All right, good afternoon. This is the end of the day, thankfully, but yet it's our first in-person session for the chest pain in my registry, so thanks for you all being here. I will quickly—my name is Kate Malish, and I'm your new product manager, and I won't bore you with another introduction, because I know that I introduced myself last week on the registry webinar call. But suffice it to say, I'm very happy to be in this role, and I look forward to working with all of you. So today we have an excellent session presented to you by Dr. Michael Kantos and Ms. Keri Morris. They're going to discuss chest pain center accreditation and how to achieve it. They'll also show you how the chest pain in my registry and chest pain center accreditation together can support your organization. So quick introduction, Dr. Kantos is—well, first of all, he's our steering committee chair, so he's very involved with the registry and with ACC in general. He is a professor at the Virginia Commonwealth University Medical Center in Richmond, Virginia, and he's also the medical director of the CICU and co-director of the chest pain center at that facility. And then Keri Morris is sort of my partner in crime when it comes to accreditation back at ACC in Washington. However, she does live in Tennessee? In Mississippi. Oh, Mississippi, sorry. So she is one of our remote workers, but she is the accreditation clinical product manager for chest pain center accreditation heart care with the ACC. So without further ado, I'm going to hand it over to them. Thank you. All right, well, thank you all for being here. As she said, I'm Mike Kantos, and together with Keri Morris, my partner in crime, we'll be discussing the role of the chest pain in my registry and chest pain accreditation and how they can be combined together to provide a synergy in overall outcomes, improving outcomes in patients with chest pain across the spectrum of ACS. The objectives of our talk are to discuss the relationship between the registry and chest pain center accreditation. And then we'll identify one benefit gained because of chest pain accreditation. So at the beginning, the CATH PCI was formed as the first registry through the NCDR and provided a firm background for assessing CATH lab procedures and outcomes. However, at that time, there wasn't a current ACC registry to provide overall outcomes on patients with acute MI. So in 2007, two registries, the National Registry of Acute MI or NAMI combined with the Crusade Registry to combine to become the Action Registry that was designed to provide outcomes across the spectrum of acute MI patients. In 2019, this was further modified after the merger of ACC with the Society of Chest Pain Providers for Clinical Outcomes. And this registry was expanded to include patients with unstable angina and low-risk chest pain patients and was renamed the Chest Pain MI Registry. The purpose of this registry is really to inform on patient characteristics and treatment strategies across the entire spectrum of patients with chest pain. The primary aim of the registry is to optimize outcomes and management of chest pain patients through the implementation of specific evidence-based guideline recommendations that are present in clinical practice. In 2017, the AHA and ACC published the Clinical Performance and Quality Measures on Adults with Acute MI, both STEMI and non-STEMI. And this currently serves as the background for performance measures across the registry. Together in concert with this, we're able to provide adjusted outcomes for both mortality and bleeding risk in these individual patient groups. As I mentioned before, the registry is able to include all patients with a possible ACS, starting with STEMI patients on the left and going down to the unstable angina and the low-risk chest pain patients. Hospitals are able to provide, submit data on just MI patients who are alone or across the spectrum of chest pain and being used for chest pain accreditation. This includes the evaluation process performed by first responders and subsequently to the emergency department, and then includes also patient-specific strategies and treatments that were delivered and the patient's discharge status and care strategies. Reviewing the process and outcomes from the pre-hospital phase, the care delivered in the emergency department, in the cath lab, whether the patient is low-risk and goes to the observation unit or is admitted to an inpatient unit for further monitoring such as a CICU, it's able to provide important interdepartmental collaboration and coordination. It's important to have representation from all these different areas to be able to ensure that we optimize overall patient care, ensuring that specific policies and practice changes are implemented and are transmitted with communication across these different areas. Otherwise it's very difficult to improve overall patient care. EMS is a critical aspect of this, particularly when we're talking about STEMI patients. With concerted efforts over the last 10 to 20 years, we've now been able to increase the number of patients coming in with acute MI to slightly over 50% in most metropolitan areas. As patients are typically traveling in by EMS, the ability to provide important feedback can be used to improve overall patient care. In recognition of this, the registry is now expanded by developing a specific EMS dashboard that's able to provide more optimized feedback to individual EMS agencies. Likewise, the information that we collect for patients that are transferred from other facilities becomes important to improve this overall collaboration, particularly given