Okay. Good afternoon everyone. Welcome to the first in-person session for the Cath PCI Registry. I'm glad to see so many of you here. I'm going to take this quick opportunity to introduce myself as your new product manager. My name is Kate Malish and I've probably talked to a lot of you through email because I was previously a clinical quality advisor for the Cath PCI Registry, and then I left the college, took a year off to go back into practicing pharmacy, and then after I'd given my umpteenth vaccine, I thought, well, I got that out of my system and I'm ready to come back to ACC. So I'm really happy to be here and I look forward to working with all of you. So we have a great session here today called You Can Speak for the Data. We'll show you. We'll show you how. And I don't, if if any of you were present in yesterday's conversations with the experts in the second session, this is a great piggyback off of that session because they did touch on the dashboard, but today Debbie and Ellen are really going to dig into that important functionality, which is the dashboard, and show you how to best utilize it to get the wealth of information that it has. We'll get into patient drill downs. They'll show you how to look at detail lines, and then when you, once you've mastered the dashboard, you can then bring that data back to your stakeholders and hopefully get some buy-in to do some process improvement and eventually improve patient care, which of course is the ultimate goal. So with that, I want to just quickly introduce our two speakers. So Ms. Debbie Hentz is a nurse and quality manager at Ascension St. Thomas in Tennessee, and then Ms. Ellen Connealy is also a nurse and registry site manager for Northwell Health in New York State. So with that, I will hand it over to Debbie. Okay, I have nothing to disclose. My name is Debbie Hentz. I am a quality manager in RN. Hold on, he told me how to do this. Okay, let's see. All right, there we go. I'm a quality manager in RN at Ascension St. Thomas. I've been with Ascension for 34 years. I started out as a telemetry nurse, and then about 17 years ago, I moved into quality and started with the PCI registry. So my team is responsible for the clinical, cardiac clinical registries, the core measures for joint commission and CMS and peer review. So Ascension St. Thomas is a part of Ascension Health. Ascension Health has 143 hospitals across 19 states and the District of Columbia. Ascension St. Thomas is an 11 hospital health system that serves the Middle Tennessee area. The three hospitals you see pictured are our hospitals that have an interventional cardiology program. So the top one and the bottom one serve the metro Nashville area, and they're actually only like four miles apart. And then that middle one is serving our fastest growing area of Tennessee in Murfreesboro. Between the three of them, we do about 2,800 cath PCIs a year. The top hospital, St. Thomas West, performs the majority of those along with complex PCIs, including brachytherapy. So the big advantage of being part of a big system like Ascension is we have the ability to have national and local collaboration. So Ascension has physician-led, specialty-specific affinity groups. These groups have physician representatives from, in this case, 53 facilities for cath PCI across Ascension. The advantage there is not only can they come together and work on cost savings through, you know, the number of devices they would use and picking those, but also more importantly with their focus on quality. So we have the ability to benchmark ourselves to ACC and to Ascension as a whole. The physicians sort of monitor all those metrics and they decide and sort of standardize the metrics that they want to work on, sort of focusing on reducing the variation of care and improve, most importantly, improve the patient outcomes across Ascension. They do that and create standardization not only in the metrics, but as much as possible in the evidence-based standard care pass, order sets, clinical guidelines. They also, as they look at this data and compare themselves against each other, they have the ability to look at the facilities that are doing really well in GLEAM best practice and then look at the facilities that aren't doing so well and help them to improve. So now that I've told you a little bit about myself and our facilities, in reviewing the outline for this presentation, I wanted to reflect on, you know, what is data? What is data analysis? What is our goal of cath PCI participation and why? So the Oxford Dictionary did a really good job of defining data as facts and statistics collected together for reference or analysis. According to Corsair, data analysis is the practice of working with data to GLEAM useful information which then can be used to make informed decisions. So our goal in participating in the cath PCI is first and foremost to improve the quality care of our patients and optimize their outcomes. We do that through the data and the data analysis, sort of ensuring that we're adhering to clinical practice guidelines, performance standards, appropriate use. We use it for benchmarking ourselves against everybody else in ACC, against Ascension, and again improving our patient safety and quality and outcomes. So where do we start? So we start by evaluating data through the cath PCI registry. The executive summary, which I'm sure everybody is accustomed to, I did notice yesterday when they were asking about