Enhancing Outcomes of Acute Coronary Syndromes

Abstract

Objective: The objectives of the initial evaluation of patients with nontraumatic chest pain are 2-fold: 1) to assess the probability that the patient's symptoms are related to acute coronary ischemia; and 2) to assess the patient's risk of recurrent cardiac events, including death and recurrent ischemia. When applied in conjunction with the clinical history, physical examination, and interpretation of the electrocardiogram, cardiac biomarkers are valuable in achieving both of these objectives. The most urgent priority of early evaluation is to identify patients with acute myocardial infarction (AMI) who should be considered for immediate reperfusion therapy and to recognize other potentially catastrophic causes of sudden patient decompensation such as aortic dissection. GOALS OF THE ACUTE CORONARY SYNDROME INITATIVE Improvement in turnaround times for cardiac injury markers (vein to brain) <30 minutes from order to physician notification Safely impact length of stay (LOS) in the emergency department (ED) Improve ED patient disposition: appropriate discharges from the ED versus admissions Enhance ED patient placement: clinical decision unit (CDU), intensive care unit (ICU), cardiac telemetry Impact patient outcomes: appropriate risk stratification of patients with ACS and AMI NEXT STEPS Addition of POC connectivity, which will further impact turn-around-time (TAT) by automating the ordering process (currently a manual process on Meditech) Submission process for HCA-Clinical Cardiovascular Management Network (CCMN); Cardiovascular Centers of Merit Program Prepare for Society of Chest Pain Centers reaccreditation Pursue a stroke initiative for West Houston Medical Center Pursue a similar process for a congestive heart failure (CHF) initiative Continue to foster multidisciplinary communication Continue to enhance key ACS quality initiatives Patient satisfaction ACS outcomes Cost of care/ROI Continue to elevate compliance to CMS AMI core measures CONCLUSIONS The foundation for successful outcomes begins with ACS disease process education from various multidisciplinary perspectives. Point of Care (POC) testing and ACS process redesign is a journey that must include a multidisciplinary team to be successful. Accurate, earlier diagnostic results favorably impacts both quality and cost. A patient-centric improvement effort must be the shared vision of both internal and external resources (ie, vendor partnership and emergency medical services) to be successful. This template may provide an avenue for future disease state management initiatives. TABLE 1: Process and Timeline Results: Outcomes Pre- and Post-Point of Care Cardiac Testing (POCT)