that many of our smaller community hospitals transfer out the vast majority of their acute MI patients, whether STEMI or non-STEMI, for further subsequent care. The ability to provide important feedback for them, particularly in a patient with STEMIs, to optimize the overall transfer process, reducing that door-in, door-out time, which is one of the most critical measures of overall outcomes in patients who are transferred for acute MI. The registry has typically been focused originally only on patients with acute MI, but again, as I mentioned before, in 2019, with the merger of the two organizations, was expanded to include both unstable angina patients as well as low-risk patients in Version 3. We're now able to collect data, again, across the entire spectrum of patients with chest pain. This expansion was done specifically to support hospitals interested in achieving chest pain center accreditation. As noted here, you can submit data for patients that are either classified into low-risk chest pain, non-STEMI, STEMI, and unstable angina. And importantly, another additional aspect that's been done for the registry is to include patients who present with in-hospital STEMI. This is, although a fairly small group of patients, they have an exceedingly high mortality and overall very long time to overall treatment. Focusing and identifying this patient cohort is also important for improving outcomes. There are a variety of different options that we have available for submitting data, whether you include only MI patients. Some states are including just STEMI patients alone, providing feedback across the entire state for their overall STEMI management strategies and outcomes. Or hospitals can also include all chest pain patients, which again can be used to augment their chest pain accreditation process. As an institution that's currently undergoing this process with chest pain reaccreditation, having that data available substantially reduces the amount of data that's required for that submission. There are specific metrics that you can provide out for chest pain accreditation. They're actually available on the dashboard, providing another useful feedback tool for identifying areas and gaps in overall treatment. Another important aspect of participating in the Chest Pain MI Registry is that it acknowledges hospitals by providing awards to those hospitals and institutions that demonstrate sustained achievement in meeting specific predetermined thresholds for a variety of measures across acute MI. This includes either individual measures such as the door-to-balloon, first medical contact to balloon time, administration of specific pharmacologic measures in the first 24 hours or time of discharge, but also requires hospitals to provide what we call defect-free care to individual patients, patients who receive every one of the single measures that is required for overall optimal care post-MI. In recognition of providing this excellent care, these hospitals are subsequently recognized each year by the U.S. News and World Report Best Hospitals Edition. So I'll turn it over to Keri now to talk about the purpose of chest pain accreditation. »» Thank you. All right. Good afternoon. All right. So when we're looking at chest pain accreditation, we're going to talk a little bit about the purpose of it and then the chest pain MI design to support and promote that chest pain accreditation. All right. Okay. Here we go. So what is Chest Pain Center Accreditation? It is this quality improvement program designed for hospital cardiovascular teams who are focused on the care of acute coronary syndrome patients as well as those that present with unknown or possible cardiac events. So a program that's going to actually help your team establish that consistent, high-quality processes and looking at the patient across the continuum of care. And then of course designed to provide a roadmap for progress and sustainable performance. So as you move forward, you know, where do you go from here? So how is the accreditation product laid out? Well, it is split out within the governance section, the quality, the community outreach. It looks at your pre-hospital care, your early stabilization. So how are those patients coming into your doors? The acute care, so once they're diagnosed with an AMI, your transitions of care. How are you setting them up to be successful once they go home? And then the clinical quality, of course, is a huge piece. And of course within chest pain accreditation, we have different designations. All right. Here we go. So Chest Pain Center Accreditation. So this is for those hospitals that do not have a primary PCI strategy 24-7. And then we do have a Chest Pain Center Accreditation with primary PCI for those that do have it 24-7. And then also with those that do have the primary PCI, they can have an add-on designation of a resuscitation. And that is for those robust programs with an out-of-hospital cardiac arrest strategy. Now when we look at comprehensive program assessment, so typically this is the documentation that you're going to upload and looking at do your current processes, order sets, policies, flow charts, does all of that speak the same language? Is that very familiar within your institution between your different departments, between your different providers? And so just making sure that it's the same process. And then science-based pathways. So making sure that we have included the science at the bedside. So advanced practice pathways that will optimize your outcomes and ensure that there's the right treatment for the right patient at the right time. And we also want to create