the detail lines there weren't a lot of hands risen. So when you go to look at your executive summary dashboard in the upper right corner there's a drop-down box where you can select the detail lines instead. These detail lines provide you almost every element that's abstracted. You can show how your facility looks compared to your volume group and then all of ACC and it's come it can come out in an Excel and you can tweak it to get more measures that maybe aren't necessarily in the executive summary for your physicians. The resources, we rely on those heavily and repeatedly looking at the dictionaries and the dictionary supplements, the companion guides, the reference documents about appropriate use, you know the risk model, all of those that help us understand and explain the measures and why we're performing the way we are. So the first thing we do is we look for trends and I've always understood that it takes five points to really constitute a trend and so I have an example here of some of ours. So the top one you can see the benchmark is that dotted line. All of our data points are below it. In this measure you want all your data points below so we have a very positive trend. So this is a metric we'll keep looking at but we're not going to focus in on it because we're performing well. If you go to the second one you can see we were at a hundred percent. The dot at the benchmarks at the bottom but you'll notice like the first three data points we're doing well. The next two come down just a little bit and then the last three were really coming down. So although we're still performing better than the bench we will start using that as a metric of focus and have actually already started reaching out to our stakeholders. We think part of the problem is our physicians are prescribing more Repatha and don't understand that they still need to write a reason why they're not on a statin. The next metric is one as you can see we don't have any any trends whatsoever. You know we've the trend line is through the middle this one you want to be below and our points are all over the place. So this is a metric of focus for us. This is a metric that we continue to work on. This is a metric I'm very excited to hear what all of you all are doing to improve and what Ellen has to share. So the last one is one you can see where that benchmark is and yes you're supposed to be under the benchmark so it's like a direct opposite of my first one. You can see all of our data points are a definite negative trend and that is another one that we focus on. So if we go on. So what is our process? So our process is ensuring that the data from the start is correct. So our physicians would tell us garbage in garbage out. A little over a year ago all of our abstraction transitioned to the registry services team. However they have very similar processes to what we had. They do a inter inter-rater reliability or IRR process in QA. I think you heard a little bit of that about that yesterday to ensure that their abstractors have a 98 or 97 percent accuracy and they use that IRR process and additional education to sort of keep them there. We so and they glance at the outliers too but we glance at them when we get them. We want to make sure that there aren't any keystroke errors that there aren't things that they missed in the chart. But then we use the companion guides and the dictionaries to really understand you know were the elements in the metric collected correctly and then when you put the elements through the companion guide specs why are they an outlier. We also review our internal registry service resources and the NCDR reports. We want to make sure that the reports are reflecting what we expect with the outliers we see and then we work on identifying trends and benchmarking things like do we have a process problem. Do we need to educate more. Do we have a documentation opportunities. So this is an example that last one I showed you where we're all above the bench. So this is sort of how we go through with this measure. We go back to that executive summary dashboard and we find our metric. You'll notice there's two blue buttons. One's gives you metric detail and that's really nice because it actually will extend your line graph I think to three years and it gives you a little more information. It's similar to the to the executive summary box and whiskers graph but it does give you a little more. But what we really want to look at is that patient detail. So we click on that button. There's a little strip across the top with an arrow that has a drop down and then you can select some specific criteria. We selected here that we want to look at quarter one because this is a process we do ongoing. So we really just want to see our newest cases. We hit retrieve. It pulls up a patient list. It also pulls up the numerators and denominators. And in this metric your numerators are your outliers. So we see that we have 49 outliers in quarter one and then down below you can see part of that line by patient line that it gives you. We export it into Excel because that's the best way to see all of your patients. And then we begin reviewing those outliers again as I said earlier. Number one to make sure we agree with abstraction and number two to see why it's an abstract or once we've sort of done our review we send it to our physician champion. And we are very fortunate to have a physician champion who has a real passion about appropriate