Transcript The Joint Commission - Light PP Presentation

Sudden Cardiac Arrest Measures
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Pilot Test Training
November 10, 2011
What You Need to Write Down
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http://manual.jointcommission.org
Training Objectives
To provide participants the information
needed to begin testing of the sudden
cardiac arrest performance measures
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– Understand the measure specifications
– Become familiar with the data collection
tool
WebEcho availability
Recorded and available for later
viewing
Can also be downloaded to one’s
computer
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– Available for 2 months on Conference
America server
– TJC will make link available
Sudden cardiac arrest accounts for
approximately 350,000 deaths in the United
States annually with a survival rate of 5-7%.
Many people affected have a history of
cardiac disease, countless others have no
cardiac history and are unaware of any risk
factors
There are no formal, evidence-based
guidelines or standards that are uniformly
recognized and employed
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Toll of Sudden Cardiac Arrest
Sponsors/Funders
– All sponsorships are through unrestricted
educational grants in which sponsors are at
arms-length.
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Development of a monograph and
performance measures is sponsored by
the Medtronic, Boston Scientific, and St.
Jude Medical corporations
Test and implement standardized, evidencebased performance measures for sudden
cardiac arrest treatment among
– Two measures address therapeutic
hypothermia – patient selection and
temperature maintenance
– One measure addresses time to defibrillation
– One measure addresses endotracheal tube
placement confirmation
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Goals and Objectives of Pilot Test Phase
Measure Milestones and Timeline
Specification
Development
Alpha
test
5/10
2/10
6/10-12/10
Final TAP Mtg
11/11
-4/12
5/11 –
8/11
Public
Comment
6/12
Pilot test
TAP meetings
9/10, 2/11 and
9/11
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Initial
TAP
Mtg
What’s in a Pilot Test?
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Data Collection and Submission
On-site Visits for reliability
Resource Tracking
Monthly Conference Calls
Six months in duration beginning for
discharges 11/1/11 and concluding for
discharges through 4/30/12.
All 4 measures to be implemented and
tested by participating sites
Data will be collected and transmitted
monthly using a secure web-based
collection tool
No sampling scheme applied
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Pilot Test
Determine Measure and Data Element
Reliability
Gain an understanding of the issues
related to implementation of sudden
cardiac arrest measures
Gain an understanding of resources
needed for implementation
Refine and enhance measure
specifications
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Pilot Test Objectives
Reliability Testing
– Two levels tested
–Measure level
–Data element level
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Definition: The extent to which a
measurement instrument yields
consistent, stable, and uniform results
over repeated observations or
measurements under the same
conditions each time.
Reliability Testing
–Identify false negatives and false
positives
–Code reasons for discrepancies
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Test Activities
– On-site visits of a subset of participating
hospitals
– Re-abstraction of a sample of records
previously transmitted to The Joint
Commission
– Compare results between the two
abstractions
On Site Reliability Visits
Focus Group Discussions
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– Discuss the measures and key
implementation issues
– Gather site recommendations for solutions
Since we will be re-abstracting the
same records as those submitted,
please keep a crosswalk of the blinded
numbers under which you submit a
case online and the actual medical
record number so it can be re-located
and re-abstracted.
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Reliability Site Visits
Tracking of Resources
Track once or twice during the test
Focus
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– Time spent in abstraction
– Time spent in data entry
– Time spent in implementation activities
– Type of staff involved
Monthly Conference Calls
Objectives
– Provide Education and Support
– Network
Schedule
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– Monthly
Conference Call Schedule
Tuesday, Nov. 29, 2:00-3:00, Central Time
Friday, Dec.16, 2:00 – 3:00,Central Time
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Invitations, agenda and call-in information will
be sent via e-mail.