that financial stability and growth. So improving that financial performance. Create efficiencies to see more patients with the same amount of resources that you have. So you can increase your volume and your revenue without the need for additional space and infrastructure. Because a lot of times you are kind of landlocked in to where your hospital is built and the departments and the layout of it. And so we want to try to help you navigate where are some of those delays or inefficiencies so that you can certainly take care of those patients much faster, quicker, with better outcomes, and with better throughput. So you increase your volume and thus your revenue. And so with this it provides a strategic roadmap for achieving your quality of care. Your strategic organizational goals. And your market share of course. So we want your program to be in line with your overall organizational strategy. And so how is what you're going to be doing within your chest pain program supporting your hospital as well. Then I will turn it back over. So one of the questions that was going to come up is why did we expand the registry to support chest pain accreditation. And the biggest reason and the largest reason is because it helps to improve patient care. And again this is a primary purpose of the registry. It's really just the tool to help you improve overall care of the patient with potential ACS. The ability to actually successfully complete a chest pain accreditation is much more difficult than at least I thought when we first went through it. As I mentioned before we've been involved in the chest pain accreditation for a number of years. And we're actually now undergoing our fifth separate chest pain accreditation. Each hospital that does undergo accreditation has to do a variety of things to be successful. The first is to do what's called a gap analysis. This helps to identify areas that you may have in your overall chest pain process. All types of chest pain low risk chest pain all the way up to the STEMI patients in which there are areas which can be improved to meet specific metrics for chest pain accreditation. Most hospitals think that they have a great process in place and particularly if one just looks at overall STEMI care. I think most hospitals say they've got that down pat. They beat that a number of years ago. This is a study that we performed looking at hospitals that perform that specific gap analysis comparatively to look how they did prior to overall chest pain accreditation. And you can see although the majority of hospitals met the specific areas that were outlined, a significant minority did not. And this includes things even as the ability of the ED physician to have the authority to activate the STEMI system. The ability of the ED physician to initiate a specific reperfusion strategy, either primary PCI or lytics for the community hospital or collaboration with EMS on 12 lead EMS ECG transmission. These are substantial gaps in overall care that can affect specific outcomes. Another area that can be improved with chest pain accreditation is the approved patient overall experience. This may seem a minor point and is not always reflected in specific metrics on outcomes, but clearly is a point of contention and irritation for many patients. I'm sure most of you can relate to the fact that how often you're walking in your hospital and you see a patient looking extremely lost trying to figure out which way to go. One can only imagine what would happen in a patient who's coming in by EMS for treatment of their acute chest pain, unable to find the location of the specific emergency department. This is still important because a significant number of patients still provide self-transport for themselves coming into the ER. This was another specific area that we identified that actually took a fair amount of work to fix because it requires non-medical people to be able to buy in to help increase your overall signage and buy in from your administration to do so. Another area that's important for chest pain accreditation can help is by improving overall clinician experience. By identifying specific champions in different areas, it provides a mechanism for communication for the multidisciplinary collaboration among the different areas. Although we usually think of chest pain evaluation process as a collaboration only involving the emergency department and cardiology, it's critical that EMS representatives be included given how many patients do come in by ambulance. We need to also begin to include hospitalists in our program as well given how frequently these patients are now evaluated in an inpatient setting with just cardiology consultation. And even other areas that you might not have thought about such as including the laboratorian is also important for improving overall troponin turnaround times. This is going to be increasingly important as hospitals transition to high sensitivity troponins, defining specific cutoff values for their troponin assays. So inclusion of all these different collaborative groups is going to be critical for the success of any institution participating in chest pain accreditation. Another important rationale for having these in communication channels is something that we've seen in our hospital is that with increasing turnover with either people leaving the institution or retiring, we've lost what I would call institutional memory, people that understand the processes and are quite familiar with it. When you have a significant turnover in your staff, that institutional memory is lost. And I noticed this particularly when we went through our third chest