Welcome to the Training Module 3 for ACC's Chest Pain Accreditation. This training module is designed for healthcare professionals who will take their facility through the chest pain accreditation process and review the data submission options, requirements for data submission, then finish with specific ACD and calculated measure training. If you are not using the ACD and using only the NCDR Chest Pain MI Registry, you may still benefit from slides 14 through 21, but this module is not required for NCDR Chest Pain MI Registry participants using only the registry for data submission requirements for the chest pain accreditation tool. The workshop modules are explicitly designed for any facility that is in the process of completing chest pain center accreditation. Any information regarding accreditation is highlighted in the workshop modules. The modules are subject to change at any time as we are continually updating the accreditation products to enhance the functionality of the tool for our customers. However, the facility's registered users of the online accreditation tool will have access to the most current workshop modules as needed. Anything shared in this training workshop module is confidential and privileged and only meant for the facility currently pursuing chest pain center accreditation. In addition, the modules and any information embedded cannot be published, distributed, or shared with any third party. The objectives for this module is to first demonstrate how to utilize and operate the Accreditation Conformance Database, also known as the ACD. We will describe the ACD randomization program option for those that will continue to use the ACD as their data collection option through the application phase of the accreditation process. We will then review the calculated measures and their functionalities when using the ACD and lastly highlight all resources that are available to support these online chest pain center accreditation tool functions. In this next section, we will focus on the ACD features. Tab 1 of the ACD includes the patient general demographics. You will enter all appropriate abstraction fields, then click save. The lookup code will generate after you click save and align with the patient's medical record number that only the facility will see moving forward. Your facility will use the lookup code for all external communication with your assigned ARS or customer care. Tab 2 will focus on the initial recognition and system entry for that patient encounter. The date and time of arrival will flow over from the add a record entry. For arrival location and portal of entry, you will open the caret and select the appropriate option for that specific patient. For the estimated symptom onset date and time, you must enter both a date and time. Please refer to the data dictionary under the additional resources tab to support you while you abstract cases until you get comfortable with the definitions and requirements of each field. You can then select yes to the chief complaints on arrival. You do not need to select no on the chief complaints that do not apply. They can be left blank. As you move through tab 2, you will enter an initial EKG completion and read date and time only if the initial EKG was performed at your facility. You must also select if that EKG was a STEMI by answering yes or no. These fields can be left blank, for example, if you have a diagnostic EKG from EMS and a facility EKG is not completed on arrival. The initial troponin field should be completed if you completed an initial troponin at your facility. Date and times are required along with answering whether or not the troponin assay was a point of care testing assay, placing a yes or no. New to the ACD abstraction tool is the field that asks you to answer yes or no to whether or not your facility is utilizing a zero hour high sensitivity troponin only protocol. This field is required for facilities utilizing only the high sensitivity troponin assays. If your facility is doing a zero hour low risk protocol that aligns with the 2022 consensus guideline statement, then you should mark yes. This will enable us to remove these low risk patients from your risk assessment denominator in your calculated measure reports for a more accurate compliance rate. For the risk stratification score field, this should be completed excluding zero hour protocol patients, STEMI, and resuscitation patient types. For all ED patients, you should enter all fields with a date and time. Disposition orders written defines the date and time when the ED provider made and documented disposition orders into the EMR. The date and time of disposition from the ED should be entered for when the patient was deemed ready to leave the ED. Under the ED disposition, open the caret to select the appropriate disposition location, then enter the date and time of when the patient actually left the ED. You should abstract yes or no on whether or not the patient was referred for an outpatient ischemic evaluation, and if yes is selected, then you must enter a date and time for the scheduled evaluation. If transferring the patient for primary PCI, you would answer yes or no. Continuing with tab 2 and EMS patient presenters as seen in the red highlighted box, the primary EMS arrival section would need to be completed with the EMS information. Dates and times will now be required for this section. If you cannot obtain the EMS field records, estimates may be accepted as a last resort to complete the record. It will be extremely important to capture as much accurate information from the EMS records as possible to assist your facility in determining areas for process improvement. There is also a new ACD data abstraction field for the EMS scene date and time of departure, which will generate an electronic calculated measure to assist with pre-hospital discussions. For patients transferring from another acute care facility to your facility, this section transfer from acute care facility would need to be completed. If the patient was not a transfer, you would not have to complete this section. Please make sure that all dates and times are entered and that all information is accurate from the transfer hospital records for process improvement purposes. For STEMI patients only, the lytic reperfusion strategy section would need to be completed. All dates and times are required. This section would be left blank for other patient types other than STEMI. If the patient had an escalation of care event during their admission event, you would complete the escalation of care section. For STEMI primary PCI patients only, you would abstract your cardiac cath lab information accurately into this section. All dates and times are required. Please refer to the data dictionary for assistance if needed to complete the abstraction fields. And finally for tab 2, if your facility is applying for PCI with resuscitation designation and does not participate in the CARES registry or the NCDR chest pain MI registry, all out of hospital cardiac arrest patients should be abstracted into this section. There are some additional new abstraction fields that will generate electronic calculated measures. All dates and times are required where a yes answer is selected. Tab 3 would need to be opened and completed for any patient that had an observation disposition for this encounter. Dates and times are required. If the patient changes from observation status to inpatient status, for example, under the observation disposition item, you would select inpatient admission from the drop down menu and place the date and time that disposition was ordered. Tab 4 would be opened and completed for any inpatient admission for this patient encounter. Medication prescribed at discharge fields are now mandatory and will calculate electronic calculated measures for acute myocardial infarction patient medication compliance. Please complete the cardiac rehab referral and follow-up appointment sections with a yes or no answer. Tab 5 looks at diagnostics and procedures during this patient encounter. If you entered an initial EKG or troponin on tab 2, those will port over into the number one fields on this tab. You could then enter your serial troponins and additional EKGs here. All dates and times are required. Looking at the ejection fraction section, please answer yes or no if an ejection fraction was assessed during this patient encounter. If yes, please populate the EF percentage. Please refer to the data dictionary for guidance on how to populate this field if a numeric value does not appear in the EMR. If you answer no, please select yes or no for documentation for not performing an EF assessment this patient encounter. If the patient had a non-invasive ischemia evaluation, please select yes next to the appropriate test, date and time it was performed, then answer whether or not the test was positive. You do not have to put a no answer in for other testing selections. If the patient did not have any non-invasive ischemia testing, you can leave this section blank. Placing no is not required. Cath Lab diagnostics or procedures performed should be completed for any patient type except STEMI patients. Please refer to the data dictionary for assistance. If the patient did not have any of these procedures performed during this encounter, you may leave this section blank. No answers are not required. Once all data fields have been entered and saved into the patient episode of care, a facility has the option to activate the record complete feature. To activate this function, click on the three line icon, select complete and click save. The patient episode of care will now be saved as a completed record and can be noted on the patient summary page. By utilizing this feature, it provides a visual cue for tracking the completion of each individual patient record. For optimal accountability, each individual record should be checked yes once data entry is completed. The patient episode of care information is now entered into the ACD. Information entered is saved upon entry. However, when working in the patient record, it is best practice to use the save icon frequently. Click the save icon and allow a few seconds for the information to save. A pop-up window will then appear to confirm that the record is successfully saved. If you completed the record from the previous slide instructions, under the record check column you will see a Y there indicating that the patient record is complete and no further abstraction is required.

Chest Pain Center

Accreditation

Healthcare

Baseline Gap Analysis

Accreditation Review Specialist

Data Submission

Patient Records

Confidentiality