Patient Discharge Month
Data Submission Date
November 2011
12/15/11
December 2011
1/15/12
January 2012
2/15/12
February 2012
3/15/12
March 2012
4/15/12
April 2012
5/15/12
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Data Collection and Transmission
Schedule
Site Visit Schedule
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Determined After 2-3 months of
Data Submission
Measure Information Forms
– Numerator and denominator, exclusions,
populations
Data Dictionary/Data Elements (Chart
Information to be Collected)
– Allowable values
– Notes for abstraction
Missing & Invalid Data
Online Data Entry
Accessing and Using the Data Collection
Tool
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Components
SCA-01 Timeliness of First
Defibrillation Attempt
SCA-02 Confirmation of Endotracheal
Tube Placement
SCA-03 Initiation of Therapeutic
Hypothermia
SCA-04 Maintenance of
Thermoregulation in Therapeutic
Hypothermia
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List of Measures
– Early defibrillation is critical in optimizing survival
outcomes from sudden cardiac arrest (SCA) due
to ventricular fibrillation (VF) or pulseless
ventricular tachycardia
– NRCPR investigators confirmed that, for patients
who arrest in the hospital with an initial rhythm of
ventricular fibrillation or pulseless ventricular
tachycardia (VT), defibrillation within 2 minutes
(compared to greater than 2 minutes) was
associated with a higher likelihood of survival to
discharge.
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SCA-01 Timeliness of First Defibrillation
Attempt
Rationale
 Denominator - The statement defining the
population of interest
– Cardiac arrest events occurring after the time of
arrival in patients with an ICD-9-CM Principal or
Other Diagnosis Code of cardiac arrest as
described in Appendix A-1 in whom the initial
rhythm is either ventricular fibrillation or pulseless
ventricular tachycardia.
 Numerator - The statement defining the cases
within the population of interest who have received
the specific care being measured
– First defibrillation shock delivered within 2
minutes (under 3 minutes) of cardiac arrest time
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SCA - 01
 Cardiac arrest events occurring prior to hospital
arrival in the ED
 Cardiac arrest events occurring wherein the initial
rhythm is not ventricular fibrillation or pulseless
ventricular tachycardia.
 Cardiac arrest events occurring in patients with a
code status order prior to the event
 Cardiac arrest events occurring during a specified
ICD-9-CM principal or other procedure (during
cardiac catheterization, during cardiac
electrophysiology testing, while on cardiac bypass
during open heart surgery, or while on
extracorporeal membrane oxygenation (ECMO).
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SCA – 01 Exclusions
 Cardiac arrest events occurring in patients with left
ventricular assist devices (LVADs) or bilateral
ventricular assist devices (BIVADs).
 Events occurring in patients with any device
implanted prior to cardiac arrest that is designed to
deliver a defibrillation shock in the event of cardiac
arrest (intra-cardiac defibrillators,
defibrillator/pacemakers, etc.).
 Age <18 years
– Note that events in ED patients and inpatients are
included; events prior to ED arrival are excluded.
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SCA – 01 Exclusions – cont’d
Data Elements – SCA-01
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–
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–
–
–
–
–
–
Arrival Date
Arrival Time
Birthdate
Cardiac Arrest
Cardiac Arrest Date
Cardiac Arrest Event Number
Cardiac Arrest Time
Implanted Device
Initial Rhythm
Left Ventricular Assist Device, Biventricular Assist Device
Code Status Order
Code Status Oder Date
Code Status Order Time
Patient Location
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Denominator
Data Elements – SCA - 01
Numerator
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– First Defibrillation Shock Date
– First Defibrillation Shock Time
SCA-02 Timely Confirmation of Correct
Endotracheal Tube Placement
– Unrecognized esophageal intubation is the most
serious complication of tracheal intubation and is
potentially catastrophic
– Chest X-Ray is not an acceptable method of
verification; other methods, such as auscultation
of the chest and fogging in the tube, likewise are
not reliable
– NRCPR database: 18% = no confirmation, 26%
= auscultation alone. Capnography or EDD =
increased ROSC and higher survival rates.
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Rationale
SCA-02
– Cardiac arrest events during which an endotracheal tube is
placed wherein confirmation of endotracheal tube
placement is documented within one minute of intubation by
a specified method :
–
–
–
–
–
Capnometry, or
Electronic waveform capnography, or
Esophageal detection devices, or
Exhaled CO2 colorimetric monitor, or
Revisualization with direct laryngoscopy
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 Denominator - The statement defining the
population of interest
– Cardiac arrest events during which an
endotracheal tube is placed.
