In monitoring CMS996v4, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED), we had a patient who presented to the ED with chest pain. The initial EKG had ischemic changes, but no STEMI. The patient received appropriate clinical treatment but had worsening symptoms after an hour while still in the ED. The second ED EKG indicated STEMI, at which time transfer was arranged. Our Facility doesn't perform PCI.
This patient did not meet the Numerator because they were transferred > 45 after ED Arrival, but transfer was not indicated until after the patient had been in the ED for over an hour. Even though the patient was transferred within 45 minutes of ED STEMI, as diagnosed by the second EKG, they did not meet the numerator.  Please consider a spec update to adjust the start time  from the ED arrival time to the ED STEMI EKG time.