Improving transitions in acute stroke patients discharged to home: the Michigan stroke transitions trial (MISTT) protocol

Table 2 Steps for In-hospital Screening and Consent

Screening Steps	Data Source	Screening criteria	Data collected
Step 1 Pre- screening	Daily census and admission notes	Confirmed acute ischemic or Hemorrhagic stroke Adult. Lives <50 miles from hospital	Number screened
If pass Step 1, then
Step 2 Screening	Chart & Attending Physician	NIHSS > = 1 at admission Lives at home mRS > = 1 at discharge or therapy ordered Discharge home or plan to go home within 4 weeks of going to rehab Life expectancy >6 months No other trial affecting follow-up No mention of cognitive deficits, significant stroke impairment or aphasia*	Screening log includes age, race, sex, stroke type, date of admission, and primary reason(s) I patient not eligible. Presence of clinical cognitive deficits, significant stroke related impairments, or aphasia.*
If pass Step 2, then
Step 3. Final confirmation	Patient	Bedside confirmation of eligibility: live at home, plan to go home, speaks English. Complete Bedside 6-item cognitive screening.*	6-item cognitive screen score.* Document primary reason(s) patient not eligible
If pass Step3, then
Step 4. Consent	Patient	Yes - agreed	Complete consent form
		No – declined	Document reason(s)
		No – not obtained ➔ study was introduced but no decision made about participation	Document reason(s)

*Proxy consent used if attending physician or chart mentions clinical cognitive deficits, significant stroke related impairments, or aphasia likely to impact the consent process (Step 2) or if patient has a 6-item cognitive screening score of <=4 (Step 3).

ISSN: 1471-2377