 Numerator - The statement defining the cases
within the population of interest who have received
the specific care being measured
Exclusions
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Cardiac arrest events occurring while
an endotracheal tube is in place
Cardiac arrest events occurring prior to
hospital arrival
Age <18 years
Data Elements – SCA-02
– Arrival Date
– Arrival Time
– Birthdate
– Cardiac Arrest
– Cardiac Arrest Date
– Cardiac Arrest Event Number
– Cardiac Arrest Time
– Endotracheal Intubation Date
– Endotracheal Intubation Time
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Denominator
Data Elements – SCA-02
Numerator
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– Endotracheal Intubation Confirmation Date
– Endotracheal Intubation Confirmation
Time
– Methods of Intubation Confirmation
SCA-03 Initiation of Therapeutic
Hypothermia
– Mild hypothermia is the only therapy applied in the postcardiac arrest setting that has been shown to increase
survival rates.
– Of benefit in overall survival rates and neurological outcome
when used for survivors of out-of-hospital sudden cardiac
arrest
– Use of therapeutic hypothermia remains limited, with recent
estimates suggesting that approximately 2300 (range 300 to
9500) additional comatose patients with cardiac arrest
annually would achieve good neurological outcomes if
hypothermia were fully implemented in US hospitals
– Current evidence supports use only for out-of-hospital
arrest survivors.
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Rationale:
SCA-03
 Denominator - The statement defining the
population of interest
– Patients who sustain a cardiac arrest prior to hospital
admission, and who meet all of the following criteria:
– Ventricular fibrillation or pulseless ventricular tachycardia
is the initial rhythm at cardiac arrest, and return of
spontaneous circulation, and comatose
– Patients for whom therapeutic hypothermia is initiated
either prior to or after hospital arrival, or who are transferred
to another acute care facility for therapeutic hypothermia.
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 Numerator - The statement defining the cases
within the population of interest who have received
the specific care being measured
SCA – 03 Exclusions
Patients without return of spontaneous circulation
Patients not comatose
Cardiac arrest occurring after hospital admission
Expired after therapeutic hypothermia ordered but
prior to initiation of hypothermia
– Age < 18 years
– Documented reason for not administering
therapeutic hypothermia
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–
–
–
–
SCA-03 Data Elements
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–
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–
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–
–
–
–
–
Admission Date
Admission Time
Birthdate
Cardiac Arrest
Cardiac Arrest Date
Cardiac Arrest Time
Comatose
Date Therapeutic Hypothermia Ordered
Discharge Date
Discharge Disposition
Discharge Time
Initial Rhythm
Reason for Not Administering Therapeutic Hypothermia
Return of Spontaneous Circulation
Time Therapeutic Hypothermia Ordered
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Denominator:
SCA-03 Data Elements
–Arrival Date
–Arrival Time
–Date Therapeutic Hypothermia Initiated
–Discharge Disposition
–Reason for Transfer
–Therapeutic Hypothermia Initiated
–Time Therapeutic Hypothermia Initiated
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Numerator:
SCA-04 Maintenance of
Thermoregulation in Therapeutic
Hypothermia
– The Advanced Life Support Task Force of the
International Liaison Committee on Resuscitation
(ILCOR) in 2003 recommended that unconscious
adult patients with spontaneous circulation after
out-of-hospital cardiac arrest should be cooled to
32 degrees C to 34 degrees C for 12 to 24 hours
when the initial rhythm was ventricular fibrillation
– This recommendation was repeated by the
American Heart Association in the 2010
Guidelines for Cardiopulmonary Resuscitation
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Rationale
 Denominator - The statement defining the
population of interest
– Patients with an ICD-9-CM Principal or Other
Diagnosis Code of cardiac arrest as described in
Appendix A-1 for whom therapeutic hypothermia
is initiated after sudden cardiac arrest.