pain accreditation that things that we had thought were in place before had kind of fallen by the wayside. So this can offer an important improvement. Another area that we found with improvement for overall chest pain care in one of our accreditations, as I mentioned earlier, was improving the process for patients who have in-house STEMIs. This is often a difficult group to identify. Patients often may spend a number of hours after the ECG is performed before it's recognized and patients are targeted for early reperfusion. We actually, because of their chest pain accreditation, set up a chest pain team that evaluates patients who have acute chest pain. This is actually primarily driven by a backbone of RRT, a rapid response team, who then is trained to perform an ECG, recognize acute ischemic changes, and then will activate our in-house cardiology team to further assess the patient to see if they're appropriate for going emergently to the cath lab or what other therapy may be involved. Another specific area which I never thought about before until I saw this study about 20 years ago is, what do we mean by routine care or standardized care? This is an interesting study called a Romeo study. It only had 100 patients, but what it did was performed a backbone of why we need chest pain accreditation in standardized processes. Fifty patients were randomized to standardized care on the right, where you can see they were randomized to undergo standard stress testing for further care. The vast majority underwent treadmill testing alone, with a small minority undergoing imaging because they were not candidates for exercise or had other issues for why they couldn't exercise. In contrast, if we look at the routine care, it was almost what I would call random care at that time, with a bell-shaped curve of overall treatment strategies, from stress testing on one aspect to DC home with no additional testing at the other, with the smattering of other things in between. So routine care has a substantial amount of variation. Reducing this variation can substantially reduce overall cost by identifying who is eligible to go home without additional testing, who needs to be admitted for further observation and testing, and ultimately who needs to be admitted. If they do need a stress test, when does a stress test need to be performed and how urgently? Or could it be done as an outpatient, further reducing overall length of stay? By standardizing this process, you can more rapidly free up ED beds, improving overall throughput. I think putting these processes in place will be increasingly important as we change over to high-sensitivity troponins, having specific algorithms for how you're going to evaluate these patients and identify the low, intermediate, and the high risk is going to be critically important. So I'll turn it back over to Carrie to finish out. All right. So what if you are a chest pain MI participant currently but not yet seeking chest pain center accreditation? What's the benefit to you? Well, you probably don't want to hear it from me because I may have a biased opinion as their product manager. But what about from our customers, from our hospitals that we have worked with for years. So here's what they're saying. The ACC represents the highest goals of clinical excellence, continuing education, constant improvement, and heart care. The assigned accreditation review specialist was an integral part of our accreditation survey process. For process improvement, guidelines for success. So it was many thanks to her and her encouragement through the survey preparation and the chart review prior to the survey was very valuable for their team. And it really identified those opportunities and improvements in the documentation and education for the patients. So whenever hospitals go through accreditation, they are assigned their very own accreditation review specialist. So somebody that's gonna walk that journey of accreditation with you. Because we never address it from a punitive standpoint. If you don't have a process, it's, hey, let me help you build that process. Or here's what other hospitals have submitted. So does this look like something that is occurring in your hospital, but maybe is not down on paper or formalized in that manner? So we have a lot of resources. So we certainly walk you through that. Because our goal is the patient. And so we help you in that care of taking care of that patient. So what if you are that Chest Pain in My Registry Award recipient? What is the benefit to you if you pursue accreditation? Well, seeing that we are aligned now, we give you credit for that award status. You obviously have some solid processes in your hospital. And your data and your metrics are showing that, improving that. So we give you credit for a big portion of the accreditation tool. So you get to leverage your award. You can go from 140 mandatory essential components that will require documentation to support, down to 69. And so you can easily achieve your accreditation within six months. So the areas that we focus on are not the AMI, which are primarily covered within your award in the registry criteria to reach that award level. But then we shift and focus on your community outreach. We shift and focus on your observation patients, that low risk chest pain patient. And what are you doing with that? Now, if you are accreditation participant and you're not yet in the registry, well, why should you join the registry? Again, let's hear from one of our customers. So what they found were that they were able to take through the registry combined with the accreditation, that they were able to