Thank you for viewing the chest pain MI registry August case scenario regarding metric 56, time to primary PCI among transferred patients. In this scenario, a 75-year-old male was brought to the emergency department by his family at 10 a.m. with complaints of chest pain and shortness of breath. The ECG performed at 10.06 a.m. revealed minor ST changes. The high-sensitivity troponin lab result was above the 99th percentile. He was evaluated by the cardiologist who diagnosed him with an NSTEMI and recommended transfer to a PCI-capable facility due to ongoing chest pain and shortness of breath despite guideline-directed medical therapy. He was transferred at 11.30 a.m. During transport to Hospital B, his chest pain worsened. EMS performed an ECG at 11.40 a.m., which revealed STEMI, and the cath lab activation was initiated. The patient was a direct admit to the cath lab at Hospital B, and a PCI was performed for STEMI. The question is, will this patient be included in the denominator of metric 56 at Hospital B? Is number one, no, or number two, yes? Please take a few moments to review the documentation and the question. The answer is number one, no. This patient is not included in the denominator of metric 56 at Hospital B. Let's look at the Executive Summary and Metric Companion Guide to see why. Per the companion guide and based on the denominator exceptions, any STEMI ECG, which occurs after the patient is transferred, removes the patient from the denominator as metric 56 is evaluating the timely transfer of STEMI patients from the first facility to a PCI-capable facility. This patient was diagnosed at the first facility with NSTEMI and had the first STEMI ECG in transit to the PCI-capable facility. Thank you for viewing the Chest Pain MI Registry's August case scenario, metric 56, time to primary PCI among transferred patients.

case scenario

75-year-old male

emergency department

chest pain

shortness of breath