the Michigan Behavioral Risk Factor Surveillance System (BRFSS) stroke surveillance brief, “An Overview of Stroke Within the Michigan Adult Population.”
• Stroke and Hypertension Among Michigan Adults [PDF – 85 KB]
  Read this newsletter from the Michigan Behavioral Risk Factor Surveillance System (BRFSS) stroke surveillance brief, “The Burden of Stroke and Hypertension among Michigan Adults.”
• Minnesota Stroke Registry Abstraction Manual, June 2019 [PDF – 777 KB]
  Incorporate this manual for the Minnesota Stroke Registry (MSR) into your own hospital’s plans. It includes case definitions, list of required and optional data elements, reporting deadlines and requirements, and more.
• 2019 Georgia Stroke Conference: Burden of Stroke In Georgia [PDF – 302 KB]
  Cite this PowerPoint presentation by Dr. Moges Seyoum Ido—a summary of the burden of stroke in Georgia, given at the Georgia Stroke Conference—in your own presentations.

Resources that support community education or outreach.

• Community Education that Works: Moundview Memorial Sees Success in Stroke Outreach [PDF – 172 KB]
  Incorporate lessons learned from this success story highlighting one hospital’s achievement in using community outreach to increase stroke patient arrival by EMS.
• Communicating with Your Health Care Team after a Stroke [PDF – 128 KB]
  For post-stroke patients, this handout shows things to leave the hospital with, what you should do when you leave the hospital, what you should do when you get home, and what to do at doctor appointments.
• Coverdell Stroke Program: BE FAST
  Learn from this page on Wisconsin’s Department of Health Services’ website describing the BE FAST campaign. It includes stroke graphics, social media messages, success stories, media materials, and additional resources.
• Empower People with Knowledge: Community Outreach Stroke Awareness Event Planning Toolkit [PDF – 3.5 MB]
  Use this toolkit to help organize community awareness events around stroke with stroke-specific community education resources, developed by the Wisconsin Coverdell Stroke Program.
• Let Bella Help You Learn the Signs and Symptoms of Stroke
  Watch this Facebook video highlighting the signs and symptoms of stroke, featuring Bella, a character adapted by the Wisconsin Department of Health Services.
• My Blood Pressure Wallet Card [PDF – 304 KB]
  Print this wallet card for patients to record information on their doctor, medication(s), lifestyle changes, and blood pressure. It also includes questions to ask the doctor if patients have high blood pressure.
• Some Things to Know When You Return Home After a Stroke [PDF – 147 KB]
  Print and share this fact sheet for post-stroke patients about how to keep track of things, staying organized after returning home from the hospital, and all the emotional changes, uncertainty, and physical, cognitive, and communication challenges that may occur.
• Stroke and Stroke Recovery Can Strain Your Finances [PDF – 608 KB]
  Share this resource list for post-stroke patients, which includes links for financial assistance in the Michigan area and beyond.
• Stroke Education Toolkit: Washington [PDF – 16.7 MB]
  Use this toolkit in your hospital to share stroke education resources for patients, the public and staff at health care facilities, emergency medical services, and community services.
• Michigan Stroke Centers: What’s the Difference? [PDF – 275 KB]
  Share this one-pager about the differences between stroke centers in Michigan.
• Bella Coloring Book [PDF – 7.8 MB]
  Share this coloring book featuring Bella, a character adapted by the Wisconsin Department of Health to promote stroke education and awareness.
• Bella Activity Book [PDF – 706 KB]
  Share this activity book featuring Bella, a character adapted by the Wisconsin Department of Health to promote stroke education and awareness.
• Community Education that Works: Moundview Memorial Sees Success in Stroke Outreach [PDF – 172 KB]
  Incorporate lessons learned from this success story highlighting one hospital’s achievement in using community outreach to increase stroke patient arrival by EMS.

Resources that support education for professionals.

• Enhancing Emergency Department Efficiency Decreases Patient Disposition Times [PDF – 854 KB]
  Incorporate lessons learned from this success story highlighting one hospital’s motivating factors for implementing new processes to reduce delays in triaging, treating, and transferring acute stroke patients in their ED.
• Getting to the Right Place First: Milwaukee County EMS Stroke Patient Transport [PDF – 203 KB]
  Incorporate lessons learned from this success story highlighting an education initiative for EMS providers to assist them in identifying LVO strokes in the field.
• Massachusetts Primary Stroke Service (PSS) validation
  Read an overview of the Primary Stroke Service (PSS) designation in Massachusetts.
• Massachusetts Primary Stroke Services (PSS) Time Target Recommendations [PDF – 24.1 KB]
  Use this chart to assist Massachusetts hospitals in assessing the timeliness of activities related to stroke evaluation and diagnosis.
• Stroke – Act FAST
  Order F.A.S.T. materials for patients in different languages, including English, Chinese, Haitian Creole, Khmer, Portuguese, Russian, and Spanish.
• 2019 Georgia Stroke Conference: Pre-hospital Stroke Identification and Its Impact on In-Hospital Care [PDF – 374 KB]
  Pre-hospital stroke identification and activation and impact on patient care in Georgia, from Dr. Moges Seyoum Ido at the 2019 Georgia Stroke Conference
• WI Stroke Recognition for EMS Providers
  Incorporate these training and continuing education opportunities for EMS providers on stroke recognition and treatment in your hospital’s protocols.
• Wisconsin Coverdell Stroke Program: Hospitals
  Review the Wisconsin Coverdell Stroke Program homepage for Coverdell overview and registry information, Coverdell Learning Collaborative, Stroke Coordinators of Wisconsin (SCOW), SCOW Mentor Program, and hospital resources.
• Washington Coverdell Stroke Program (WACSP)
  Review Washington state’s Coverdell Program’s homepage for stroke prevention resources and EMS resources.
• Best Practices to Improve Coordinated Stroke Care for Emergency Medical Service Professionals [PDF – 2.65 MB]
  Use this toolkit to assist EMS agencies in providing optimal stroke care and to improve care coordination among EMS agencies and hospital emergency departments (EDs), created by EMS and quality improvement professionals.
• Building Blocks of a Stroke Program [PDF – 2.46 MB]
  Use this toolkit to assist your hospital as it pursues Acute Stroke-Ready Hospital certification in Wisconsin.
• Every Minute Counts: Theda Clark Medical Center Sees Success in Stroke Care [PDF – 177 KB]
  Incorporate lessons learned from this success story highlighting EMS pre-notification leading to a successful patient outcome at a hospital in Wisconsin.
• Stroke Care Closer to Home: Building a Stroke Program at Beloit Memorial Hospital [PDF – 1 MB]
  Incorporate lessons learned from this success story highlighting a small Wisconsin hospital’s improvements in managing stroke care by becoming a certified stroke center.
• Stroke Patient Care Performance Improvement Guide [PDF – 1.28 MB]
  Incorporate these guidelines for best practices into your hospital’s protocols. The guidelines include tools and templates specifically related to the performance improvement component of a successful stroke program.
• The Nurse Practitioner Model: Achieving Exceptional Results at ProHealth Care [PDF – 690 KB]
  Incorporate lessons learned from this success story highlighting the value of a new stroke care model involving nurse practitioners and physicians from multiple departments involved in treating stroke.
• Stroke Patient Transitions of Care Toolkit [PDF – 810 KB]
  Use this toolkit to provide resources for hospitals and other health facilities staff to help implement strategies to improve the transition for stroke patients from hospital to home, including tips, tools, and resources for implementing strategies.
• Reducing Risk Factors of Stroke Patients after Discharge [PDF – 587 KB]
  Incorporate lessons learned from this success story highlighting a Comprehensive Stroke Center hospital and its quality improvement project established to further engage patients on healthy lifestyle changes for secondary stroke prevention.
• Rethinking Inpatient Stroke Care Transitions at Gunderson Health System [PDF – 381 KB]
  Incorporate lessons learned from this success story highlighting how one hospital’s neuroscience unit administrative director and clinical nurse leader spearheaded a holistic review of admissions and transfer practices for all post-alteplase stroke patients.
• Emergency Cardiac and Stroke (ECS) System Legislation [PDF – 46 KB]
  Read the details of the bill that created the ECS System in Washington state from the 2010 regular session.

Resources that support evaluation activities to monitor progress of stroke care improvements and systems integration.

• Assessment of EMS Agency Survey [PDF – 205 KB]
  Read this sample report based on surveys of EMS agencies transporting patients to Michigan Coverdell hospitals.
• Assessment of Hospital Community Outreach: Awareness of the Stroke Symptoms and Signs and Intent to Call 9-1-1 [PDF – 235 KB]
  Read this sample report based on a survey administered to hospitals participating in the Coverdell program to determine the effectiveness of community awareness for that state.
• EMS Agency Survey [PDF – 507 KB]
  Review this survey for EMS agencies that transport patients to hospitals participating in the Michigan Coverdell program, the full list of questions, and instructions.
• Hospital Data Scorecard Template [PDF – 281 KB]
  Use this template of an annual data scorecard, including GWTG measure definitions, to  improve the quality of care and outcomes for patients hospitalized with stroke and TIA.
• Ohio Coverdell Stroke Program Data and Publications – Stroke Performance Measures
  Learn from these 9 stroke performance measures developed by The Joint Commission, the American Heart Association, and CDC.
• Hospital Community Outreach Survey [PDF – 121 KB]
  Trying to assess community awareness of stroke signs and symptoms? Review this survey that was distributed to hospitals to assess the work of Michigan’s Coverdell program.
• New York State Community Health Indicator Reports (CHIRS)
  Use this website of annually updated health indicators in the County Health Assessment Indicators (CHAI) for all communities in New York.
• Ohio Coverdell Stroke Program Benchmark Report – 2017
  Use this sample annual report created for the Ohio Coverdell hospitals to assess programs against local and nationwide benchmarks that include type of stroke, demographics, mode of transport, pre-notification, door-to-needle times, and more.
• 2019 Georgia Stroke Conference — Stroke Health Status: Where are we now? [PDF – 598 KB]
  Use this summary of stroke health in Georgia from J. Patrick O’Neal, M.D., Commissioner.
• Georgia Legislative Stroke Report — 2018 [PDF – 458 KB]
  Review this legislative report on stroke in Georgia.
• Georgia Legislative Stroke Reports (2013–2018)
  Review this website, which provides links to many years’ legislative reports on stroke in Georgia, as required by the Coverdell-Murphy Act.