take very complex guidelines and data and a very much fragmented team and a bunch of pieces of paper and transition those to characteristics of their everyday existence. So they've gone from a very complex, confusing maze to very clear pathways for success. And so they now have a multidisciplinary team that utilizes evidence-based processes to develop care and provide care, as well as better quality metrics reflecting the results of that care. And I think that speaks volumes. So within the registry and accreditation, so you get lots of data evaluation tools. So within the registry, you have your eReport dashboards, you have your executive summary metrics, there's detail line dashboards, professional level dashboards. So you can look at individual provider level data. You can also look at interest system care delivery dashboards. So looking at transfer facility information and insights that you'll be sharing with them, EMS insights. Comparator, so you can now compare what your performance at your hospital is with those against other size similar hospitals. And then there's patient level data reports. So you can drill down into the individual metrics to understand why that metric is, why your hospital's performing at that level. So like we talked about in an earlier session this morning of, you know, is it the data was not entered into the registry correctly and you can update that and fix that? Or is there truly like a broken process or not a well-defined process that you need to look at and review? So if you want to learn some more, if you're not currently within the registry or you're not currently within the accreditation, so reach out to our business development teams. And so here's the information for the registry or you can contact them through ncdr at acc.org or for accreditation, you contact the accreditation info at acc.org. And now we'll switch over and take some questions. So Kate, do we have some questions in the queue? Yes, we do. So the question that has been moved up to the top, so most people want to hear this answer, is the ACC's free ACD registry that can be utilized for chest pain center accreditation only requires a sample of unstable angina, low risk and in STEMI patients. If an accredited CPC hospital were to switch from that registry to the chest pain MI registry, would the requirement change from a sample to all patients with these diagnoses? Great question. So this is something that when we were looking at harmonizing between the registry and the accreditation, so historically they only looked at the AMI patients, so that STEMI and non-STEMI population. And then when they added into the low risk and unstable angina, they did create a sampling pathway. So yes, you can do sampling of the low risk and unstable angina populations. So you can continue that within the registry, absolutely. And then you'll get your benchmarks against other hospitals, which is not available within the ACD at the time. Great, yeah. This is Michael, just to expand on that, hospitals do have the option of submitting all their patients if they like to. There actually are a number of hospitals that do that to be able to keep track of all their chest pain patients. And then for the low risk chest pain patients, at least currently in upcoming versions of our registry case report form, we'll be reducing number of elements required for the low risk chest pain patient to make it easier for hospitals to enter in those patients, given how low risk they are and how frequently many of these patients are just being discharged home. Yeah, and just one clarification on that question. The chest pain MI registry does not allow a sampling of NSTEMI patients. There's only sampling for low risk chest pain and unstable angina. Okay, so next question is, what is the benefit of ACC's chest pain center accreditation versus TJC accreditation? Okay, great question. So within ACC accreditation, you do get your assigned accreditation review specialist. We do have a massive library of shared practices that you can see what did other hospitals submit for things. So when you do realize that there's a gap in your care or processes, that you do have framework to build out and formalize those processes. We also help you connect the dots between your processes and the dollars spent in your hospital, because we all know that every step within the hospital requires money. So for a patient to be there for X amount of hours, it requires a lot of resources, right? So you have not just your clinical team, you also have dietary and housekeeping and environmental services and a host of other team members in the hospital. And those all cost money, right? So when we look at your processes and we're trying to make it more efficient for you, we're trying to assist your hospital in reducing the cost of the care for that patient, for each of those patients. So that way you can see more patients with the same amount of resources like I was speaking to earlier, especially with the low risk patients. So if they go into observation, you get this one flat rate reimbursement typically. And so if you get this one reimbursement rate, so regardless if they spent 16 hours at your hospital or 32 hours at your hospital, which is going to help your bottom line, right? It's gonna be the 16 hour one because if you get that patient out in 16 hours, you can put another patient in that bed, right? But still without compromising the safety and the quality of care at your hospital. So making sure that every patient is cared for appropriately. Okay, thank you very much. Let's see the next question. Have you found difficulties with compliance with