• Chest Pain Center Accreditation

Society Of Cardiovascular Patient Care. A Stamp of Excellence. Payors are absolutely looking at the Society as a stamp of excellence. So when you're approaching.

STEMI Assistant is a condensed 40 page reference manual for health care practitioners who care for patients experiencing acute ST Segment Elevation Myocardial Infarction (STEMI). STEMI Assistant presents the latest evidence-based practices described in the American College of Cardiology (ACC) / American Heart Association (AHA) 2013 STEMI Guidelines, AHA/ACC 2014 Non-ST Elevation (NSTE)-ACS Guidelines and evidence based practices described in 19 additional recent scientific journal articles. STEMI Assistant is designed to serve as both a classroom textbook and an emergency bedside reference. It's formatted in a sequential, easy to follow order starting with basic definitions of typical and atypical symptoms of Acute Coronary Syndrome (ACS), the latest AHA/ACC/Heart Rhythm Society guidelines for obtaining 12 and 18 Lead ECGs, accurate identification of pre-infarction and STEMI ECG patterns and the identification of STEMI when bundle branch blocks are present. Model protocols for hospital and pre-hospital practitioners describe the latest evidence based practices for the management of patients with acute chest pain, NSTE-ACS, and STEMI in PCI capable and non-PCI capable scenarios. A generic Emergency Department Physician's STEMI order set reflects the latest AHA/ACC practices for the treatment of STEMI in the ER and satisfies multiple Key Items listed in the Society of Cardiovascular Patient Care's Chest Pain Center accreditation standards. Remote Ischemic Conditioning (RIC), an emerging non-invasive procedure proven to reduce myocardial injury from heart attack is introduced, along with a suggested protocol for its application.

RIC can be implemented by EMS personnel while enroute to a hospital or in the emergency department prior to cardiac catheterization. When used as an emergency bedside reference, the book cover features a 12 Lead ECG divided into five color-coded anatomic regions of the heart. Arrows lead from each anatomic region and point to the page number where information specific to each type of STEMI can be found. The information provided advises the clinician of the coronary artery that is most likely occluded, specific complications to anticipate and special considerations that should be observed based on correlations of abnormal ST patterns with common coronary artery anatomy as described in multiple evidence-based publications.

Chest Pain Center Accreditation

Ruppert, CVT, CCCC, NREMT-P is an Interventional Cardiovascular and Electrophysiology Technologist who has logged over 13,000 cardiac catheterizations and electrophysiology studies during the past 20 years. He is certified as a Cardiovascular Clinical Coordinator by the Society of Cardiovascular Patient Care and has coordinated the successful Chest Pain Center and Atrial Fibrillation Center accreditation of Bayfront Health Dade City in Dade City, Florida. In 2010 he authored '12 Lead ECG Interpretation in Acute Coronary Syndrome with Case Studies from the Cardiac Catheterization Lab,' a 304 page textbook that is marketed and distributed worldwide by the Ingram Book Company. Ruppert is a frequent presenter at medical conferences and workshops nationwide on the subjects of 12 Lead ECG Interpretation, Acute Coronary Syndrome, and ECG indicators of conditions known to cause Sudden Cardiac Death.

Between 1980 and 1994 he served as a Paramedic, Firefighter, Field Training Officer, Education and QI Director. He currently serves as the Cardiovascular Clinical Coordinator for Bayfront Health Dade City in Florida. Barbara E Backus, MD, PhD of the University Medical Center Ultrecht, Department of Cardiology, Utrecht, Netherlands. Backus is the developer of the HEART Score, and has reviewed and edited the Risk Stratification section of this book (pages 15 & 16). Backus has authored 24 academic journal articles.

Her areas of expertise include Research, Emergency Medicine and Cardiology. Anna Ek, BSN, RN is an Accreditation Review Specialist for the Society of Cardiovascular Patient Care. Anna Ek joined the Society with a strong background in cardiac, surgical, and PACU nursing. She began her nursing career during the time of thrombolytic trials which ignited her longtime passion for cardiology.

She has a strong interest in EMS practices and has met with EMS throughout the United States. She is a strong advocate of EMS and the part they play in the pre-hospital care of the cardiac patient. In addition, Anna has a keen interest in induced hypothermia therapy and is working with the Society to research its effects on the post-cardiac arrest patient.