use. He's fairly knowledgeable and he will go through them and then he is actually the one we may present the data at all the cardiac meetings but he's the one who will share with his physician partners what the opportunities are that he sees. You can see we have some that don't have a stress test. We have some that have three vessel or left main disease that don't have a syntax score. We have some that don't have a result so he'll share and make sure they understand that the stress test has to be within the past six months. You have to document what type and the risk that even if there's three vessels greater than 50 and you don't work on all of them it still counts as three vessel disease. So you still need the syntax score and those type of things. So how do we identify opportunities. Again we review those outliers either through our registry services team outlier reports or the detail lines. We detail each outlier for trends and contributing factors. Again do we have educational opportunities. Do we have documentation opportunities. Do we have process issues. Our physician champion reviews them as well. Not only does he sort of look for the opportunities but he also in measures that are appropriate will go out and look at current literature get more education share it with his peer group in the meetings and then they'll look at are there things from best practice or evidence based that we need to try to implement. I think an example of that is we were really focusing in on acute kidney injury the one that's all over the place and we we we they thought that it was a contrast issue. So we developed a metric through the detail lines where we would calculate the GFR times 2.5 and the contrast value and their expectation is that they wouldn't give more contrast than the GFR times 2.5. When we looked through the little snippets of our outliers we found that there were very very very few that ever had contrast value greater than GFR times 2.5. So now they're looking at all the literature on hydration and that and they're working on that next step getting rid of all those old favorite order order sets and reinstituting a good hydration program. We also review resources on the ACC cath PCI. There are plenty of resources not only to help you understand the measures but to to find best practice the quality improvement for institution sites with their toolkits. Then what do we share. So of course we share the executive summary outcomes reports and then we also like I said we create metrics from the from the patient outcome lines and our registry service reports. We have internal performance reports that we do for the facility. They give like a red or green for how each facility is performing. We do facility type dashboards where it has well our system is as a whole. There are three bar graphs that show our three facilities. If they're red they're not meeting the metric if they're green they are. There's a line graph that shows month by month and then the really neat thing about these reports and we do display them unblinded at our interventional council and our cardiac division and department meetings is there is a physician heat map and this heat map has the physician names and squares. The squares are either red or green whether they're meeting the measure and then the size of the square indicates their volume. Our physicians there are some really good physician specific reports in the ACC cath PCI registry and in our registry services team. However there are multiple pages and our physicians wanted a one pager where they could go and look and see how they're performing. So we worked with them. We used a report from our registry services team. We added our custom metrics and this is an example of one. You can see the first column lists the metrics that they chose that were important to follow. The next one we put in the NCR 50th or the Ascension target and the next one that next box AST is our system as a whole. So all three hospitals performance together and then that individual physician's facility will be the next column and then the physician with their metrics either being green or red. They like it because they can look right away and see what where they need where they have opportunity. The one that doesn't have a color is where our internal goal is much stricter than the others and they didn't like being read there. So even though they are not meeting our internal goal they didn't want to be read if they weren't meeting the ACC goal. So we compromised and just left them without a color. So who do we share it with? So number one we share it with our physician champions. As these younger doctors are coming up and they have all this wonderful enthusiasm and they are all up to date on their research we have found that they are very engaged. So rather than just having one physician champion as we did in the past at each facility we actually are at the point where we can have one for appropriate use and one for acute kidney injury. But our facility physician champions get sort of a snapshot look at how they look each week how they're looking for the for the individual month today and for the 12 months and then they get a list of all the outliers including the ones the intra and post events that aren't in a measure just so that we can make sure they're aware of what's being collected. We show these at all of our cardiovascular service line meetings interventional council and the quality committee because