 Numerator - The statement defining the cases
within the population of interest who have received
the specific care being measured
– Patients for whom thermoregulation is
maintained. (There is at least one core
temperature recording every hour between 34
and 32 degrees C for a minimum of 12
continuous hours.
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SCA - 04
– Code Status order enacted after initiation
of therapeutic hypothermia
– Expired during therapeutic hypothermia
– Transferred out within 12 hours after
initiation of therapeutic hypothermia
– Non-system reason for early
discontinuance of therapeutic hypothermia
–Note that patients receiving
therapeutic hypothermia after inhospital or out-of-hospital arrest are
included
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SCA – 04 Exclusions
SCA – 04 Data Elements
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
Cardiac Arrest
Cardiac Arrest Date
Cardiac Arrest Time
Date Therapeutic Hypothermia Ended
Date Therapeutic Hypothermia Initiated
Discharge Date
Discharge Disposition
Discharge Time
Reason for Early Discontinuation of Therapeutic
Hypothermia
Code Status Order
Code Status Order Date
Code Status Order Time
Therapeutic Hypothermia Initiated
Time Therapeutic Hypothermia Ended
Time Therapeutic Hypothermia Initiated
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 Denominator
SCA – 04 Data Elements
Numerator
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– Thermoregulation Maintained
Diagnosis Codes
– 427.5 - Cardiorespiratory arrest
– 668.10 through 668.14, inclusive -Cardiac arrest
or failure following anesthesia or other sedation in
labor and delivery
– 997.1 - Cardiac arrest during or resulting from a
procedure, Cardiac insufficiency during or
resulting from a procedure, Cardiorespiratory
failure during or resulting from a procedure, Heart
failure during or resulting from a procedure
– V12.53 - Sudden cardiac death successfully
resuscitated
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Cardiac Arrest ICD-9-CM Code
Not all CPT codes for hypothermia are
specific to cardiac arrest; therefore, use
hypothermia records as a source to
identify patients receiving therapeutic
hypothermia.
Procedure codes for exclusionary
procedures in SCA-01 are given in the
data element “Patient Location”.
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Procedure Codes
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Questions
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Measure Set-Specific
Data Elements
 Denominator
– Cardiac Arrest
– Cardiac Arrest Date
– Cardiac Arrest Event Number
– Cardiac Arrest Time
– Implanted Device
– Initial Rhythm
– Left Ventricular Assist Device, Biventricular Assist
Device
– Code Status Order
– Code Status Oder Date
– Code Status Order Time
– Patient Location
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Data Elements – SCA-01
Cardiac Arrest
Equivalent terms for cardiac arrest include
Code Blue or cardiorespiratory arrest
The preferred source is the resuscitation
(Code Blue) record.
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Absence of both pulse and breathing.
–Y
The patient sustained a cardiac
arrest
–N
The patient did not sustain a
cardiac arrest
 The time of cardiac arrest for a patient NOT on a
cardiac monitor, or on a monitor that is not
recording, is the time a Code Blue is called.
 The time of cardiac arrest for a patient on a
recording cardiac monitor is the time documented on
the rhythm strip that the cardiac arrest occurred. For
patients on a recording monitor, this time
supersedes the time a Code Blue was called.
 For times that include “seconds”, remove the
seconds and record the time as is.
Example: 15:00:35 would be recorded as 15:00
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Cardiac Arrest Time
 The number used to identify the numerical sequence
of the cardiac arrest event for which data are being
abstracted. You may record data for up to 5 arrest
events.
 A cardiac arrest event may be a single instance of
cardiac arrest, or multiple arrests occurring within
minutes of each other
 If the time elapsed between cardiac arrests is more
than one hour, they are separate Cardiac Arrest
Event Numbers. If the time elapsed between arrests
is less than one hour, both arrests are part of the
same Cardiac Arrest Event Number.
Allowable values are 1, 2, 3, 4, and 5.
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Cardiac Arrest Event Number
 An implanted device is one inserted into the patient,
either temporarily or permanently, that is designed to
deliver a defibrillation shock at the time of a cardiac
arrest.
