Chest Pain Center FAQs

A: The vision for the ACS service line is to extend the focus beyond STEMI patients and help hospitals improve the care of the NSTE-ACS (NSTEMI and UA) and LOW-RISK patient populations. In most cases, these processes seem to be less defined. The LOW-RISK population accounts for 80% of the chest pain patient volume. Our accreditation tool guides hospitals in building hardwired protocols and pathways to efficiently risk stratify and manage these patients. Research shows not all Low-Risk chest pain 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. There is a great 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. Hospitals have done an amazing job at building solid processes to facilitate reperfusion of the culprit lesion. With a NSTEMI, the patient is still having a heart attack but has not progressed to a STEMI yet. The UA patient is displaying signs and symptoms of a heart attack but it is not evident on the ECG or cardiac biomarker (Troponin). Often the plan of care remains variable, dependent upon such factors such as the time of day, day of the week, risk stratification method, provider-dependent strategy, hospital resources, etc. Accreditation frequently reveals these variabilities and assists hospitals in developing pre-determined pathways to ensure the right care is delivered at the right time to the right patient. The guidelines are out there, but hospitals continue to struggle with operationalizing the science. For the Low-Risk patient care, pathways are even less well-defined, yet this group reflects the majority of the volume which brings a huge liability.

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 hospital. 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 lengths of stay, inappropriate resources 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 tool, 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, although it is only requested monthly for Chest Pain Center Accreditation and Certification. 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). On average, it takes a seasoned data abstractor about 10-15 minutes for a Low-Risk case, 30-40 minutes for a NSTEMI case, and 20-30 minutes for a STEMI case in the basic data set. The more you do it, the faster you become. Once you enter data, there is a simple process to submit and each Monday you will be able to see your facility's dashboard. 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 and FreeStanding Emergency Departments 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.