LKW Resolution Grid
Enter what you find in the chart for each source. The tool resolves your final abstraction values using spec priority rules.
How to useFill in each row with what the chart shows — dates, times, whether LKW/normal is explicitly stated vs. S/Sx only, and whether unknown is documented. Leave blank if not present. Hit Resolve when done.
COLUMN PRIORITY:
1 — Unknown (MD)
2 — Code Stroke Form
3 — LKW / Normal
4 — S/Sx Only
| Source | Row Priority |
Priority 4 S/Sx Onlysymptom onset, no explicit LKW |
Priority 3 LKW / Normalexplicitly last known well |
Priority 1 Unknownunknown / uncertain / unclear |
Priority 2 Code Stroke FormRN-completed; not MD priority |
|---|---|---|---|---|---|
| MD Physician / APN / PA |
1 | See RN row | |||
| RN Nursing / EMS |
2 | ✕ |
Context Flags
Abstraction Result
Last Known Well (Y/N)
—
Date LKW
—
Time LKW
—
Rule Applied
Guided Workflow
Answer each question to determine your LKW abstraction values step by step.
Step 1 — Stroke Timing
Did LKW / stroke signs first occur after hospital arrival?
Quick Reference
v2026B · STK-4 / ASR-IP-1 / ASR-OP-1
LKW Documentation Priority Matrix
Column priority determines what type of documentation wins. Row priority determines who wins when the same column has multiple entries. The hierarchy shown here (1=Unknown, 2=CSF, 3=LKW/Normal, 4=S/Sx) is the spec-derived hierarchy.
| Source | Row Priority | 4 S/Sx Only | 3 LKW/Normal | 1 Unknown | 2 Code Stroke Form |
|---|---|---|---|---|---|
| MD | 1 | Date / Time/s | Date / Time/s | Yes / No YES = cancels ALL | See RN row |
| RN | 2 | Date / Time/s | Date / Time/s | ✕ irrelevant | Date / Time/s Not MD-level priority — but beats all other positive sources |
Time LKW — Multiple timesMultiple S/Sx episodes → most recent. Multiple MD times → earliest. MD unknown → cancels ALL. No CSF + multiple times → MD first.
Date LKW — Multiple datesAlways use the earliest date when multiple are documented.
Last Known Well (Y/N)
Select YES whenBOTH date AND time present
NO — MD says unknownCancels all
NO — in-house strokePost-arrival LKW
NO — time >2h, no specific timeUTD
"Just prior to arrival"YES → use arrival time
RN unknown, MD has timeYES
MD unknown, RN has timeNO
Date Last Known Well
FormatMM-DD-YYYY
Invalid date (03-42)UTD
"This evening," arr 00:30Day before arrival
Midnight → advance date00:00 next calendar day
Multiple datesEarliest
CSF dateTakes precedence
Time Last Known Well
FormatHH:MM military
Invalid time (3300)UTD
With seconds (15:00:35)Drop seconds → 15:00
Hours ago ("2 hrs ago")Arrival − 2h
Range ("2–3 hrs ago")MAX → Arrival − 3h
"Less than X hrs ago"Use X → Arrival − X
"Just prior to arrival"Use arrival time
⏱ Calculators
MILITARY TIME CONVERTER
→
—
HOURS-AGO SUBTRACTOR
− hrs:
→
—
Always use MAX for ranges
Top Abstractor Pitfalls
Pitfall #1 — Using S/Sx when explicit LKW is documented"Patient normal at 8 PM" + "symptoms at 8:30 PM" → LKW = 20:00, not 20:30. Explicit LKW always beats symptom onset.
Pitfall #2 — Ignoring MD "unknown" because nursing has a timeMD Unknown (Priority 1) cancels everything. One MD saying unknown = NO. RN unknown = irrelevant.
Pitfall #3 — Forgetting to advance date at midnight24:00 on 11-24 → 00:00 on 11-25. Always change the Date LKW when converting midnight.
Pitfall #4 — Assuming wake-up stroke = unknownIf the physician documents a bedtime as LKW — use it. Only "unknown" if MD explicitly states it.
Pitfall #5 — Stroke Education Form ≠ Code Stroke FormStroke Education Form and Core Measure Form are excluded. Only acute stroke response forms qualify as CSF.
Pitfall #6 — Using first episode instead of lastSymptoms → resolved → recurred = use most recent episode before arrival. Grid note: "symptom onset/resolved → closest to arrival."
Practice Quiz
10 scenario-based questions covering every major LKW rule.
Full step-by-step case walkthroughs are in the Case Walkthroughs tab.
Case Walkthroughs
Step-by-step cases that explain the abstraction reasoning at every decision point.
How to useSelect a case, then work through each step. The trainer's reasoning appears at each decision point.