STEMI- Transfer from Free-standing ED

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Susan Maillis
    • 917 301 5340
    • Maimonides Medical Center
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure captures three potential numerators for ED encounters with a STEMI diagnosis: PCI procedure within 90 minutes of ED arrival, fibrinolytic therapy within 30 minutes of ED arrival, or discharge to PCI-capable acute care within 45 minutes of ED arrival. We understand your question to be whether an order for transfer to acute care (numerator #3) or documentation indicating PCI is not appropriate (numerator #1) are sufficient for this measure.

      Cases where a patient is initially seen at a satellite ED and subsequently transferred to the main facility under the same CCN and the same encounter ID are considered as a single encounter.

      Logic for the measure’s third numerator criteria – discharge to PCI-capable acute care within 45 minutes of ED arrival – can be found in the definition below from the measure’s HTML file posted on the eCQI Resource Center [https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html].

      ED Departure With Discharge To Acute Care Facility Within 45 Minutes Of Arrival
        "ED Encounter With STEMI Diagnosis" EDwSTEMI
          with ( Global."HospitalDepartureTime" ( EDwSTEMI ) ) Departure
            such that Departure 45 minutes or less after Global."EmergencyDepartmentArrivalTime" (EDwSTEMI )
              and EDwSTEMI.dischargeDisposition in "Discharge To Acute Care Facility"

      Under this definition an order for transfer, without the discharge disposition of “Discharge to Acute Care Facility” does not satisfy this numerator criterion.

      Regarding numerator #1 (PCI procedure within 90 minutes of ED arrival) reasons for not performing a PCI can be captured using the “Procedure, Not Performed” data type together with the “Patient Refusal” (OID: 2.16.840.1.113883.3.117.1.7.1.93) and “Procedure Not Indicated/Contraindicated" (OID: 2.16.840.1.113762.1.4.1282.2) value sets. These value sets can be found in the Value Set Authority Center (VSAC) by searching each value set’s OID [https://vsac.nlm.nih.gov/welcome]. Please note that you may need to create a free account to view these codes.
      Show
      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure captures three potential numerators for ED encounters with a STEMI diagnosis: PCI procedure within 90 minutes of ED arrival, fibrinolytic therapy within 30 minutes of ED arrival, or discharge to PCI-capable acute care within 45 minutes of ED arrival. We understand your question to be whether an order for transfer to acute care (numerator #3) or documentation indicating PCI is not appropriate (numerator #1) are sufficient for this measure. Cases where a patient is initially seen at a satellite ED and subsequently transferred to the main facility under the same CCN and the same encounter ID are considered as a single encounter. Logic for the measure’s third numerator criteria – discharge to PCI-capable acute care within 45 minutes of ED arrival – can be found in the definition below from the measure’s HTML file posted on the eCQI Resource Center [ https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html ]. ED Departure With Discharge To Acute Care Facility Within 45 Minutes Of Arrival   "ED Encounter With STEMI Diagnosis" EDwSTEMI     with ( Global."HospitalDepartureTime" ( EDwSTEMI ) ) Departure       such that Departure 45 minutes or less after Global."EmergencyDepartmentArrivalTime" (EDwSTEMI )         and EDwSTEMI.dischargeDisposition in "Discharge To Acute Care Facility" Under this definition an order for transfer, without the discharge disposition of “Discharge to Acute Care Facility” does not satisfy this numerator criterion. Regarding numerator #1 (PCI procedure within 90 minutes of ED arrival) reasons for not performing a PCI can be captured using the “Procedure, Not Performed” data type together with the “Patient Refusal” (OID: 2.16.840.1.113883.3.117.1.7.1.93) and “Procedure Not Indicated/Contraindicated" (OID: 2.16.840.1.113762.1.4.1282.2) value sets. These value sets can be found in the Value Set Authority Center (VSAC) by searching each value set’s OID [ https://vsac.nlm.nih.gov/welcome ]. Please note that you may need to create a free account to view these codes.
    • CMS0996v6
    • CMS0996v5
    • Patients not being excepted from the Numerator appropriately

      Please refer to Case CQM-8292. The case is closed, but we would appreciate further clarification.

      Maimonides has a free-standing ED. When patients are transferred to the main ED, they are not discharged from the free-standing ED and keep the same visit number (account/encounter). The only visit type options are Inpatient or Emergency.

      Since STEMI patients are usually admitted (whether or not they have PCI), they end up with an Inpatient designation. The workflow is either:

      • Patient goes directly to PCI if appropriate, or
      • Patient is admitted to an inpatient floor for medical management.

      We have orders like Transfer or Admit to Inpatient, but everything stays under the same encounter/visit number.

      Is there any flexibility to identify patients transferred to Acute Care using an order or chart documentation (e.g., indicating PCI is not appropriate), instead of using the two-visit number method that other free-standing EDs might use?

      Thank you for your help!

      Susan

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Susan Maillis
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