Peer-reviewed articles published by Coverdell grantees.

• Establishing Recommendations for Stroke Systems in the Thrombectomy Era: The Upstate New York Stakeholder Proceedings
  Read this publication from the American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program regarding a stakeholder meeting in upstate New York to develop recommendations to enhance stroke systems for acute large vessel occlusion.
• Hip Hop Stroke: Statewide Dissemination and Implementation of an Evidence-based Stroke Preparedness Intervention [PDF – 532 KB]
  Review this report about the dissemination of an evidence-based stroke preparedness program targeting elementary school children, Hip Hop Stroke (HHS), to a heterogeneous population of schools via 47 New York State Stroke Centers.
•  A Unique Approach to Quality Improvement Within the Stroke System of Care Utilizing Developmental Evaluation
  Learn how the Wisconsin Coverdell Stroke Program partnered with a Model Hospital and used developmental execution to understand and improve the stroke system of care in one community.
• Impact of Participation in a Telestroke Network on Clinical Outcomes
  This study used data collected by the Georgia Coverdell Acute Stroke Registry to assess whether a hospital’s participation in a telestroke network was associated with improvement in clinical outcomes and quality indicators.
• Quality of Care and its Impact on One-Year Mortatlity: The Georgia Coverdell Acute Stroke Registry
  Learn how  hospitals participating in the Georgia Coverdell Acute Stroke Registry assessed the 1-year mortality of acute ischemic stroke patients.
• Coverdell Status and Hospital Performance: Findings from a State Stroke Registry
  This report from the APHA 2017 Annual Meeting and Expo provides support that targeted quality improvement programming can lead to better outcomes for patients. Learn how the California Stroke Registry compared performance measures among Coverdell hospitals and non-Coverdell hospitals.
• Designated Stroke Center Status and Hospital Characteristics as Predictors of In-Hospital Hospital Mortality Among Hemorrhagic Stroke Patients in New York, 2008-2012
  Read how data collected in New York State Department of Health Statewide Planning and Research Cooperative System was used to identify and improve  gaps in care for ICH and SAH patients treated at designated stroke centers.
• Quantifying selection bias in National Institute of Health Stroke Scale data documented in an acute stroke registry
  Learn about selection bias in the National Institutes of Health Stroke Scale (NIHSS) in this evaluation of data from the Michigan Stroke Registry.
• Presenting symptoms and dysphagia screen predict outcome in mild and rapidly improving acute stroke patients
  Learn how data from the Georgia Coverdell Acute Stroke Registry was used to identify factors associated with a lower likelihood of favorable outcomes.
• Door to intravenous tissue plasminogen activator time and hospital length of stay in acute ischemic stroke patients, Georgia, 2007-2013
  Read this study to learn how hospitals participating in the Georgia Coverdell Acute Stroke Registry determined that shortening the door-to-treatment time for ishcemic strokes is associated with better patient outcomes.
• Characteristics and Outcomes of Stroke Patients Transferred to Hospitals Participating in the Michigan Coverdell Acute Stroke Registry
  Learn about the characteristics and outcomes of stroke cases transferred to hospitals participating in the Michigan Coverdell Stroke Registry.

Protocols developed by Coverdell grantees.

• EMS Interfacility Ground Transport Protocol (Georgia) [PDF – 109 KB]
  Incorporate this EMS interfacility ground transport protocol for patients during and after IV alteplase administration for acute ischemic stroke.
• Sample EMS Stroke Protocol [PDF – 83 KB]
  Adapt this protocol containing the best-practices recommendations from the Minnesota Department of Health.
• Inclusion and Exclusion Criteria for IV Alteplase Treatment of Ischemic Stroke for Consideration of Eligibility within 0-4.5 Hours of Time Last Known Well [PDF – 184 KB]
  Incorporate this list of criteria in your hospital’s protocol. The criteria are for medical providers to determine when to administer IV alteplase for ischemic stroke.
• Stroke Follow-Up Call Triage Algorithm [PDF – 964 KB]
  Use this triage guidance in your hospital. This protocol is for staff who perform follow-up calls with stroke survivors and their caregivers.
• California Stroke Registry [PDF – 1 MB]
  Read the California Stroke Registry/California Coverdell Program (CSR/CCP) Hospital Stroke Center Chart Audits: Inter-Rater Reliability and Concordance Methodology and Documentation.
• 911 Door to Needle [PDF – 233 KB]
  Use this process map for EMS, ED, and chart review for stroke patients.