– Y (Yes)
There is a documentation that the
patient had an implanted device in place prior
to the date and time of cardiac arrest
– N (No)
There is no documentation that the
patient had an implanted device in place prior
to the date and time of cardiac arrest
 Internal pacemaker/defibrillators are included;
external or wearable devices, such as LifeVest, are
not included as implanted devices
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Implanted Device
 The first cardiac rhythm recorded during a cardiac
arrest on a cardiac monitor or automated external
defibrillator strip, or the first rhythm recorded on the
resuscitation record (code sheet).
– 1 The initial rhythm recorded during a cardiac
arrest via electronic interpretation on a cardiac
monitor or automated external defibrillator strip,
or recorded on the code sheet, was ventricular
fibrillation or pulseless ventricular tachycardia.
– 2 The initial rhythm recorded during a cardiac
arrest via electronic interpretation on a cardiac
monitor or automated external defibrillator strip,
or recorded on the resuscitation record (code
sheet) was asystole or some other rhythm.
– 3 Unable to determine (UTD) the initial rhythm
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Initial Rhythm
Left Ventricular Assist Device/BIVAD
 A left ventricular assist device (LVAD) is an
implantable mechanical pump that helps pump blood
from the left ventricle; a biventricular assist device; a
biventricular assist device (BiVAD) is a mechanical
pump implanted to assist both the right and left
– Y (Yes) There is a documentation that the patient had
either an LVAD or BiVAD in place prior to the date and time
of cardiac arrest
– N (No) There is no documentation that the patient had
either an LVAD or BiVAD in place prior to the date and time
of cardiac arrest
– NOTE: the device must be in place prior to cardiac
arrest to answer Yes.
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ventricles.
 A code status order is a physician order directing
actions to be taken or treatment approaches for a
patient in the event that his or her condition
deteriorates, in the event of cardiac or respiratory
arrest, or for patients who are or will become
terminal. Orders to terminate life support are also
considered code status orders.
 Includes: DNR, MOLST/POLST, Comfort Measures,
Hospice, etc.
 Excluded:
– Advance directive signed by patient or family with
no accompanying order
– Living will signed by patient with no
accompanying order
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Code Status Order
Patient Location
 Location of the patient at the time of cardiac arrest
– 1 – In the electrophysiology department/lab, in the cardiac
catheterization suite, on cardiac bypass during open heart
surgery, or while on extracorporeal membrane oxygenation
bypass.
– 2- cardiac arrest occurred prior to arrival in the ED
– 6 – in the general operating room
– 7 – in a general hospital area, such as lobby, elevator,
hallway, or during transport
– 8 – in a diagnostic testing or therapy area, such as
diagnostic imaging, nuclear imaging, or physical therapy
– 9 - in the ED
10 – other
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– 3 – In a monitored patient bed in a patient care unit,
including observation units
– 4 – in an unmonitored patient bed in a patient care unit,
including observation units
– 5 – in the dialysis suite
 When determining location, if there is a procedure record, such
as electrophysiology lab or ambulatory surgery, refer to the
recorded times of arrival and departure from those areas that
are recorded on the procedure note.
 Be as specific as possible
 When more than one choice is possible, choose the lowest
applicable number. For example, if an outpatient comes for
physical therapy and experiences a cardiac arrest in physical
therapy and is subsequently transported to the ED for
treatment, although Value 8 is applicable, Value 2 is also
applicable and you would choose value 2, cardiac arrest
occurred prior to arrival in the ED.
 The patient must be actively in the cardiac cath lab,
electrophysiology suite, or on open heart bypass or ECMO
bypass to answer Value 1. ICD9-CM codes are given to assist
abstraction, but their presence does not automatically require
Value 1 to be chosen; the patient must be undergoing the
bypass or in the specialty suites at the time of arrest.
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Patient Location – cont’d.
Data Elements – SCA-02
Numerator
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– Endotracheal Intubation Confirmation Date
– Endotracheal Intubation Confirmation
Time
– Methods of Intubation Confirmation
Methods of Intubation Confirmation
– Capnometry – Measurement of the partial pressure of
carbon dioxide in exhaled air, usually via a device attached
to the endotracheal tube. Such measurements are
abbreviated as PetCO2, plus a number.
