Patient assessment on arrival was developed for ease in data entry as it captures the initial evaluation of the patient upon arrival to your facility. Sequence 12218, Location of First Evaluation, seeks to capture the location where the patient was first evaluated between arrival at this facility and discharge. The selection of inpatient indicates the patient was first evaluated in an inpatient unit, such as in the setting of an in-hospital STEMI patient or a direct admission. Sequence 15452 seeks to capture the CSHA clinical frailty scale of the patient as they presented to the hospital. This is not an assessment of their status prior to arrival. Documentation anywhere within the current medical record is acceptable. For facilities participating in cath PCI, the CSHA clinical frailty score documented prior to the first procedure is sufficient to code sequence 15452 in the chest pain MI registry. The selections and definitions are outlined on the next two slides. Very fit. These people are robust, active, energetic, and motivated. They commonly exercise regularly and are among the fittest for their age. Well, these people have no active disease symptoms, but are less fit than category one. Often they exercise or are very active occasionally or seasonally. Managing well. These are people whose medical problems are well controlled, but are not regularly active beyond routine walking. Vulnerable. While not dependent on others for daily health, their symptoms often limit activities. A common complaint is being slowed up and or being tired during the day. Mildly frail. These individuals often have more evidence slowing and need help in high order instrumental activities of daily living, such as finances, transportation, heavy housework, and medications. Severely mild frailty progressively impair shopping and walking outside alone, meal preparation and housework. Moderately frail individuals need help with all outside activities and with housekeeping. Inside, they often have problems with stairs and need help with bathing and might need minimal assistance with dressing. Severely frail individuals are completely dependent for personal care. Even so, they seem stable. Very severely frail individuals are completely dependent and approaching the end of life. Typically, they could not recover even from a minor illness. Terminally ill individuals are approaching the end of life. This category applies to people with a life expectancy less than six months who are not otherwise evidently frail. Sequence 15440, chest pain symptoms, seeks to capture when the patient noticed symptoms lasting greater than or equal to 10 minutes that prompted them to seek medical care 24 hours prior to first medical contact and discharge. These symptoms are coded as prior to arrival, after arrival, no symptoms, or unknown. Symptoms may be expressed not only as chest pain, but also as chest burning, fullness, pressure, sharp, squeezing, stabbing, tearing, and or tightness. Symptoms may also include jaw pain, arm pain, shortness of breath, nausea, vomiting, fatigue, malaise, or other equivalent discomfort suggestive of myocardial infarction and or myocardial ischemia. Sequence 5441, time unknown, seeks to capture when the time the patient experienced chest pain or its equivalent prior to arrival is unknown or not documented in the medical record. Sequence 15443, date, seeks to capture the date the patient experienced symptoms of chest pain or its equivalent lasting greater than or equal to 10 minutes after arrival to this facility and discharge for those patients with STEMI setting coded as in hospital. Sequence 15505, time, seeks to capture the time the patient experienced symptoms of chest pain or its equivalent lasting greater than or equal to 10 minutes after arrival to this facility and discharge. Please use the data dictionary full specifications to approximate the time for coding purposes when needed. Sequence 15442, time unknown, seeks to capture when the time the patient experienced symptoms after arrival is unknown or not documented in the medical record.

patient assessment

initial evaluation

frailty scale

chest pain symptoms

symptom onset