heart score documentation since implementing high sensitivity troponin due to providers utilizing high sensitivity as the risk stratification? I can answer that from what we're seeing. Dr. Contos, do you find or within your hospital doing high sensitivity troponins, do you guys find risk stratification documentation lacking? So we find risk stratification documentation difficult across the board. We have not switched to high sensitivity troponins yet. I think what you will see though is for the, what we're working on with the updated version for CP, the new case report form will hopefully come out next year, is in response to the new chest pain guidelines, it's much less important for risk stratification, documenting those scores. What we're gonna ask is that hospitals provide their specific strategy that they're using for troponin sampling if they're using high sensitivity troponins. I think with the more recent literature shows that it's somewhat varied, but in many cases that the high sensitivity troponin, particularly if it's undetectable or at the very low range, you don't really need to have a chest pain score anymore. So I think what we're gonna see is that that's gonna be required less frequently as hospitals change over. It still should be used for patients that are using, for hospitals that are using unconventional troponin assays or the ones that have been around for the last few years. Okay. What we've seen historically is with customers, hospitals that are using the high sensitivity troponin, they have built in the heart score into the documentation, into the clinical like PDOCS, so that it's all, it's like an automatic stop. So if a patient has chest pain, that it's an automatic stop that it's already built in or we see it built into order sets that they have to plug in the number. So there's different strategies, whatever works best in your institution with what EMR you have and your capabilities. All right. So now we're getting down to the nitty gritty with these questions. So how much does it cost to apply for chest pain accreditation? And do you have any comparison as to that cost versus joint commission accreditation? The cost is going to be per our business development specialists. And so it will also depend upon, is your hospital a PCI center? Are they not a PCI center? Are they gonna add on resuscitation? Are you gonna go through the accreditation as a standalone facility? Are you gonna go through as a system and could possibly leverage a discount with going through as a cohort? And so there's differences there in addition to say the joint commission, whereas there is a two year certification, ours is a three year accreditation. So it's just different, it's apples and oranges. And along with that, how often is recertification? Once you are accredited? Three years. Every three years. And how long does it take to become accredited? Well, again, that's gonna depend on, do you have robust processes already built? Do you already have the latest science already embedded in your order sets and your pathways? And do you already have your committee together? Are you already having a solid relationship and ongoing conversations with your EMS partners? So there's lots of different variables. I would say for the more robust, you can reach accreditation in as little as six months, but we give you a year, 12 months. And also, are you a Chest Pain MI award recipient where your requirements are going to drop from 140 to 69? So that's gonna speed up your process as well. I think the other factor would be if you've done chest pain accreditation before, because first, you're familiar with the process and then second, the second or third, fourth time you're doing it, it becomes a little bit easier because you do have those processes already established in place. You have the communication channels set together. You have your frequent chest pain meetings where you're discussing the different outcomes all put together and that collaboration has already been built. I think without that, it can take longer to do, but I think I would look at it as not just the cost of doing the chest pain accreditation, but the fact that you end up doing it means that you have to put these processes in place and establish those lines of communication for improving overall patient care. And to me, as someone, when we first did the first go-round, I really didn't see that this was gonna offer that much value. I thought we said we have a great institution. We published a number of papers on our chest pain evaluation process for our low-risk chest pain patients. Our STEMI care was excellent with door-to-balloon times at that time, well under 60 minutes in many times, but I was surprised at how many gaps that we actually did find. And I think that, to me, is one of the most valuable parts of the chest pain accreditation. And as I mentioned before, I think many of these institutions are gonna lose some of that institutional memory and having that ongoing collaboration can keep those processes in place and it becomes particularly important as things change around. The biggest thing now is what a few years ago was we no longer really needed to do that many stress tests and low-risk chest pain patients now with high-sensitivity troponins, we're gonna be able to discharge these people in two or three hours. Being able to have that collaboration already in place and being able to plan ahead for how you're gonna manage that becomes a critical strategy for success in your institution. Okay, thank you. So if a hospital, excuse me, if a hospital only tracks STEMI and NSTEMI patients in the chest pain MI registry, would