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Improving clinical documentation and coding for acute strokes

Improving clinical documentation and coding for acute strokes

Improve the management of and outcomes for stroke patients by having a better understanding of what type of stroke they are presenting with.


  • The management of stroke and its outcomes vary according to whether the stroke is ischaemic[1] or haemorrhagic[2]
  • Treatment with clot-busting drugs can help some patients with ischaemic stroke but is unsuitable for patients with haemorrhagic stroke
  • In order to know the proportion of our patients with ischaemic stroke receiving clot-busting drugs, we need to know whether they have had an ischaemic versus a haemorrhagic stroke

What did we find?

We found that an average of 19.7% of patients were being coded as having an ‘unspecified’ type of stroke compared to an average of only 8.4% for the other three northern DHBs.

What did we do?

  • Clinical leaders and managers from our stroke service and coding department reviewed clinical documentation for accuracy of coding.
  • Guidance was then provided for clinical coders on the appropriate use of the ‘unspecified’ type of stroke code.

Did we make a difference?

We reduced the number of patients with unspecified type of stroke to less than 1% for the first quarter of 2015.

Acute 'unspecified' stroke rates for northern regional DHBs
Acute 'unspecified' stroke rates for norther regional DHBs

Where to from here?

  • We now have a better understanding of the proportion of our patients with ischaemic stroke who have received clot-busting drugs.
  • We can use this information to improve access to clot-busting drugs for suitable patients with ischaemic stroke.
  1. Ischaemic strokes occur when blood vessels are blocked by a clot or become too narrow for blood to get through to the brain. The severely reduced blood flow (ischaemia) causes brain cells in the area to die from lack of oxygen.
  2. Haemorrhagic strokes occur when a blood vessel in your brain leaks or bursts and spills into the surrounding tissue damaging brain cells, or into the space around the brain (subarachnoid haemorrhage) causing damage.

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