1. RCSN Ontario Stroke Audit Overview of 2010/11 Audit Moira K. Kapral, MD MSc FRCPC Stroke Evaluation Quality Committee Meeting June 2011 Moira K. Kapral, MD MSc FRCPC Stroke Evaluation Quality Committee Meeting June 2011

2. Purpose of the 2010/11 Ontario Stroke Audit Provide data on key indicators for the Ontario Stroke Evaluation Program –Time to arrival, stroke unit care, tPA, neuroimaging, carotid imaging, dysphagia screening, medications Allow for comparisons across –Regions (LHINs and OSS regions) –Hospital types (RSCs, DSCs, non-designated) –Individual hospitals Need for much larger sample size

3. History of the Ontario Stroke Audit 1999 (pilot) = 1,074 charts, 4 sites 2001 = 1,111 charts, 41 sites 2002/03 = 3,534 charts,151 sites 2004/05 = 5,032 charts, 152 sites 2008/09 = 4,699 charts, 142 sites 2010/11 = 15,640 charts, 152 sites

4. Details of sampling strategy All patients seen in ED or admitted to hospital All Ontario acute care institutions with > 10 strokes/year Includes pediatric institutions and pediatric strokes Patients identified from medical records using ICD-10 codes for stroke and TIA

5. Volumes sampled by institution type Institution typeSampleN Regional stroke centres100%5,816 Enhanced district and district stroke centres100%5,142 Non-designated high volume (>100/yr)30%2,594 Non-designated medium (33-99/yr) volume30 pts690 Non-designated low (< 33/yr) volume10 pts450 Telestroke centres (non-designated sites)100%450 Pediatric facilities and cases100%498 Total15,640

6. Data collection procedure RSCs and EDSCs Most of data already collected by regional coordinators through web- based SPIRIT Acute Care system; remaining data to be collected by laptop Need to convert web- based data to laptop format to allow merging of databases and completion of data entry. Complex programming now in progress. Other sites Data collection by centrally trained abstractors and laptop computers with updated program Data collection in progress

7. Progress to date New data collection program created, audited and approved, with updated case record form and data dictionary Training and validation of chart abstractors Approval for data collection at 125 of 152 hospitals Complete data collection on 860 charts Partial data collection on 3,700 charts (SPIRIT Acute)

8. Timelines March/April 2011 – Coordinator training completed May 2011 –Data abstraction began August 2011 – Need 50% of data collection complete November 30, 2011 – Deadline for OSA data entry December 2011 – Data cleaning January 2012 – Draft reports to Regional Directors April 2012 – SEQC Report June 2012 – OSA Report

9. Challenges Launch of audit coincided with RCSN migration from CSN to ICES and with termination of SPIRIT program Laptop program required auditing and approval by ICES TrialStat SPIRIT web-based application terminated –Need to perform transfer and close-out procedures –Need to develop ICES web-based application –Need to transfer partially completed SPIRIT data to laptops Very large audit, with need to perform data entry on many charts towards the end of the audit period (since can’t identify charts from end of 10/11 fiscal year until later in 2011) leads to tight timelines

10. Summary – Ontario Stroke Audit 2010/11 audit is largest to date Tight timelines given unanticipated programming and logistical issues Should provide valuable information for regions and hospitals