Chest Pain Center FAQs

A: Facilities have three options for collecting data:

1. Submit patient records only into the Accreditation Conformance Database (ACD). The ACD is the data repository housed in the CPC Accreditation tool which enables ongoing reporting of collected metrics to gauge progress toward meeting established goals.
2. Submit patient records only into the NCDR® Chest Pain - MI Registry™.
3. Submit all AMI (STEMI, NSTEMI, and Resuscitation (if applicable)) patients into the Chest Pain - MI Registry™ and Low-Risk and Unstable Angina patients into the ACD. This is a hybrid approach to data collection made available to participants in the Chest Pain-MI Registry.

By providing these three methods, facilities have the flexibility to choose which words best for their program

A: The latest model continues to build on the foundation of previous iterations of Chest Pain Center (CPC) Accreditation, further raising the bar and ensuring the most current guidelines are reflected in the tool requirements. The model continues to provide 'Recommended' items for facilities who choose to further advance. We have enhanced our CPC Accreditation platform to reduce redundancies, streamline guideline-driven mandatory requirements, and allow for Return-on-Investment (ROI) alignment utilizing facility-specific data.

Greater Focus on ROI

The latest model further expands the financial benefits of establishing or improving a facilities chest pain program while ensuring quality care is rendered with limited variation. The assigned Accreditation Review Specialist (ARS) has access to ACC derived ROI Calculators which utilizes your data to provide an example of facility-specific cost savings and/or revenue enhancement for the following: Observation Length of Stay (LOS), Emergency Department (ED) LOS, and Acute Myocardial Infarction (AMI) re-admission reduction through Cardiac Rehab.

Expanded Focus on the Acute Coronary Syndrome (ACS) patients in Observation Status

The latest model includes a section on the treatment of the ACS patient placed in Observation status. This section provides guidance on reducing LOS, increasing revenue, reducing costly delays, and improving patient satisfaction and safety. These improvements will favorably impact ED throughput by accelerating existing bed turnover. Our ARS team will also work with your facility to ensure patient throughput improvements for an accelerated diagnostic protocol, where applicable.

Quality

Quality is the cornerstone requirement to integrate continuous improvement in all aspects of care. Requirements include the development of a Quality Assurance Performance Improvement (QAPI) plan, alignment with overall organization strategic goals, recognition, and treatment strategies for potential and known ACS patients, and case reviews.

Seamless integration with the Chest Pain - MI Registry™ to reduce the data burden for participating facilities.

An accelerated pathway to Accreditation is available to facilities who have earned a Chest Pain – MI Registry™ Performance Achievement Award (Platinum, Gold, Silver).

A: The vision for the ACS service line is to extend the focus beyond STEMI patients and assist facilities to improve the care of the NSTE-ACS (NSTEMI and Unstable Angina) and Low-Risk patient populations. In many cases, these processes seem to be less defined. The Low-Risk population accounts for 80% of the chest pain/ACS patient volume.

Our Accreditation tool guides facilities in building hardwired protocols and pathways to efficiently risk stratify and manage these patients. Research shows not all Low-Risk patients require provocative testing or observation services. Implementing appropriate risk stratification for identification of those at sufficient risk of an acute event will better guide clinical decision making, along with disposition and stress testing options. These should always be coupled with shared decision making with the patient. The Accreditation process provides the focus to minimize the variability between providers and improve the utilization of resources to reduce costs while elevating the delivery of care.

A: STEMI patients are the most critical upon presentation. They are the quintessential emergency. Facilities have done an amazing job at building solid processes to facilitate reperfusion of the culprit lesion. With a NSTEMI, the patient is still experiencing a heart attack but has not progressed to a STEMI diagnosis. The Unstable Angina (UA) patient may be displaying signs and symptoms of a heart attack however, it is not evident on the ECG or cardiac biomarker (Troponin).

Often the plan of care remains variable, dependent upon such factors as the time of day, day of the week, risk stratification method, provider-dependent strategy, facility resources, etc. Accreditation frequently reveals these variabilities and assists facilities in developing pre-determined pathways to ensure the right care is delivered at the right time to the right patient. The guidelines are available, yet facilities continue to struggle with operationalizing the science. The development of patient care pathways reduces the facility’s liability risk and allows for the high percentage of Low-Risk patients to be risk stratified and dispositioned timely and safely.

A: The Low-Risk population is an ongoing challenge. Despite an array of diagnostic modalities and strategies, there remains this task to appropriately identify those patients who require extended work-up or rule-out versus those who can safely be discharged from the ED.

Failure to detect a patient with ACS and inadvertently discharging them can result not only in harm to the patient, but significant liability to the provider and facility. On the other hand, patients not at high risk of having an acute event who are inappropriately admitted and undergo expensive evaluations set the facility up for extended LOS, inappropriate resource utilization, avoidable costs, and decreased patient satisfaction. ACC Accreditation Services plays a vital role in setting the standard of care for the Low-Risk patient.

By taking science to the bedside™ through the Accreditation process, facilities are given a road map to guide them in delivering evidence-based care. By collecting performance and outcomes data, we can demonstrate the impact our tool has on the components of value-based purchasing and reimbursement programs.

A: Data for the Chest Pain - MI Registry™ is entered and submitted on a quarterly basis. Concurrent data entry will give the best results as you can get real time metrics to monitor your facility's processes such as door-to-ECG time and door-in-door-out (DIDO)/Door to Reperfusion (D2R) STEMI times.

On average, it takes a seasoned data abstractor approximately 15 minutes for a Low-Risk case, 30 minutes for a NSTEMI case, and 20-30 minutes for a STEMI case. The concept is “…the more you do it, the faster you become…”.

Once data is entered into the Chest Pain - MI Registry™, there is a simple process to submit the abstracted data which will be available on your facility's dashboard every Monday. You can also see how you compare to hospitals of a similar size.

For Chest Pain Center Certification customers, the anticipated time and effort will be much lower than a tertiary facility. The patient volume and applicable data points collected for Critical Access Hospitals (CAH) and FreeStanding Emergency Departments (FSED) will be measurably less. Participating in this registry will provide your facility with quality metrics for each population, allowing you to keep a pulse on quality to identify areas of process improvement. As a CAH or FSED, your facility can utilize the STEMI Referral Facilities (STRF) data collection form.