OP-40 STEMI

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Unresolved
    • Priority: Moderate
    • Component/s: None
    • None
    • CMS0996v5
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      Patient is appearing in eCQM submission data as being included in the denominator and not as an exclusion, resulting in this case failing the OP-40 STEMI measure. We are requesting clarification why this case would not qualify as an exclusion as the coronary findings yielded a higher level of intervention with CABG surgery, and a PCI was not indicated. Case details below.
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      Patient is appearing in eCQM submission data as being included in the denominator and not as an exclusion, resulting in this case failing the OP-40 STEMI measure. We are requesting clarification why this case would not qualify as an exclusion as the coronary findings yielded a higher level of intervention with CABG surgery, and a PCI was not indicated. Case details below.

      Question #1: Why would a patient with a STEMI diagnosis in the emergency department who went for a cardiac catheterization with findings of Multi-Vessel Disease, followed by the placement of an Impella/Mechanical support device, and an Emergent CABG (Coronary Artery Bypass Grafting) surgery directly from the Cardiac Catheterization Lab not yield an exclusion? The coronary findings yielded a higher level of intervention with CABG surgery, and a PCI was not indicated.

      Details for Question #1: 

      10/14 at 0410: Admitted to ED, diagnosed with STEMI.

      10/14 at 0517: Transferred from ED to Cardiac Catheterization Lab. Insertion of Mechanical Support Device/Impella placement. Cardiothoracic Consult.

      10/14 at 0709: Transferred from Cardiac Catheterization Lab directly to Cardiothoracic Operating Room. 

      10/14 at 0842: CABG x4 procedure start time.

      Question #2: How do you account for Mechanical Circulatory assist device placement that occurs after the ED encounter and in the Cath Lab prior to the PCI. Exclusion has defined it has to occur 24 hours or less before the start of the ED encounter or during the ED encounter. The reality is these devices are almost never placed in the ER and may impact the door to balloon times. 

      Thank you.

       

       

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Vivian Steinmetz
            Votes:
            1 Vote for this issue
            Watchers:
            3 Start watching this issue

              Created:
              Updated: