Ask the Experts: Acute Coronary Syndrom (ACS) Accreditation
Donna Hunn, RN, MSc, MAN, ANP-C, AACC
Clinical Education-Accreditation Manager
Donna L. Hunn has an extensive background in Clinical Cardiology, Cardiovascular Research and academia. She has a wealth of experience in accreditation practice, especially Chest Pain Center Accreditation.Q: What's the vision for the ACS service line? That is, where do you want to take it?
A: My vision for the ACS service line is to extend our focus beyond the STEMI patient and help hospitals improve the care of the NSTEMI/UA and low-risk patient. In most cases, these processes seem to be less well established.
There are no national registries to know what is happening with the low-risk patient. If we can capture some of these metrics, we can provide useful data on standards of care for this group of individuals. Through our tool, we have helped hospitals "hardwire" the care they deliver to STEMI patients. We need to now focus our attention on the 80% of the ACS population that is not STEMI.
Q: Why do you think that is … that NSTEMI/UA and low risk has been overlooked, or under-serviced?
A: I think because it is less sexy … STEMI is the quintessential emergency. Patient is rolled in on the stretcher … clutching his chest … having the big one. He is rushed to the cath lab, blocked vessel is opened, blood flow is restored and all is well. The plan of care is very clear cut. With a NSTEMI, the patient has still had a heart attack, but the plan of care is variable. It is open to interpretation. Data is conflicting. Is the patient high risk? Low risk? Does he go to the cath lab? If so, when? Does he get 2b3a inhibitors? Who decides? The guidelines are out there, but the care delivered is often dependant on the physician, time of day, and day of the week. Care of the low-risk patient is even less well defined, yet reflects a huge population and represents a huge liability.
Q: Because of the huge population, and huge liability, how do you see that changing? Can accreditation drive that change?
A: The low risk population remains a challenge. Despite an array of diagnostic modalities and strategies, there remains the task to identify those patients who require admission and those who can safely be discharged. 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/hospital. On the other hand, patients with non-critical syndromes 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 bringing science to the bedside through the use of our tool, facilities will have a road map to guide them to delivering evidenced based care. By collecting outcomes data from our accredited facilities, we will be able to demonstrate what impact our tool has on the components of value based purchasing; quality, cost and patient satisfaction.