you know they have real meat in the game in those meetings. But we also show it at our inpatient council and our imaging council because those physicians may be the ones that are discharging the patient. We need to make sure they understand the importance of all the discharge meds. They may be the ones that they're not interventionalist but they had this initial stress test. We need to make sure that they help our interventionalist with the documentation required for appropriate use or for the imaging docs. They may be you know make sure making sure they understand the importance of having that risk score on that when they read the stress test. We do have a system quality meeting that has physician leaders from across the system as well as quality leaders and once a year the chair of the quality CVS quality committee will present there. We are very fortunate that most of our hospitals are hospital employed. Most of our physicians are hospital employed and so the ministry service agreement they have tagged on several of the PCI and ICD metrics. So those are shared at every CVSL meeting and then the individual physicians through the physician dashboard. Now we'll take just a moment and I may say this again when you get ready to send out those individual physicians scorecards you really need to be prepared that you do it at a good time when you're ready for lots of phone calls because they don't like they want to be a students and they don't like that red and so they're gonna call and have a conversation with you which is actually good because then you have an opportunity to share the definitions the companion guide what you saw in the data that they that they need to improve on. So how do you get them and in my opinion the first way to get them is to build that trust with your physicians. So you want to make sure that you've utilized all the material on the NCDI and the cath PCI to make sure you have a great understanding of not only the definitions and how the metrics are compiled but the population included. When you speak to them you want to speak confidently and if you don't know something that's okay. I have found with my docs if I simply say you know I really don't want to answer that right now I need to double check on a couple details because I don't want to miss speak but I will get back to you and as long as you get back to them then you know they're there it's all a process of building that trust and for doctors who you know I have my own philosophy on the physicians acceptance of data and the very first step in that cycle is they're gonna really grumble and so if they're grumbling that's a perfect time to have them help you write a question on why they disagree and send it in to the NCDR and then having our engaged physician champion I sort of went rambling and I lost my place the MSA metrics are important and then when we show the data showing them where the 50th and the 90th are because again they want to be a students they think they're wonderful and when you show them that they're not it gets their attention they're vested they do the grumbling but then they want to hear why they're not the event individual physician dashboards one pagers and then for for measures that we're focusing on like the two I showed you at the bottom we share the definitions and in talk through how it's compiled what the population is and then we rely on our physician champions to really step in you know we'd like to think we have all the information and they should listen to us but they're going to listen to that physician champion they're going to hear what he has to say before they're going to hear what I have to say so that is pretty much what I think Ellen is going to come speak to you now. Thank you, Ellen. Well, I don't know where I am. I'm sorry. Oh, there I am. Okay, cool. Yes, hi. I'm Ellen Keneally, and I have absolutely nothing to disclose. So I represent Northwell Health. I am the CAF PCI registry site manager for multiple facilities, and I'm the nurse manager who manages the team that collects and extracts the data for the CAF PCI registry. A little bit about Northwell Health. We are New York State's largest employer and New York State's largest health care provider. Our facilities are located in three regions. The western region is Westchester County in New York City, and the eastern and central regions cover all of Long Island. We have 23 hospitals and over 830 outpatient facilities, and we employ over 80,000 people. Ten of our 23 facilities have cardiac catheterization labs. Our annual volume is over 10,000 or close to 10,000. The Sandra Atlas Bass Heart Hospital is recognized as one of the top two cardiac surgery programs in the U.S. and Canada. We're also partnered with Hofstra University and the Barbara and Donald Zucker School of Medicine, and soon to be School of Nursing. We're supported by Best Places to Work by Fortune and Glassdoor and one of the best 100 companies to work for for diversity. Just a little glance at our volume. We have facilities that range from 150 PCIs a year to greater than 2,500, and a little bit of everything in between. So getting into the weeds of AKIs, you need to understand your AKIs. So how are you tracking them and reviewing them? Do you use the patient dashboard and metric drilldowns? Do you review the cases that fall into the AKI metric and the NCDR outcomes? Do you know what your observed over expected ratio is? Is it positive? Is it negative? And what can