The Chest Pain MI Registry Case Scenario for July of 2022 will review Part 2 of a two-part series going beyond the obvious in-metric review. Please review the June case scenario, Part 1, of this lesson prior to continuing. A 41-year-old male presents to the emergency department at 11 a.m. with complaints of shortness of breath, headache, mild chest pressure, and a toothache. He has a history of heavy smoking and daily alcohol use. He admits to no medical care in the past 10 years and does not have a primary care physician. The initial and second ECG are negative for STEMI, and the droponin values are below the 99th percentile URL. The ED physician proceeds to explain the plan of care based on the hospital's chest pain protocol. The patient refused to proceed with the recommended plan of care and left against medical advice. At 4.25 p.m., the patient returns to the ED with the same symptoms. The first ECG obtained during the second ED visit is positive for STEMI, with ST elevations greater than 3 millimeters in four contiguous leads, V3, V4, V5, and V6, signifying an anterolateral MI. The cath lab staff is activated, and the patient receives a drug-eluting stent to the distal portion of the LAD. The first visit to the ED is not included in the registry, as this facility abstracts NSTEMI and STEMI patient types only, and inclusion criteria is not met. The second patient visit is entered into the chest pain MI registry, as the patient met both the inclusion criteria and the patient type definition for STEMI pre-admit. The following ECGs were entered correctly into the ACC online data collection tool per the Data Dictionary's coding instructions and target value of any occurrence between 24 hours prior to first medical contact and discharge. During the discussion between NCDR and the abstractor, the abstractor asked if there are any resources available to assist in evaluating door-to-ECG time. We indicated the hospital policy states an ECG will be obtained within 10 minutes of arrival on all patients, regardless of symptoms. For the given scenario, what functionality in the eReports dashboard will assist in evaluation? Number one, the comparator. Number two, detail lines. Number three, intersystem care delivery. The answer is number two, the detail lines. Where is the detail line located in this specific scenario? Let's review it together. Start with the detail line companion guide, which is located by selecting the resources link from the homepage. Next, select the documents tab. Scroll down to user guide documents, then download the detail lines companion guide. Once the document is open, depress control and F keys simultaneously to display the search text box. Then, type the keywords in the search box. In this scenario, the focus of search is time of arrival to the first ECG. Note, one of over 12 indicates that there are 12 areas where arrival to ECG is mentioned in the document. To move through the document to find the appropriate arrival to ECG metric key, depress the down arrow key or enter key. The search text of arrival to ECG is highlighted in blue. Metric key 10901 provides the information needed to evaluate the delay in obtaining an ECG after arrival to this facility. This patient arrived by self family, therefore, he is included in the denominator. Metric key 10901 is specific to accreditation. However, it is provided for all facilities participating in the chest pain MI registry. With the companion guide in hand, let's evaluate the details of this scenario using metric key 10901. Proceed to the eReports dashboard, ensuring the desired ending time frame is selected. From the view dropdown menu, select detail lines. Then, from the category dropdown menu, scroll down to accreditation and select all populations except resuscitation based on the information found in the detail lines companion guide. Displayed for review is the detail line report for all populations except resuscitation, which provides the information regarding patients with arrival time to ECG less than or equal to 10 minutes. Select patient details to evaluate all patients in this rolling four quarter time frame. To select only those patients identified as no in the numerator, select the down arrow button in the light gray horizontal box. Next, from the patient display dropdown list, select patients not in numerator, then select retrieve. This will provide all patients who did not meet the numerator criteria. However, we are going to focus on the specific patient in question. The numerator criteria is not met with a door to ECG time of 42 minutes. NCDR further assisted the participant in the utilization of the detail lines to evaluate all door to ECG times which identified this issue was not isolated to this one patient. The NCDR chest pain MI registry detail line report provided tangible evidence needed to present to the facility's quality council and administration to develop 2022 quarter three's process improvement initiative. Due to the diligence of this abstractor, all aggregated data available was evaluated to initiate a plan to regain their facility's high standards of care. Thank you for reviewing the chest pain MI registry July 2022 scenario, part two of a two part case scenario.

Chest Pain MI Registry

Case Scenario

July 2022

heart attack

eReports dashboard