In late 2011, the Center for Heart and Vascular Care made the decision to proceed with accreditation as a Chest Pain Center (CPC) through the Society for Cardiovascular Patient Care. The Society for Cardiovascular Patient Care (formerly known as The Society of Chest Pain Centers SCPC) was established in 1998 as a nonprofit international organization dedicated to eliminating heart disease as the number one cause of death worldwide. SCPC pursues this mission by providing education and accreditation to healthcare facilities to improve the care of the cardiac patient. UNC chose to pursue accreditation to ensure our facilities meet quality-of-care measures for the care of the acute coronary syndrome (ACS) patient.

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Tracey Blevins, RN BSN MBA HCM CEN, Chest Pain Center Coordinator, says, “Successful improvement of ACS care supports the reduction of deaths and major adverse events from heart attacks.” The accreditation process, required for designation as a Chest Pain Center by the Society, is multi-faceted, comprehensive, and complex. The goal set by the Heart and Vascular team is to complete submission of all accreditation materials by June 1, 2013.

As part of her role, Blevins has and continues to review all processes and policies that are currently in place, while comparing them to the requirements for CPC accreditation. Teams are being put in place to discuss and implement any changes and processes that will improve ACS patient outcomes. Team members are selected based on the needs that are identified in the gap analysis. An external peer assessment process will occur through the manual submission and site visit. Eight key elements must be met to achieve accreditation: 1) Community Education about Early Heart Attack Care (EHAC) - The primary goal of EHAC is to promote public awareness that heart attacks have 'beginnings' that can occur weeks before the actual attack. EHAC focuses on intervention during these beginnings to help prevent acute myocardial infarction (heart attack) and cardiac arrest. 2) Emergency Department (ED) integration with Emergency Medical Services (EMS) – The hospital will enter into a formal relationship with EMS in order to collaborate and share metrics on care of the ACS patient.

UNC will also offer resources and education to EMS. 3) Emergency Assessment of patients with symptoms of ACS, including timely diagnosis and treatment – This element requires demonstration of written protocols and processes that allow for timely recognition of patients experiencing ACS, regardless of how they present to the Emergency department.

Whether arrival by walk-in, EMS, or OSH transfer, evidence-based medicine for ACS shall be utilized in a consistent manner. 4) Assessment of patients with low-risk ACS and no assignable cause for their symptoms – Risk stratification of all ACS patients - including evidence-based cardiac biomarkers and 12 lead ECG interpretation - as well as appropriate stress testing for low risk patients must be verified in accordance with ACC/AHA guidelines.

5) Process Improvement – A quality plan will be put in place for the facility that integrates continuous improvement of all aspects of care, including quality monitoring and evaluation of processes of the ACS patient. 6) Personnel, competencies and training – A process will be developed for monitoring physician credentialing and CME for all providers who care for the ACS patient. It will be a priority to make sure all staff have been educated on the ACS patient and that annual training and educational opportunities are provided. Training will include EHAC, ACS signs and symptoms, and protocol/process review. 7) Organizational structure and commitment – The administration must show a commitment to Chest Pain Center Accreditation and to the facility's reperfusion strategy of first choice. They will also support and attend CPC activities and strategic planning. 8) Functional facility design – This includes ease of access to the facility by patients and EMS providers, as well as signage and wayfinding opportunities.

After the accumulated data from the self-assessment, the external peer assessment, and the supporting materials for these eight elements are submitted to the Society, they will evaluate our level of performance. They can also choose to make suggestions for quality improvement, improved customer satisfaction, and cost containment.

If our data passes their review, the Society will make a site visit within three months before deciding on accreditation. Currently, there are 30 hospitals in North Carolina who are accredited by the Society. The closest facilities to UNC Hospitals are Rex Healthcare, Central Carolina Hospital in Sanford, and Wake Med in Cary and Raleigh. Blevins says, “I believe that the expertise and dedication of our staff makes us one of the best heart hospitals in North Carolina, and receiving this accreditation would be an additional validation of that belief.” Many steps have already been taken toward completing the accreditation process.

The hiring of Blevins in April 2012 as the Chest Pain Center Coordinator was vital from the start.