Discharge version 3.1 training. Sequence 15521, LVF Assessed, seeks to capture the last left ventricular ejection fraction that was assessed between arrival at the first facility and discharge. LVF Assessed includes the following selections. Yes, indicates the test was completed. No, no reason indicates the test was not completed. There is neither a medical reason nor a patient reason documented explaining why it was not done. No medical reason indicates the test was not completed. There is clear documentation of a reason related to the patient's medical issue or concern explaining why it was not done. And no patient reason indicates the test was not completed. There is clear documentation of a reason related to the patient's and or family's preference explaining why it was not done. Sequence 15491, LVF After Discharge Not Indicated, is open for selection when Sequence 15521, LVF Assessed, is coded as no, no reason, no medical reason, or no patient reason. The Chest Pain MI Registry does not support implied coding, therefore clear documentation by an independent licensed provider, the MD, PA, or nurse practitioner is necessary to make the selection. Sequence 15490, Cerebral Performance Category or CPC Score, seeks to capture the patient's neurological status using the Cerebral Performance Category score upon discharge when Sequence 4630, Cardiac Arrest Out of Healthcare Facility is coded yes, or Sequence 4635, Cardiac Arrest at Transferring Healthcare Facility is coded yes, or Sequence 12344, Event Occurred is coded yes for cardiac arrest. Cerebral Performance Category score is widely used in the assessment of patients with cardiac arrest. The CPC score usually ranges from one, indicating good cerebral performance, to five, indicating brain death. In prior investigations, a CPC score of one to two is generally categorized as a good neurological outcome, and a score of three to five as a poor outcome. Current studies have proven that the CPC score at hospital discharge can forecast long-term survival outcomes of out-of-hospital cardiac arrest and survivors of in-hospital cardiac arrest. Some cardiac arrest survivors have neurological deficits as a result of the hypoxic ischemic insult from the cardiac arrest and subsequent reperfusion injury. It is a challenge in post-cardiac arrest care to accurately predict outcomes, especially in the early phase when patients are treated in the intensive care unit. Research has found that a low CPC score on hospital discharge predicts a better long-term prognosis. Sequence 15490, CPC score, is captured at discharge when a patient experienced a cardiac arrest out of healthcare facility, or a cardiac arrest at transferring healthcare facility, or a cardiac arrest occurred during this admission. One is good cerebral performance, two is moderate cerebral disability, three, severe cerebral disability, four is comatose or vegetative state, five is brain death, and we'll discuss these specific selections on the next slide. The CPC definitions can be found in the data dictionary for your convenience. The selections are defined as follows. A score of one indicates good cerebral performance. The patient is conscious, alert, able to work, and might have a mild neurologic or psychological deficit. A score of two indicates moderate cerebral disability. The patient is conscious and has sufficient cerebral function for independent activities of daily life and can work in a sheltered environment. A score of three indicates severe cerebral disability. The patient is conscious, however, is dependent on others for daily support because of impaired brain function. This can range from an ambulatory state to severe dementia or paralysis. A score of four indicates a coma or vegetative state. The patient has any degree of coma without the presence of all brain death criteria and is unaware, even if he or she appears awake without interaction with the environment and may have spontaneous eye opening and sleep-awake cycles as in a vegetative state. The patient has cerebral unresponsiveness. A score of five indicates brain death. The patient has apnea, areflexia, and a silent EEG. To decrease the data burden, this portion of the discharge section is only required for the STEMI or NSTEMI patients who are discharged alive. Sequence 15492, Patient-Centered Reason for Delay to Transfer Out, seeks to capture if there was a patient-centered reason that delayed the patient's departure in the first 30 minutes after arrival at this facility or within the first 30 minutes after a STEMI diagnosis. A patient-centered reason for delay is an issue and or condition understood and documented to originate with the patient. It is not associated with the healthcare system, such as in an issue with staffing or processes. Some examples include a patient's delay in providing consent for transfer, a patient has a cardiac arrest and or a need for intubation before transfer, an emergent CT scan is required to rule out a CVA, or the patient is too unstable for transport, such as in the instance of acute heart failure or cardiogenic shock. Sequence 15493, Transfer for Cardiac Evaluation, seeks to capture if the patient was transferred to another facility for additional cardiac evaluation at the time of the transfer. Additional testing may be helpful to identify the cause that may alter an ensuing therapeutic strategy. When the initial facility in which the patient presented does not have the capacity for these additional tests, the patient is transferred for additional cardiac assessment and testing.

discharge procedures

left ventricular ejection fraction

neurological status

CPC score

cardiac evaluation