they have to start tracking all ACS patients for chest pain center accreditation? They would have to add in the low-risk and unstable angina patient populations, yes. But they can do a sampling of that. Let's see. I see a question. The current chest pain accreditation is version 7.0. Is that correct? What was added and or changed compared to version 6.0? Okay, so great question. So version 7, we have the chest pain guidelines that were just released last year. Those are embedded within the accreditation. So one of the benefits of being the ACC is we have writing committee of the guidelines that are already engaged with us on the accreditation side. So we are very forward-thinking. We are very much on the cusp of, hey, what's in works, what's coming out? What's about to be the next thing that we're gonna be looking at? Within 7.0, we also did observation, set out a separate observation tab to really help hospitals hone in on that observation patient and the throughput and the efficiency to really allow that patient to rule themselves in or rule themselves out in a much faster manner. And so really help guide hospitals because working with, golly, a thousand hospitals through accreditation, the most popular question that we got or a hot topic and most questions about were observation. How do you do that? How do you do that and not lose money? How do you do that and make the patient happy and be satisfied with their care and it not be such a waiting game? So we have put all the observation piece in there. We have moved everything into under quality. That was just quality instead of it being kind of splattered throughout the entire tool. And so we've been much more focused and you have a lot of resources, the latest science and guidelines embedded in there. Okay, thanks, Carrie. I think we have time for one more. So how often, oh, wait, I'm sorry. How do you obtain the chest pain awards that can be utilized for accreditation? So those awards are driven by performance measures and meeting specific ones. They vary depending on whether you're looking at STEMI patients or non-STEMI patients but there's a significant amount of overlap. Care processes and treatments are included in that. So for example, for the STEMI patient, first medical contact to reperfusion within 90 minutes is one of the care metrics. Discharge metrics that are common to all of those would be assessment of ejection fraction for both assessment for both STEMI and non-STEMI, use of ACE inhibitors or ARBs in patients with low EFs, addition of beta blockers at the time of discharge are all part of those same components. Probably the biggest one we found at our institution that's the hardest one is the cardiac rehab one. Just trying to get patients set up for rehab scheduled and particularly if they're going to an outside institution can be somewhat difficult and that's one of the hardest ones to do. So overall you'll see many of these hospitals will have very high composite scores. That's where you take every one of those measures, say anywhere from eight to 12 with the patients eligible for it and then you divide that, that becomes your denominator in your numerators how many of those care processes you've met. So most hospitals are running in the 90% range. The hardest one to meet is what we call defect free care. That means if a patient's eligible for 10 different types of treatments or measurements, they have to meet every single one of those to count. So that's where it becomes difficult because although you may have given an ACE inhibitor for a low EF assessed ejection fraction beta blocker at the time of discharge, but you failed to schedule for cardiac rehab, that patient becomes a miss where the composite measures you would meet three or four or five out of the total number. So being able to meet those specific, then there are specific numbers depending on whether you're going to be gold or silver. I think it's between 75% adherent, 75% for gold, 65% for silver gets you an award for that year. And for hospitals that have continued demonstration of ongoing performance, they become platinum award winners. So those standards change typically yearly depending on what the specific metrics are and what the specific performance measures are that may have changed over time. And those awards are given out each year, typically in the springs based on the prior calendar year of data that you've submitted through Chest Pain MI. Typically only pertains to the MI patients, STEMI and non-STEMI patients. If they're not in specific performance measures, I think for the lower risk chest pain patients. Thank you, Mike. So just to add to that information, if you want to find out more about the Performance Achievement Award programs, if you go on to our ncdr.com on the Chest Pain MI Registry website, go to resources, and under the quality tools and reference documents, you'll find the second from last 2023 Performance Achievement Award program. And it's a PDF that tells you everything that you need to know. And it also gets you in the US News and World Report. Yes. All right, well, thank you so much for your great questions and for attending. Just one quick thing to add, just keep an eye out for an evaluation. Just let us know what you liked, what you didn't like. That'll be in your mobile app tomorrow. And be sure to claim your credits. You can get your CE credits. Okay, thanks so much. Thank you.

chest pain center accreditation

chest pain MI registry

accreditation benefits

patient outcomes improvement

collaboration among departments

chest pain patient data tracking

data evaluation tools

cost and time of accreditation