What is OP-23?
The short answer
OP-23 counts how often a stroke patient’s head CT or MRI is interpreted within 45 minutes of arriving in the ED. The clock starts at arrival, not when the scan is done, so every minute spent on ordering, scanning, sending images and reaching a radiologist counts. Overnight, a teleradiology provider that reads stroke studies first and calls the result is what keeps the night inside the window.
- 45 minED arrival to head CT/MRI interpretation
- 2 hrssymptom onset window for the measure
- 15 minTeleRads critical call standard
OP-23 at a glance
- Measure
- OP-23: Head CT or MRI scan results for acute ischemic stroke or hemorrhagic stroke patients who received head CT or MRI scan interpretation within 45 minutes of ED arrival.
- Program
- CMS Hospital Outpatient Quality Reporting (OQR), publicly reported.
- Who counts
- ED patients with a diagnosis of acute ischemic or hemorrhagic stroke who arrived within two hours of the time they were last known well.
- What counts as on time
- The head CT or MRI is interpreted within 45 minutes of ED arrival.
- What it means overnight
- If your own radiologists are off, the interpretation comes from whoever covers your nights, so their speed is your score.
Where the 45 minutes go
The 45-minute window covers the whole path from the door to the read, and most of it happens before a radiologist sees anything. A typical overnight stroke alert looks like this:
- 01
Arrival and triage
The patient arrives, stroke is suspected and the stroke alert is called.
- 02
Order and scan
Head CT (often with CT angiography) is ordered and performed. National stroke targets aim to start imaging within about 25 minutes of arrival.
- 03
Images reach the radiologist
Images route to the teleradiology PACS. Delays here are usually technical: incomplete series, a stuck router, an order that didn’t arrive.
- 04
The read
The radiologist reads the head CT first, before anything else on the list, to answer the question that drives treatment: is there a bleed?
- 05
The call
The result is called to the ED, read back, and logged with name, role and time. A signed final follows in your system.
Because the radiologist’s part comes last, every minute lost upstream shrinks the time left for the read. That is why stroke studies must jump the worklist, and why the critical call matters as much as the signed report.
How TeleRads handles a stroke at night
- Stroke studies are read first, ahead of routine work on the list.
- One number answered by a person, so your ED can reach the reader during a stroke alert.
- Critical results are called within 15 minutes, read back, and logged with the name, role and time of the person who took the call.
- Signed finals, not preliminaries, go back into your system in your format.
- A named backup reader, already credentialed at your hospital, is on every night.
- A monthly scorecard shows turnaround and critical calls, call by call.
Questions to ask any overnight provider about stroke
- Do stroke studies go to the top of the worklist automatically, or does the ED have to call?
- How fast is the critical call, and is every call read back and documented?
- Who answers the phone at 3 AM, a person or a queue?
- Is the report a signed final or a preliminary your group re-reads?
- Will you report stroke turnaround to us monthly, study by study?
For the wider emergency picture, see our guide to emergency and stroke teleradiology.
Questions
What is OP-23?
OP-23 is a CMS Hospital Outpatient Quality Reporting measure. It tracks the percentage of ED patients with acute ischemic or hemorrhagic stroke, arriving within two hours of symptom onset, whose head CT or MRI is interpreted within 45 minutes of ED arrival.
When does the 45-minute clock start?
At ED arrival, not when the scan is performed. Triage, ordering, scanning, image routing and the read all happen inside the same 45 minutes.
Does a preliminary read count for OP-23?
The measure looks at when the scan is interpreted. TeleRads sends signed finals and calls critical results, so the ED has a usable answer and the chart has the report of record.
How does TeleRads prioritize stroke studies overnight?
Stroke studies are read first, ahead of routine work. Critical results are called within 15 minutes, read back and logged, and a signed final goes back into your system.
Are there surcharges for STAT or stroke reads?
No. TeleRads has no STAT, after-hours or weekend surcharges, and reads outside the agreed turnaround are not charged.