– Electronic Waveform Capnography – Graphic tracing of
carbon dioxide content in exhaled air, abbreviated as
ETCO2.
– Esophageal Detection Devices – Mechanical devices used
to check for tube placement that rely on the anatomy of the
larynx and esophagus, more commonly used outside the
hospital by EMS systems.
– Exhaled CO2 colorimetric monitor – measurement of
exhaled carbon dioxide via infrared or other technology,
abbreviated as ETCO2.
.
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 The acceptable methods of confirmation of
intubation are:
– Revisualization with direct laryngoscopy – use of the
laryngoscope to revisualize the endotracheal tube insertion
point.
– Video-assisted laryngoscopy – Use of a video cable or
camera in a rigid laryngoscope blade to visualize the glottis;
images may be displayed on a LCD monitor. Common
names for this equipment are Glidescope, Laryflex,
McGrath, Airtraq, Macintosh, and others. This includes
fiberoptic visualization
Note: Begin abstracting at the time of endotracheal intubation
and look for any inclusion term within 30 minutes of
intubation.
 Examples of Inclusions: PetCO2 (plus any number), ETCO2
(plus any number), Esophageal detection device, EDD,
Capnometry, Capnography, Color Waveform, Cords revisualized.
 Exclusions: Bilateral breath sounds, Chest OK, Tube placed
OK, No gurgling, Chest X-Ray (CXR) for tube placement, Chest
PA and lateral, Abdomen negative for air
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Methods of Intubation Confirmation
SCA-03 Data Elements
Denominator:
–Comatose
–Reason for Not Administering
Therapeutic Hypothermia
–Return of Spontaneous Circulation
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Numerator:
– Reason for Transfer
Comatose
– Y (Yes) There is documentation the patient
was comatose.
– N (No) There is no documentation that the
patient was comatose.
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Comatose patients are those patients
documented as lacking purposeful
movement or lacking response to
painful stimuli or those patients for
whom the term “comatose” has been
entered into the clinical record
Reason for Not Administering
Therapeutic Hypothermia
– 1 - There is a system reason documented
for not administering therapeutic
hypothermia.
– 2 – There is another reason documented
for not administering therapeutic
hypothermia
– 3 -There is no reason documented for not
administering therapeutic hypothermia, or
unable to determine from medical record
documentation.
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Allowable Values:
Reason for Not Administering
Therapeutic Hypothermia
System reasons for not administering
therapeutic hypothermia are:
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– Equipment-related (e.g., machine malfunction, ice
machine broken, power outage)
– Staff-related (e.g., nursing staffed in numbers
inadequate for hypothermia)
 Patients with a return of spontaneous circulation are
those patients who have a detectable pulse without
human or mechanical assistance, such as chest
compressions or ventricular assistance devices,
after a period of pulselessness.
– Y Yes – there was return of spontaneous
circulation
– N No - there was no return of spontaneous
circulation
Note: Begin abstraction at the Cardiac Arrest Time
and end 2 hours after cardiac arrest, looking for a
pulse rate recording by any method (apical,
Doppler, etc.) at the same time that there are no
chest compressions or mechanical assistance.
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Return of Spontaneous Circulation
Reason for Transfer
Allowable Values:
– 1 –Transferred for therapeutic hypothermia
– 2 – Transferred for some other reason not related to
therapeutic hypothermia
– 3 – Unable to determine reason for transfer, or no reason
stated.
– The specific reason for transfer must be stated; if there is
no reason stated, select value 3, unable to determine the
reason for transfer.
– If the reason stated is “Cardiac Care”, “Cardiac ICU’, or a
similar term select value 2.
– If the reason for transfer is “consider hypothermia”, or “for
hypothermia administration”, select value 1.
– If the transfer occurs more than 24 hours after the time of
cardiac arrest, select N (No).
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Notes for Abstraction:.
