DASpecialists, LLC

Webinar attendee comments

"We very much enjoyed the (June 14) STS documentation webinar. Best one I have actually seen"

L. Keys, Performance Improvement Analyst I`

Arkansas Heart Hospital

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"Very Helpful"

J. Morris, RN BSN

Quality Management

King's Daughters Medical Center

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"I would like to thank all of you for taking the time to do this very important presentation. It was very informative and very helpful to me. i do appreciate everyone's efforts in helping us meet this big change in the STS v 2.73 documentation and abstraction process"

S. Krivanek, RN, BS

Clinical Research Coordinator

Eastern Idaho Regional Medical Center

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"We thought the (June 14) material was timely and very well presented. The presenters were knowledgeable and we felt the entire presentation was excellent"

J. Derrick, RN - PI Analyst

Arkansas Heart Hospital

PCI Documentation webinar Q&A

DISCLOSURE: DASpecialists, LLC has answered the following questions related to our experience abstracting and submitting data to the STS Registry as it pertains to the documentation of the changes that take effect July 1, 2011. DASpecialists, LLC has redirected specific abstraction issues that were asked about to the STS as they are the ultimate authority on the abstraction definitions of the STS Registry.

Question: Will the presentation be available after the webinar?

Answer: The webinar’s PowerPoint presentation is not available, but  condensed reference materials will be emailed at a later date to all participates.   For more information on any of the contents of this presentation, please contact DASpecialists at 336-684-7253 or at support@daspecialists.com.

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Question: For lesion length - if there are consecutive stents placed, should we list the total length of all stents inserted?

Answer: Yes, that is correct as long as the stents as specified in the question are the longest devices used during the case (which in most cases they are).

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Question: What about elevated troponin’s and MB’s after a particularly difficult PCI?  Wouldn't you expect an elevation after an extensive intervention that might not necessarily be an MI?

Answer: Yes, it is expected, but the elevation of Troponin and/or CK-MB above three times the upper normal limit as specified by your facility’s lab will still be considered a Post-procedure MI.

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Question: For the rehab referral- is this only for PCI or CABG as well?

Answer: Referral to Outpatient Cardiac Rehab is only for PCI.  Those with Dx are exempt and those who had PCI and were sent to CABG will be collected but not included in the population as reported on the quarterly Executive Summary.  The NCDR has stated that for patients who go for CABG, the responsibility to refer to OP Cardiac Rehab falls to the facility/department/surgeon that performed the CABG (see the NCDR CathPCI FAQ’s for more info on this question).

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Question: Will having a staff member from the cardiac rehab program, which is “housed” in our hospital, document that they have seen the patient and they meet/do not meet criteria for acceptance count as a referral to OP Cardiac Rehab?

Answer: Yes it will as long as the staff member making the documentation in the chart clarifies that the documentation is for the OUTPATIENT Cardiac Rehab.

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Question: Can documentation by a nurse be an acceptable form to determine if the patient has a Family Hx of premature CAD?  For instance, the MD states in his H&P that the mother passed away as a result of an MI.  The nurse then gets clarification from the patient that the mother was 49 years old and documents as such….will that work?

Answer: Yes, this is acceptable.

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Question: Can we remove specific devices from the list of intracoronary/closure devices as supplied by the ACC?

Answer: If you are using a third party vendor (Apollo, Axis PATS, Cedaron, etc,) , you should contact your vendor and get instructions on how to remove them if it is possible to remove them.  If you are using the on-line ACC/NCDR tool, you cannot remove them.

STS Documentation webinar Q&A

DISCLOSURE: DASpecialists, LLC has answered the following questions related to our experience abstracting and submitting data to the STS Registry as it pertains to the documentation of the changes that take effect July 1, 2011. DASpecialists, LLC has redirected specific abstraction issues that were asked about to the STS as they are the ultimate authority on the abstraction definitions of the STS Registry.

Q: For the five meter walk test if the patient is unable to perform, do you just answer No that it was not perfomed or do you answer the highest score indicating that the patient was too frail to perform?

A: If not performed, enter ‘no’.

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Q: For Ace/Arb at discharge it appears from the data collection sheet that you can only answer Yes  or No contrainidicated or No not indicated.....what do you answer for the patients who don't receive the ACE/ARB on discharge with no documented contraindication and an EF < 40%

A: Unfortunately, you can only choose no, this cannot be fixed until next upgrade. STS does not track this as a quality measure but it is a core measure for CHF so you will want to track your exclusions.

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 Q: I was on the webinar today for STS cardiac database. Someone who I work with told me you all mentioned something about having the database form as part of your record. I missed that. Would you tell me what was said regarding this?

 A: The form that I think you are referring to is the STS Valve worksheet. It is part of the STS Data Collection Tool and has been implemented by several of the hospitals that we work with into their permanent medical record as part of the OR report.

 A: Yes, STS does go by surgery date and new changes begin July 1 2011. It is unclear from the STS Training Manual and Data Collection Form whether echo findings should be routinely documented as in the past STS Versions. This question was sent to STS and we have not heard from them.

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 Q: One question regarding pre-op meds. The training manual says to code Effient (prasugrel) under "ADP inhibitors within 5 days" but also mentions it as an example of what to code in the field for other "Antiplatelets within 5 days". I'm assuming "ADP inhibitors within 5 days" is the most appropriate field?

