STEMI ED transfers

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Maria C Gomez
    • 505-272-7437
    • The University of New Mexico Hospital
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      Thank you for your inquiry regarding CMS996v5: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure defines appropriate STEMI treatment using three numerators: fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or discharge to acute care within 45 minutes of ED arrival. We understand the intent of your question is to determine which timestamp can be used to start the clock for numerator inclusion based on a scenario in which a patient is transferred from hospital #1 (no cardiac catheterization laboratory – “cath lab”) to hospital #2 (with a “cath lab”). In this scenario, both hospitals have the same CMS Certification Number (CCN), and the EHR documents the transfer between hospitals as one ED encounter with no discharges.

      Since this scenario is documented in the EHR as only one ED encounter, the measure will be calculated using the ED arrival time of the first hospital to determine numerator inclusion. The time that the patient physically leaves the first hospital should not be used to start of the clock to determine numerator inclusion as this does not align with the intent of the measure, which is to assess timely treatment. Because the patient only has one ED encounter, the clock should start at ED arrival time of hospital #1, regardless of the 45-minute transfer time to hospital #2. If the patient is given fibrinolytic therapy within 30 minutes of ED arrival at hospital #1, before they are transferred to hospital #2, the ED encounter can still meet the measure numerator.
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      Thank you for your inquiry regarding CMS996v5: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure defines appropriate STEMI treatment using three numerators: fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or discharge to acute care within 45 minutes of ED arrival. We understand the intent of your question is to determine which timestamp can be used to start the clock for numerator inclusion based on a scenario in which a patient is transferred from hospital #1 (no cardiac catheterization laboratory – “cath lab”) to hospital #2 (with a “cath lab”). In this scenario, both hospitals have the same CMS Certification Number (CCN), and the EHR documents the transfer between hospitals as one ED encounter with no discharges. Since this scenario is documented in the EHR as only one ED encounter, the measure will be calculated using the ED arrival time of the first hospital to determine numerator inclusion. The time that the patient physically leaves the first hospital should not be used to start of the clock to determine numerator inclusion as this does not align with the intent of the measure, which is to assess timely treatment. Because the patient only has one ED encounter, the clock should start at ED arrival time of hospital #1, regardless of the 45-minute transfer time to hospital #2. If the patient is given fibrinolytic therapy within 30 minutes of ED arrival at hospital #1, before they are transferred to hospital #2, the ED encounter can still meet the measure numerator.
    • CMS0996v5
    • standardize a process to improve data capture

      There are currently two hospitals under the same CCN within ~45 minute driving distance from each other. Only one has a Cath lab for PCI. However the patient keeps the same ED encounter regardless of location transfer. For this reason, Instead of capturing the time stamp from the first ED arrival to the hospital with a Cath lab (time of PCI) Can the time the patient leaves the first hospital be captured as the "transfer" variable?

      Please keep in mind that there aren't any discharge orders in the process, therefore the mapping would be a timestamp indicating when the patient has left the ED with no Cath lab to the location that has a cath lab.

       

      For example, 

      Patient arrives to location 1 (no cath lab), STEMI identified , gets transferred to Location 2 (with cath lab), both locations share same CCN, and the patient keeps the same encounter. there aren't any discharge orders, so can we capture the transfer time as the "Transfer" variable to meet numerator. 

      OR

      Because patient keeps same ED encounter would the timestamp to PCI begin  at the time of location 1 arrival (regardless of the transport time).{}

       

      Thank you 

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Maria C Gomez
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