SCA – 04 Data Elements
Denominator
– Date Therapeutic Hypothermia Ended
– Date Therapeutic Hypothermia Initiated
– Reason for Early Discontinuation of Therapeutic
Hypothermia
– Therapeutic Hypothermia Initiated
– Thermoregulation Maintained
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Numerator
Date Therapeutic Hypothermia Ended
– Use the date that re-warming began
– If therapeutic hypothermia is being given via a
machine that uses cooling catheters or
endovascular probe attached to a machine, and
the catheter or probe is inserted in advance of the
machine being turned on or activated, use the
date the machine was turned on. If the date the
machine was turned on is not documented, use
the date the catheter or probe was inserted.
– In some cases, this date may be the date before
arrival
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Date Therapeutic Hypothermia Initiated
Reason for Early Discontinuance of
Therapeutic Hypothermia
discontinuation of therapeutic hypothermia
– 2 There is any other reason documented for
discontinuation of therapeutic hypothermia
– 3 There is no reason documented for discontinuation of
therapeutic hypothermia
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Documentation of a reason for
discontinuation of therapeutic hypothermia
before the achievement of twelve continuous
hours of temperature between 32 degrees
and 34 degrees Celsius
– 1 There is a system reason documented for
Reason for Early Discontinuance of
Therapeutic Hypothermia
System reasons for discontinuation are:
If a system or staff-related reason is given for discontinuance,
select value 1, there is a system reason. If there is a medical
reason documented for discontinuance of hypothermia before
the achievement of 12 continuous hours of temperature in the
range of 32 to 34 degrees Celsius, select value 2, any other
reason. (An example of this might be uncontrollable
shivering.)
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– Equipment-related (e.g., machine malfunction, ice
machine broken, power outage)
– Staff-related (e.g., nursing staffed in numbers
inadequate for hypothermia)
Therapeutic Hypothermia Initiated
– Therapeutic hypothermia is a process of cooling a
patient to a temperature range of 34 degrees to
32 degrees Centigrade following cardiac arrest.
Cooling may be accomplished in a variety of
ways that include administration of iced or
refrigerated saline, application of cooling
blankets, application of ice bags to various points
of the body simultaneously, or by use of
therapeutic hypothermia systems that use
indwelling central venous cooling catheters and
endovascular probes. In some cases, therapeutic
hypothermia may be initiated prior to hospital
arrival.
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Documentation that therapeutic hypothermia
was begun.
Thermoregulation Maintained
– Definition: Maintenance of thermoregulation in
therapeutic hypothermia occurs when there is at
least one core temperature recording between 32
and 34 degrees Celsius every hour for a
minimum of twelve continuous hours.
– Suggested Data Collection Question:
– Allowable Values:
– Yes, No, UTD
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Was there a core temperature recording every
hour that was between 32 and 34 degrees
Celsius for a minimum of 12 continuous hours?
Begin assessing temperature when the first
temperature recorded is between 34 and 32
degrees Celsius. Since SCA-04 assesses
the maintenance of appropriate temperature
for a minimum of 12 continuous hours, there
must be a temperature recording between 32
and 34 degrees Celsius as the first
temperature recorded in each of the eleven
hours after the first hour in which that
temperature range is reached
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Thermoregulation Maintained
If there is an hour within those next eleven
hours in which there is no first temperature
recording between 32 and 34 degrees
Celsius, look at the next hour in which a
temperature is recorded within 32 to 34
degree Celsius and count that as the first
hour of another 12 hour period.
If there is no continuous 12 hour period in
which the first temperature recorded each
hour was within the range of 32 to 34
degrees Celsius, select value 2, No.
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Thermoregulation Maintained
Thermoregulation Maintained
– Any probe inserted in the cardiovascular system,
such as pulmonary artery catheter or
endovascular probe
– Any temperature probe inserted in the bladder or
rectum
– Tympanic (ear) temperature
– Axillary
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Conversion chart for Fahrenheit to Celsius
given, as well as calculation formula
If there is more than one temperature
recorded at the same time from different
sources, use the temperature source in the
following order:
Code tables for cardiac arrest are in
Appendix A-1; the hypothermia code is not
exclusive to cardiac arrest and is not often
used.