you share with your team and your cardiac cath lab directors, all your stakeholders? Sorry. Well, am I doing something wrong, Debbie? Just pointing it? That is not okay. That is not okay. Just click in the black window. Sorry, I had to be handicapped. All right. You're not handicapped. There you go. Now you can advance. Okay. Okay. Tracking your AKIs in real time. We used simple Microsoft Excel spreadsheets, based it off of the executive summary inclusion and exclusion criteria. We're trying to track potential AKIs compared to the NCDR outcomes. We try to do this in real time and to quantify real time. Most of our facilities are six weeks to a month behind the cath lab. So that's post-discharge. We look for unexpected AKIs versus what we tracked versus what's in the NCDR outcomes. And this is where we learned so much. We would track five, they would have six, or vice versa. We would track six, they would have five. And then we would review, what did we miss? What are we not understanding about the inclusion and exclusion criteria? And once you identify your AKIs, then you can look for trends. Is it a physician, a specific operator? Is it on weekends? Is it voluntary physicians? Look for anything that stands out. Your resource documents. Understand where your resource documents are. NCDR homepage, documents, look for user guides. As Debbie was pointing out and I just said, the Cath PCI Executive Summary Companion Guide. Look at all of your inclusion and exclusion criterias. Know your model specifications. If you do have questions, if it doesn't make sense, always reach out to the registry for guidance. Excel. Excel. If you're not an expert, you don't have to be an expert, you just need to know some basics. And there are great tools on Google. Just basic Excel and you'll find tutorials for free. Dashboard. Again, this is a little bit repetitive of what Debbie had, but knowing where to drill down. You have your executive summary, your ending time frame, your patient level detail. When you want to get into the weeds of the patients, you go to the patient level detail. For the risk adjusted metrics, understand that this is only available after the outcome is published. We download it to Excel. The top picture is raw Excel file. I zeroed in on observed over expected. In that header, I just apply a filter. It's the simplest thing in Excel, but it allows you to sort. And I want to sort by my observed AKIs because those are the AKIs the registry recognized. And then once you know who you're looking at, who the AKIs were, then you can take a look at your predicted probability. If you look at the third case, it has a much higher predicted probability than the others. Why was that? What were the risk factors? Understanding your risk factors was a big hurdle for us and communicating this to the physicians to get that trust and that buy-in, to have them know that we knew what we were doing made a big difference. Metric-level drilldowns. There's the patient-level drilldown and the metric-level drilldown. Again, you want to select your ending time frame. And once you're in the metric-level drilldown, you can zoom around to all of the measures. You don't have to log back out and come out of metric wherever you were and then go to another one and look. You can specify right in there where you want to go from here. So right now I'm looking at metric 39. I want to go to metric 30 after this or metric 2, whatever. You don't have to. You can do it all in here. And again, you can see a historical performance over three years. Again, up and down, up and down, no consistency. When you get your outcomes report, again, the dashboard, the executive summary, when you hit the drilldown, you can see the detail lines. Detail lines are key. You want to make sure you're in the right ending time frame for the quarter that's published. And then you can look for whatever you want to look for. You want to look at bleeds, you want to look at AKIs, you want to look at STEMIs. Right now I'm focused on AKIs. So this is where knowing a little bit of Excel helps you sort and filter because it's a massive spreadsheet, right? You want to kind of pull it all together and look at just the elements that you want to look at. You want to look at your observed over expected ratio. Is your expected higher than your observed or vice versa? In the first box broken out at the bottom, you see that the first quarter that we're looking at, the observed AKI was less than the expected. So that means we risk adjusted in the right direction. And knowing how you risk adjust, there are risk resources on the documents page that you can take a look at. But basically, you want that OE ratio to be less than 1. If it's greater than 1, you're risk adjusting in the wrong direction. And I'll get to that. The next quarter, we risk adjusted below 1, so we risk adjusted in the right direction but not that much. Look at the next quarter, 13. There were 13 AKIs when the registry expected 7.6. This is an opportunity to go in and take a look at those cases and see if you missed any risk factors. Would improved documentation have helped? And bring that back to your physicians. But clearly, we didn't capture enough risk in this quarter. And then the next quarter, the roller coaster. There were four AKIs. The registry expected 6.5, so we did better. To recap, you want to know what your observed over expected is. Have you reviewed the risk model resources? Is poor documentation