National Grading of The Presented Stroke Care Services
Hospitals are responsible for the data they submit into the online system ( based on the nominated program [ n=6 ] comprising a mix of up to 5 variable bundles – see attached variable s summary ).
• The 6 levels of services is designed according to the the capability of each service spot (hospital , center , etc) to present a range of the 5 stroke service bundles of care. each Service Spot (SS) will have one of the following colors according to the avalibility of the services
- Green: (EVT variables Bundle + tPA capabilities bundle +Telemedicine Core Bundle + DISMAST Bundle + Process of care Bundle)
- Yellow: ( tPA capabilities bundle +Telemedicine Core Bundle+DISMAST Bundle+Process of care Bundle)
- Red:(EVT variables Bundle +Telemedicine Core Bundle+tPA capabilities bundle+Process of care Bundle)
- Purple: (DISMAST Bundle+Process of care Bundle)
- Blue: ( tPA capabilities bundle +Telemedicine Core Bundle + Process of care Bundle)
Black: ( Process of care Bundle)
WHAT IS SECRET REGISTRY?
- The SECRET is a clinical quality registry designed to facilitate the promotion, monitoring and improvement of acute care for stroke and transient ischaemic attack and aneurysms.
- All hospitals require ethics approval to participate in the SECRET. The SECRET Office has established processes to assist hospital staff in progressing these applications.
- Hospital staff are trained in the use of the SECRET data management system including how to export their own data and access their “live reports” which include benchmarked information against all other SECRET sites.
- The data can be entered manually , via an automated data upload process, or a combination of both.
- SECRET Office staff upload data import files on behalf of hospitals. Hospitals are required to transfer their verified data using a secure cloud system. In the future , hospitals may be encouraged to do uploads independently.
THE 5 BUNDLES OF Stroke SERVICE
They the mix of the services for stroke patient which are available at the SS
- EVT bundle: is the availablity of the Endovascular services
- Telemedicine core bundle : is the ability to guide or guided via tele-medicne for discion making for stoke patients
- tPA core bundle : the avalibility of all infrastructure to adminster tPA in the first 3 hours of onset (NNT=8)
- DISMAST bundle : which refer to the availability of Dysphagia detection and management ,Aspirin in hyper acute phase , The Mobilization plans and programs for the patients, anticoagulant and statin prescription for selected patients for secondary prophylaxis programs
Process of care bundle : like registering patients and morphology of the disease, screening programs for risk factors , following primary prevention plans all bunldes should be judged by the 8M approach
How we Judge the Quality of the presented bundles in any SS
All bunldes should be judged by the 8M approach according SVIN recommendations
Essential personnel including medical director, physicians, nurses and radiology technicians
Appropriate angiographic equipment and facility level resources
Medical device inventory, angiography room supplies and medications
Standardized protocols for stroke workflow optimization within hospital and within the stroke interventional lab
Annual volume criteria for facilities as well as stroke interventionists to obtain as well as maintain certification or credentials
Benchmarks for performance improvement and quality assurance with meaningful measures within the stroke interventional lab
Radiation and procedural safety practices
Fair market value compensation standards for physician manpower needs to provide 24/7 coverage of stroke interventional labs