Especially if you are collecting data while
patients are still hospitalized, use Code Blue
Records to identify patients for measures 01,
02, and 03. Also, check ED records,
especially for Measure 03, looking for
cardiac arrest and intubations.
For measure 04, use hypothermia
administration records.
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How to Identify Patients Eligible for the
Measures?
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http://manual.jointcommission.org
Enter data into the online form
Keep a crosswalk of the patient
identification numbers
First conference call is on Tuesday
November 29th.
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Questions
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Navigating the
Sudden Cardiac Arrest Project
Data Collection Tool
GET STARTED
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Access the project website at: http://manual.jointcommission.org
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LOG IN TO THE PROJECT SITE
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SUDDEN CARDIAC ARREST PROJECT
From this page you can:
 Access your hospital page
 Access the Measure and Data Element info
 Find data submission dates
 Submit questions and provide feedback
 Find news, tools and other resources that may
become available during the project
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SUDDEN CARDIAC ARREST PROJECT PAGE
YOUR HOSPITAL PAGE
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From this page you can:
 Add or update your hospital information
 Enter new records
 View and update existing records
 Mark records as “complete”
 Review records that have been completed
 Identify records that have been flagged for reabstraction
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Updating Hospital Demographic Information
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Updating Hospital Demographic Information
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Entering New Records
View and update existing records
Click the Pencil
icon to “Edit” an
existing record
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Click the UBCI
number to “expand”
an existing record
Mark records as complete
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Click the empty box
to “Complete” and
“Lock” a record
Review records that have been completed
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Click the “Complete” radio
button and then click “Filter” to
view completed records
Identify records flagged for re-abstraction
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The “Lock” icon means the
record is complete. The blue
flag icon means the record will
be re-abstracted.
ENTERING NEW RECORDS
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Note: hovering over the green “i” next to a data element will show you the
question and allowable values associated with that data element as well as
a link to the data element page.
ENTERING NEW RECORDS
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Once you have completed data entry for this record, save the
data record.
DATA ENTRY CASE SCENARIOS
general patient data elements
The “:” colon needs to be added to all “time” fields –
in the HH:MM time format.
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if the patient was not
admitted, leave the
Admission Date and
Time blank
Discharge Date, Birthdate, and Admission Date
have the format locked in place, but for Arrival
Date, you will need to add the “-“ dashes to the
MM-DD-YYYY format.
CARDIAC EVENT SECTION
If Tube Insertion is “N”, you can leave the
remaining Intubation elements blank
Answer Therapeutic Hypothermia Initiated
for each Cardiac Event entered
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If Code Status Order is “N”, enter
UTD for date and time
Click “Save Data Record” when all
data entry is finished for the patient
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THERAPEUTIC HYPOTHERMIA SECTION
FIND EXISTING RECORDS
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To find a record by Unique Blinded Case Identifier (UBCI), enter
the UBCI and ignore the “Complete” and “Incomplete”, then click
“Filter” button.
VIEW RECORD’S DETAILS
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To view an existing record, click on the UBCI number. You can contract the drop down by
clicking on the ‘-’or expand by clicking on the ‘+’ before the different sections.
EDIT EXISTING RECORDS
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To edit the “General and other patient-level data elements”, click
on the pencil icon.
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MARKING RECORDS AS “COMPLETE”
VIEW EXISTING RECORDS
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To view the complete records, check the “Complete” radio
button then click “Filter” button.
REVIEWING COMPLETED RECORDS
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The completed records are LOCKED and can not be edited. The
blue flag indicates that record will be re-abstracted.
UNLOCK A RECORD
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To send an e-mail request to unlock a record, click on the “lock” icon and an e-mail form
will appear. In the e-mail, please briefly explain why the record needs to be unlocked (e.g.,
Accidentally clicked the “Complete” checkbox).
ASK A QUESTION
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On the SCA project
page – the very
bottom has a link to
ask a clinical or
technical question.
The FAQ table also
will display the
common questions.
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QUESTIONS?