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The Center for Heart and Vascular Care is working to achieve accreditation as a Chest Pain Center (CPC) through the Society for Cardiovascular Patient Care.

Prashant Kaul, MD, FACC, has been named as the UNC Chest Pain Center Medical Director

In late 2011, the Center for Heart and Vascular Care made the decision to proceed with accreditation as a Chest Pain Center (CPC) through the Society for Cardiovascular Patient Care.

The Society for Cardiovascular Patient Care (formerly known as The Society of Chest Pain Centers [SCPC]) was established in 1998 as a nonprofit international organization dedicated to eliminating heart disease as the number one cause of death worldwide. SCPC pursues this mission by providing education and accreditation to healthcare facilities to improve the care of the cardiac patient.

UNC chose to pursue accreditation to ensure our facilities meet quality-of-care measures for the care of the acute coronary syndrome (ACS) patient.

Tracey Blevins, RN BSN MBA HCM CEN, Chest Pain Center Coordinator, says, “Successful improvement of ACS care supports the reduction of deaths and major adverse events from heart attacks.”

The accreditation process, required for designation as a Chest Pain Center by the Society, is multi-faceted, comprehensive, and complex. The goal set by the Heart and Vascular team is to complete submission of all accreditation materials by June 1, 2013.

As part of her role, Blevins has and continues to review all processes and policies that are currently in place, while comparing them to the requirements for CPC accreditation. Teams are being put in place to discuss and implement any changes and processes that will improve ACS patient outcomes. Team members are selected based on the needs that are identified in the gap analysis.

An external peer assessment process will occur through the manual submission and site visit.

Eight key elements must be met to achieve accreditation:

1) Community Education about Early Heart Attack Care (EHAC) – The primary goal of EHAC is to promote public awareness that heart attacks have “beginnings” that can occur weeks before the actual attack. EHAC focuses on intervention during these beginnings to help prevent acute myocardial infarction (heart attack) and cardiac arrest.

2) Emergency Department (ED) integration with Emergency Medical Services (EMS) – The hospital will enter into a formal relationship with EMS in order to collaborate and share metrics on care of the ACS patient. UNC will also offer resources and education to EMS.

3) Emergency Assessment of patients with symptoms of ACS, including timely diagnosis and treatment – This element requires demonstration of written protocols and processes that allow for timely recognition of patients experiencing ACS, regardless of how they present to the Emergency department. Whether arrival by walk-in, EMS, or OSH transfer, evidence-based medicine for ACS shall be utilized in a consistent manner.

4) Assessment of patients with low-risk ACS and no assignable cause for their symptoms – Risk stratification of all ACS patients – including evidence-based cardiac biomarkers and 12 lead ECG interpretation – as well as appropriate stress testing for low risk patients must be verified in accordance with ACC/AHA guidelines.

5) Process Improvement – A quality plan will be put in place for the facility that integrates continuous improvement of all aspects of care, including quality monitoring and evaluation of processes of the ACS patient.

6) Personnel, competencies and training – A process will be developed for monitoring physician credentialing and CME for all providers who care for the ACS patient. It will be a priority to make sure all staff have been educated on the ACS patient and that annual training and educational opportunities are provided. Training will include EHAC, ACS signs and symptoms, and protocol/process review.

7) Organizational structure and commitment – The administration must show a commitment to Chest Pain Center Accreditation and to the facility’s reperfusion strategy of first choice. They will also support and attend CPC activities and strategic planning.

8) Functional facility design – This includes ease of access to the facility by patients and EMS providers, as well as signage and wayfinding opportunities.

After the accumulated data from the self-assessment, the external peer assessment, and the supporting materials for these eight elements are submitted to the Society, they will evaluate our level of performance. They can also choose to make suggestions for quality improvement, improved customer satisfaction, and cost containment.

If our data passes their review, the Society will make a site visit within three months before deciding on accreditation.

Currently, there are 30 hospitals in North Carolina who are accredited by the Society. The closest facilities to UNC Hospitals are Rex Healthcare, Central Carolina Hospital in Sanford , and Wake Med in Cary and Raleigh.

Blevins says, “I believe that the expertise and dedication of our staff makes us one of the best heart hospitals in North Carolina, and receiving this accreditation would be an additional validation of that belief.”

Many steps have already been taken toward completing the accreditation process. The hiring of Blevins in April 2012 as the Chest Pain Center Coordinator was vital from the start.

Jacci Harden, MHA, RN, Director, Inpatient Heart & Vascular Services, says, “Tracey plays a pivotal role in the organization’s success throughout the accreditation process and, most importantly, to the achievement of quality outcomes for all patients who experience ACS within our hospital and the community we serve.”

Harden adds, “Her previous experience and passion for the care of this patient population has already proven that her addition to our team was the most important first step in our pursuit of Chest Pain Center accreditation.”

Prashant Kaul, MD, FACC, has been named as the Chest Pain Center Medical Director, and the ST Elevation Myocardial Infarction (STEMI) committee has reformatted their assessments to include Chest Pain Center data and reporting.

“As a medical community, we have made significant advances over the last decade towards improving cardiovascular care,” says Dr. Kaul. “However, cardiovascular disease continues to account for more deaths than any other major disease entity in the United States.”

Dr. Kaul adds, “At the UNC Center for Heart & Vascular Care, we are dedicated to becoming one of the leading heart centers in the country. Our recent American Heart Association’s Mission: Lifeline Gold performance achievement award is a testament to the incredible teamwork that we already have in place to provide excellence in cardiac care.”

“The Chest Pain Center accreditation process itself now allows us to build on our success and further improve our clinical processes and systems of care. It underlines our commitment to the highest standards of cardiovascular care and to improving the cardiovascular outcomes of our patients,” states Dr. Kaul.

A new reperfusion protocol has already been drafted, as well as drafts for consistent, evidence-based order sets for ACS, chest pain observation, and STEMI.

A collaborative effort between the Center for Heart and Vascular Care and the Emergency Department is ongoing towards the establishment of a dedicated space and system of care for chest pain observation patients. This includes efficient and specialized care, 72-hour outpatient stress testing follow-up, and appropriate, evidence-based, and consistent patient disposition.

As the accreditation process continues, Blevins will be collecting data from physicians, nurses, and managers in the UNC Center for Heart and Vascular Care, as well as many other departments within the hospital.

Blevins says, “Since my arrival at UNC Hospitals, everyone has been extremely positive and excited about becoming a certified Chest Pain Center. The level of cooperation and commitment to quality witnessed during this process has been unprecedented. I am confident that UNC Hospitals will be successful in our quest for Accreditation as a Chest Pain Center.”