Thank you for viewing the Chest Pain MI Registry January case scenario regarding metric 56, time to primary PCI among transferred patients. In this scenario, a 52-year-old male presents to the ED at 9.38 a.m. via EMS for severe ankle pain due to a fall. The patient did not remember how he fell. He only remembers waking up on his back with severe left ankle pain. The ED physician orders an ECG, Rainbow Labs, and x-ray of lower left limb to rule out fracture. The ECG is performed at 10 o'clock a.m. and is markedly positive for STEMI. Transfer arrangements are made and the patient departs from the ED at 10.23. Upon arrival to the PCI-capable facility, the patient is taken immediately to the cath lab for primary PCI for STEMI. The first balloon inflation is noted in the procedure log at 11.39. This is how the abstract are coded. Is this patient excluded from the denominator of metric 56, time to primary PCI among transferred patients? No or yes? Please take a moment to review the documentation and the question. This patient is excluded from metric 56. Let's review this metric in detail to see why this patient is removed from the denominator. This patient is excluded from metric 56 with the Steering Committee's newly approved denominator exception. When the travel time is greater than or equal to 45 minutes and the time to device is greater than 120 minutes, then the algorithm will remove this patient from the denominator. Denominator exceptions remove those patients or episodes that have not met the metric numerator criteria and have an acceptable rationale to remove the patient from the eligible metric population. Metrics are only considering eligible patients or episodes when assessing and evaluating for metric compliance. Denominator exclusions and denominator exceptions are automatically applied by the algorithms. In this scenario, the patient met the denominator criteria of transfer patients with preadmitted STEMI who received primary PCI for acute STEMI. However, the numerator was not met due to the time to device time was 121 minutes. When the numerator criteria are not met, the algorithm will evaluate if an exception criteria is applicable to the patient scenario. In this scenario, the patient had an EMS travel time of 46 minutes and a time to first device of 121 minutes, thus meeting the exception criteria and removing the patient from the denominator. This patient will not be displayed in the patient-level report of the individual performance measure of metric 56. Let us see how metric 56 is displayed within the composite metrics for this patient. Within all the composite metrics, an empty cell under a metric column identifies the patient was not eligible for that individual performance measure. In this scenario, the denominator exception removed the patient from the denominator of metric 56 time to primary PCI among transferred patients. Therefore, the patient is not eligible for metric 56 and the column cell for this patient is empty. It is important to remember per the 2013 ACCF AHA guideline for management of STEMI, interhospital transfer to a PCI-capable hospital is the recommended strategy if primary PCI can be consistently performed within 120 minutes of first medical contact. If not, then fibrinolytic therapy should be administered in the absence of any contraindications. This is a Class 1 recommendation. Thank you for viewing the Chest Pain MI Registry's January case scenario.

Chest Pain MI Registry

metric 56

time to primary PCI

transferred patients

STEMI