Increase capacity with chest pain accreditation

If you already are working to optimize the care of cardiac patients in your ED, seeking accreditation as a chest pain center can be a good way to draw attention to your efforts, improve capacity, and make sure you maintain those standards over time. And if you’re not yet focusing on how you can improve in this area, accreditation could be one more reason to get started.

That’s the advice from an ED manager who is seeking chest pain accreditation for six additional EDs at Florida Hospital in Orlando, after receiving the state’s first accreditation as a chest pain center in one of the EDs. The hospital has seven campuses in the area.

Florida Hospital’s first ED was accredited as a chest pain center by the Society of Chest Pain Centers and Providers (SCPCP) in Columbus, OH, which began offering accreditation in 2003.

Florida Hospital’s seven EDs treat more than 18,000 patients with chest pain annually and have been working for years to improve cardiac care, according to Jackie Mueller, RN, MSHS, administrative director of emergency services and flight medicine.

Some of the improvements have included shorter times between arrival in the ED and the patient’s electrocardiogram (EKG) and faster transfers for angioplasty and other treatment. Chest pain patients are transferred to the cath lab within 30 minutes, when necessary. Patients needing angioplasty are transferred within 15 minutes. All of the clinical improvements were based on best practices in cardiology from the Dallas-based American Heart Association and current literature, Mueller says.

"The primary goal was to improve patient care, but there also is a tremendous benefit to the capacity for the ED because we’ve developed a continuum of care with places appropriate for the patient, such as a chest pain observation unit," she says. "Once we’ve made some very quick decisions about a patient, we’re able to move them out of the ED in a timely manner to continue the flow of patients through the ED."

With the focus on improved care of chest pain patients, the ED is able to turn over beds for those patients faster, and staff are excited about providing the best treatment possible.

That’s all well and good, but an ED could pursue the same goals without accreditation, right? That’s true, Mueller says, but accreditation provides the recognition that the ED staff deserve and helps get the most public relations benefit out of the improved care.

"Staff appreciate hearing that not only is all this hard work paying off in better quality care, better capacity, and better relationships with the department of cardiology, but they’re also being recognized for what they’re doing," she explains. "There are lots of good reasons to take the steps to improve cardiac care, and then accreditation is icing on the cake."

The hospital’s marketing department is making use of the new accreditation by pointing to it as a mark of excellence that sets the hospital apart from others in the state, Mueller points out.

Actually obtaining the accreditation was not difficult, she says. Most of the work involved compiling information for the visit, such as education plans and how the hospital’s care plan includes working with emergency medical services.

"They came in for a one-day site visit and reviewed what we do, visited the different areas, and went through some information with us," Mueller adds. "It wasn’t much of a burden. All the hard work is in the clinical processes that make you eligible for accreditation."

The SCPCP requires a hospital to meet specific criteria for accreditation, such as integrating the ED with the local EMS and ensuring prompt transfers out of the ED. To start preparing for chest pain accreditation, the hospital can purchase a kit that includes a manual, application, self-evaluation, and other materials for $150.

When the hospital is ready for a site visit to seek accreditation, the fee is $15,000. (For more on the accreditation program, see sources at end of article.)

About 30 chest pain centers have been accredited so far, and another 30 or so should be accredited by May 2004, one year after the program was announced, says Robert Weisenburger Lipetz, executive director of the SCPCP. "The number of accredited facilities is greatly exceeding expectations," he says. "It’s looking like the market is embracing this idea."

Much of the accreditation criteria focus on process improvement systems, Lipetz adds. The SCPCP also requires a collaborative effort between many hospital departments, most notably the emergency and cardiology departments, he explains. The accreditation criteria are intended to keep the hospital focused on providing the best cardiac care possible even as clinical guidelines change. "We’re not talking about a form that you fill out and throw in a drawer until the inspectors come by again," Lipetz says. "If you meet our criteria, you will have a system of protocols, policies, people interactions, and everything the hospital will need to keep moving forward and creating better outcomes."

While accreditation as a chest pain center requires a hospitalwide effort, the ED manager always will be a key player, if not leading the charge, Mueller explains. Nearly all chest pain patients enter the hospital through the ED, she notes, and the quality of care in the ED can affect everything that happens afterward.

Mueller and the rest of the ED team worked collaboratively with physician groups and the cardiology department to improve quality of care. "Being able to quickly identify the patients needing cardiac care and have a process for moving those patients — that’s where the ED manager is going to be working the hardest and getting the biggest benefit," she adds.

Sources

For more on chest pain accreditation, contact:

Robert Weisenburger Lipetz, Executive Director, Society of Chest Pain Centers and Providers, 4900 Reed Road, Suite 209, Columbus, OH 43220-3164. Phone: (614) 326-1264. Web: www.scpcp.org.

Jackie Mueller, RN, MSHS, Administrative Director of Emergency Services and Flight Medicine, Florida Hospital, 601 E. Rollins St., Orlando, FL 32803.