Ask the Experts: Acute Coronary Syndrome (ACS) Accreditation

Maghee Disch

Keri Morris, BSN, RN, AACC, CCCC
Accreditation Service Line Specialist

Q: What's the vision for the ACS service line?

A: The vision for the ACS service line is to extend the focus beyond STEMI patients and help hospitals improve the care of the NSTE-ACS (NSTEMI and UA) and LOW-RISK patient populations. In most cases, these processes seem to be less defined.

Of important note, currently there are no national registries capturing the LOW-RISK population at all. Our Accreditation Conformance Database (ACD) collects these metrics, so we can provide useful feedback on the hospital's process as it aligns with the recommended management and treatment strategies. The LOW-RISK population accounts for 80% of the chest pain patient volume. Our accreditation tool guides hospitals in building hardwired protocols and pathways to efficiently risk stratify and manage these patients. There is a great focus to minimize the variability between providers and improve the utilization of resources to reduce costs while elevating the delivery of care.

Q: Why have the NSTE-ACS and LOW-RISK populations been overlooked or under-serviced?
A: STEMI patients are the most critical upon presentation. They are the quintessential emergency. Hospitals have done an amazing job at building solid processes to facilitate reperfusion of the culprit lesion. With a NSTEMI, the patient is still having a heart attack but has not progressed to a STEMI yet. The UA patient is displaying signs and symptoms of a heart attack but it is not evident on the ECG or cardiac biomarker (Troponin). Often the plan of care remains variable, dependent upon such factors such as the time of day, day of the week, risk stratification method, provider-dependent strategy, hospital resources, etc. Accreditation frequently reveals these variabilities and assists hospitals in developing pre-determined pathways to ensure the right care is delivered at the right time to the right patient. The guidelines are out there, but hospitals continue to struggle with operationalizing the science. For the LOW-RISK patient care, pathways are even less well-defined, yet this group reflects the majority of the volume which brings a huge liability.

Q: Because of the large LOW-RISK population and liability, how do you see that changing? Can accreditation drive that change?
A: The LOW-RISK population is an ongoing challenge. Despite an array of diagnostic modalities and strategies, there remains this task to appropriately identify those patients who require extended work-up or rule-out versus those who can safely be discharged from the ED. Failure to detect a patient with ACS and inadvertently discharging them can result not only in harm to the patient, but significant liability to the provider and hospital. On the other hand, patients not at high risk of having an acute event who are inappropriately admitted and undergo expensive evaluations set the facility up for RAC audits. I believe ACC Accreditation Services plays a vital role in setting the standard of care for the LOW-RISK patient. By taking science to the bedside through the accreditation tool, facilities are given a road map to guide them in delivering evidence-based care. By collecting performance and outcomes data in the ACD, we are able to demonstrate the impact our tool has on the components of value-based purchasing and reimbursement programs.