Competencies in Acute Coronary Syndromes, a Comprehensive Systems Model

Abstract

Purpose: As a result of individual hospital participation in the Chest Pain Center Accreditation process, the need for a systemwide approach to competencies and training was recognized within a hospital network. Background: Ten hospitals in the HCA MidAmerica Division participated as beta sites for the Cycle I Chest Pain Center Accreditation process. Additional divisional hospitals later achieved accreditation. A Cardiovascular Rapid Design session was held in June 2004. Practitioners from all disciplines from 17 facilities in 3 states worked together to improve the acute coronary syndrome (ACS) care process. Three themes emerged: the need for structured care tools, staff orientation and education processes, and information systems. This abstract reports on competencies that support staff orientation and education. Methods: An education workgroup was formed with accountability to a systemwide improvement council with support of senior management. Workgroup members evaluated ACS competency assessment process of all 17 facilities. The Society of Chest Pain Centers Cycle I Accreditation Manual was used. Guidance was sought from Cycle II Key Element 5 Subcommittee Chairs at the Society. Results: Substantial variation among the 17 facilities was identified. No one facility had a comprehensive, discipline-specific skill assessment program for chest pain and ACS. All facilities had parts, which when viewed as a whole, had potential for a comprehensive approach for the system. The workgroup developed and deployed computer-based ACS education to introduce Chest Pain Center Accreditation, evidence-based care, and competency expectations. Fifteen competency elements for 8 disciplines, which include best practice recommendations for technical skills, medication administration, equipment use, and medical documentation, were developed and disseminated. Conclusions: A standardized, scaleable, best practice model is applied to competencies and training in ACS that supports Chest Pain Center administration and accreditation and will improve ACS patient care through improved staff skill and knowledge. Because it is likely that the work is applicable to other Accredited Chest Pain Centers, documentation is available on request.