leading to missing risk? Can you clarify the documentation, educate, and engage your stakeholders? Review the risk factors that impact the metric. Follow trends, physician operator, contrast use, presentation, et cetera. So Northwell's journey with acute kidney injuries started in 2018 when it became clearly obvious that we were not doing well in this measure. And our physician champion and administrative directors and cath lab directors all noticed that we were, across the board, performing under the 50th or at the 50th percentile. In 2022, Q1, we're either worse, better, and actually three facilities were a little bit better, but it's inconsistent. You know, it's kind of a random thing that those three facilities are doing well. Because if you look at the trend, it's not a consistent five quarters of data of improvement. It's the rolling four quarters favored them this time. In the upper left, you'll see the 50th percentile in 2018 was 5.7, and in 2022, Q1, it's 7.3. So everybody's struggling here. So what are we doing with our AKIs and what's our plan? We started an initiative earlier this year. But to back up, in 2018, again, we noticed that everything was below the 50th percentile. That this was an increase risk for all of our patients, and the physician champion appointed one physician to come up with a plan. So by 2019, the plan was set, the guidelines were established, and the rollout was to all facilities, which is a bit disorganized. There was a lack of ownership at each facility. Who was handling this? Who was responsible? The continued poor outcomes, we didn't get any better. By 2020, COVID hit, and we were really overwhelmed. Only emergent and urgent PCIs were done, but the AKI outcomes were worse than ever. In 2021, the volumes returned to pre-pandemic levels. There's renewed AKI rate concerns. The past initiative was re-evaluated, and an improved plan was piloted in one region, not at every facility. It showed promising results, so we moved it to launch to all facilities in March of 2022. We had all facilities on board by May. We have our own data abstractors collecting the data. They're entering it into a dedicated database, and the process is monitored weekly, monthly, and quarterly. Where did we start? Provider engagement, tough one. It's trust. It's going over and over and over and communicating that you know what you're doing, you understand the measures, communicating what the guidelines are, what they missed, how did they miss it. And next, moving on to our initiative, it's who's going to monitor the compliance, what data points are collected, where will the compliance be tracked, and how are the outcomes going to be reviewed and presented. Engagement and buy-in, drill downs, pinpoint your trends in your AKIs, explain to the physicians where they missed. Communicating complete documentation, initiate compliance checks, and report process breakdowns. Improved documentation allows you to focus on the process improvement project. Local and physician champions are monitoring all sites for progress. Who's monitoring the compliance? RN data abstractors track compliance, deviation, and AKI. There are weekly meetings with the RSM and the RNs to maintain the process. The RSM shares the data and progress of the initiative with all the RNs at the weekly meeting, and the physician champion attends all the weekly calls to support the RNs, and corrective actions are applied when needed. What will the initiative track? It tracks hydration pre, intra, and post-PCI, patient demographics, operator and PCI status, pre and post-creatinine, GFR and hemoglobin, contrast type and volume. Deviations from the protocol include STEMI, heart failure, chronic renal insufficiency, fluid overload, and missing documentation. Where will the data be tracked? Data is entered into REDCap, a data management system. The advantages are that it's cloud-based, customizable, and there's simple data mining. REDCap is a secure community created for knowledge management. REDCap provides security for data breach, hackers, and data loss. REDCap is free. All you have to do is request administrative use. How are the outcomes reviewed and presented? The SYN initiative data is presented monthly per hospital. The data is reported on local levels during PCIG conferences. The cath physician champion attends all of the QAs throughout the system, and the NCDR outcomes and SYN data are presented quarterly at system meetings. And where are we now? So we have about 60.7% compliance, patients following the protocol, and of the patients following the protocol, 1.5% are showing AKI. The deviations, patients who are not fully hydrated, according to the protocol, we have a deviation rate of 39.3%, and the deviations with AKI are 5.9%. Look at a breakdown of the deviations. By far, the biggest reason is that there was no documentation. So there's no documentation to explain either that the patient was hydrated or received partial hydration, and why was that? Because they need to see it pre and post. So a lot of this we're not really too worried about because it's pretty new, and we have 10 facilities joining on board. Some were on board May 1st, some were on board May 15th, some were on board in April, et cetera. So once now that everybody's on the same page, we're expecting that number to go down. Protocol and deviation, this is something we wanted to take a look at. 68.7% of the AKIs in the deviations had a GFR less than 60, and in the deviation category of greater than 60 with a pre-procedure GFR, 31.3% had an AKI. So that's a particular area of focus because those patients have possibly normal renal function to start out with or near-normal renal function. So those are your patients we're thinking might be a 0.6 pre and a 0.9 post that just fall in. So we're really trying to focus on that group, and maybe we can get that down to a lot less. Our system-wide average, so taking all of the system-wide Q1 outcomes, our average was 6.7%. The raw, unadjusted data showing up in REDCap right now puts our AKI rate at about 3.3%. So it looks like it's working, but it is early. What's next? We're going to continue to track compliance, communicate and re-educate. We're going to monitor for adverse events, acute heart failure, hemoglobin drops. We need to know, is the initiative working, and what patients are best protected? Is there a need to modify the guidelines? And we're going to continue to validate our REDCap AKI outcomes against the NCDR outcomes and see where we are. And that is it for us. Thank you. Okay, thanks so much. We do have a few minutes for some questions. Our top-rated question is for Debbie. They want to know, how did you decide on an EGFR times 2.5 as your max contrast threshold? And did you do this for all patients or only for those deemed at higher risk? So our physicians went out, like I said, researched our physician champion for AKI and our physician champion for sort of our system intervention discussed. I think there was a lot of numbers out there, and they really wanted to be very, very conservative. I think they realized that there are some numbers that are a bit higher than 2.5. But for their purposes, they chose to go with the 2.5 with the expectation that the physicians would be in compliance, would be out of compliance no less than 20% of the time, or they wanted 20%. Am I saying that all backwards? No. But it came from the physician, from their review of the literature, for them wanting to be very conservative. Because, you know, this AKI issue hurts their hearts. They feel like they do a really good job, and so they're really trying to find an effective way. I hope that answered your question. Thank you. This would be a good one for you, Ellen. What data are you looking at pre-procedure to determine if a patient is at risk for AKI? And then following that, what data is being tracked post-procedure? I'm not sure we're talking about in general or for the initiative. So what are we looking at? To answer that question, we're looking at, so the database has 43 points, and it's basic demographics. We're looking at their presentation, what their GFR was pre, what their creatinine was pre, if they were diabetic pre, and that's about it. It's pretty basic. It's a pretty simple plan. And post-procedure, we just want to see if they had a 0.3 rise. Yeah, I'm not sure I'm answering the question appropriately. So for your particular facility, did your patients get ordered a hydration protocol ahead of time to help limit AKI? Yes. So the hydration protocol is based off of the Poseidon trial, and that's where we started in 2018, which was focusing on patients that had a GFR less than 60. The new guidelines are focusing on all patients. It's not restrictive to GFR less than 60. So there is an algorithm and a protocol where there's hydration guidelines for inpatients and for patients who are arriving on the day of procedure. So inpatients would receive fluids for six hours pre-cath, and patients that are coming in for the procedure on the day would get a bolus pre and post. But the hydration is pre and post, and it's open to everybody. So it's just a little bit different between an inpatient and an outpatient. Great. Okay. I think we have time for one more question. Let me see what the highest ranking is. So Debbie, can you review again who made the physician's dashboard? You're talking about the individual one pager, the Ascension Clinical Analytics Registry Service Team. They have a wonderful tool that they built that has all kinds of reporting in it. And they sort of have the skeleton of a physician-specific report that just is more than one page. So in my shop I have an Excel guru. So she sort of made us a template where we copy and paste that, and we copy and paste the NCDR, the most recent quarter, to get those baselines. And it populates and, of course, uses conditional formatting to make it red and green. Probably the majority of that scorecard came from our registry services team. And then we just made it a one pager with the custom questions at the bottom and with those benchmarks they wanted to look at being the NCDR, Ascension as a whole, Ascension St. Thomas, and then their facility. It looks like we're getting some questions now. People are piggybacking off of the original questions. And I'm sorry that we're out of time. But we do have these questions here on my computer, so I'm happy to stay and chat with you after the session is over. Just a quick reminder before you go, just watch out for an evaluation that should be in the app tomorrow, on the 16th, just to let us know what you thought of the session. And there's also going to be a claim your credits tile on the virtual platform and on the mobile app so you can claim your CE credits. Okay, thanks so much for coming.

Cath PCI Registry

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acute kidney injuries

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