 A: It does appear from the Training Manual that it could be coded in both places, but the STS is the best resources for this question. Please send a FAQ to the STS.

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 Q: I would like clarification if the incision made into the atria for access to the mitral valve can be collected as a 'cut and sew' procedure for arrhythmia control?

 A: The STS would need to answer this question. Please send a FAQ to them.

 A: Most if any of the elements that we discussed during the webinar will affect your Star Rating. For an element-by-element breakdown of what will or will not affect your Star rating, contact the STS.

 Q: Is this ECHO they are referring to an intra-OP TEE? ECHO-assessment of Ascending Aorta/Arch'?

 A: Intra-op echo's can be used to assess the ascending aorta and we frequently see physicians document their assessment of the ascending aorta from the intra-op echo.

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 Q: Which blank fields might cause our cases to be left out of the harvest?

 A: STS has minimal requirements for harvest inclusion which include participant ID, Data Version, patient age, DOB and surgery date.

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 Q: Would microplegia be classified as blood or other cardioplegia?

 A: Our experience leads us to classify microplegia as blood, but for a definitive answer you should contact the STS.

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Q: Can the PA systolic be measured at the time of cath or does STS want it at the time of OR?

 A: Prior to OR is preferred.

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 Q: Is the Five Meter Walk test similar to the 6:00 minute walk test?

 A: Yes, very similar. If you look in the training manual under sequence 1161 you will find very detailed instructions on this new element.

A: Awaiting verification from the STS. Check back for their response which we will post upon receipt.

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 Q: Which parts of all of this data is critical to the star rating system granted by the STS?

 A: Most if any of the elements that we discussed during the webinar will affect your Star Rating. For an element-by-element breakdown of what will or will not affect your Star rating, contact the STS.

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 Q: In your opinion, would you fill in the mitral valve disease section if the patient had mild mitral insufficiency or mild mv stenosis?

 A: It is unclear from the STS Training Manual and Data Collection Form whether echo findings should be routinely documented as in the past STS Versions. We are awaiting verification from the STS. Check back for their response which we will post upon receipt.

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 Q: Do you expect us to fill out mitral valve etiology if "mild" was dictated on heart cath?

 A: It is unclear from the STS Training Manual and Data Collection Form whether echo findings should be routinely documented as in the past STS Versions. We are awaiting verification from the STS. Check back for their response which we will post upon receipt.

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 A: All of the hospitals that we work with will be collecting all the additional data and are currently in the process of updating their order sets and other protocols to appropriately address the additional data elements.

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 Q: Do you know if the 5 meter walk test is Risk Adjusted? Seems unfair to answer NO if your patient is too critical to walk?

 A: It does not appear to be based on the STS Training Manual. The Training manual does state that it is a measure of frailty in ambulatory patients.

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 Q: If you have two Echo reports couple of days apart, can you use the data off both of these, or do you only use the one most recent to surgery. Sometimes they don't address a valve, but they do on the other.

 A: DASpecialists always uses all the available data contained in the medical record to complete the STS form.

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 Q: So if you have tricuspid regurg and they are not having a tricuspid procedure, do you call that tricuspid valve disease or not?

 A: It is unclear from the STS Training Manual and Data Collection Form whether echo findings should be routinely documented as in the past STS Versions. We are awaiting verification from the STS. Check back for their response which we will post upon receipt.

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 Q: It seems our doctors do some of the prep of vein before the vein is out. How do we answer this?

 A: The Training manual specifies that we are to indicate the time needed to prepare the harvested graft from removal until suitable for use.

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 Q: I am still confused about the valve data that we usually get on ECHO. Are you saying we do not put if they have valve regurg unless the doctor says the valve is diseased?

 A: It is unclear from the STS Training Manual and Data Collection Form whether echo findings should be routinely documented as in the past STS Versions. We are awaiting verification from the STS. Check back for their response which we will post upon receipt.

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 Q: How is the STS worksheet for Valvular disease being incorporated into the permanent record?

 A: Physicians are using it as their post-op note. Check with your Hospital's Medical Record Department to see how you can best incorporate it into your record.

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 Q: Is the MELD score going to be part of the risk assessment?

 A: MELD will be automatically calculated by your system software. It is unclear as what STS plans on doing with this data at this point.

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 Q: Can we use outside hospital data?

 A: Yes as long as it is contained in the patient’s medical record.

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 Q: What is the time frame for pre op labs for the MELD score?

 A: You are to capture pre-op labs closet to entry into the OR or prior to Anesthesia management. There does not appear to be time limit in the Data Specifications or Training Manual

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Q: For post-op echo, can we take info from the Intra-op TEE done after surgery, but before leaving the OR?

 A: No, it must be the info from the echo done after the patient leaves the OR.

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 Q: How far ahead can an echo be done and used in the data collection for valves? The NCDR allows 6 months.

A: No time limit in the STS Data Specifications or Training Manual.

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 Q: Will documentation on conduit sheet qualify as a source document if it is NOT included in the pt record?

 A: The STS would need to answer this question. Please send a FAQ to them.

2012 Summer Webinar Series Schedule

Coming soon

Webinar Presentation Downloads

STS Registry v2.73 "Is Your Documentation Ready?"- Condensed version of presentation.  Reader must have Adobe PowerPoint to open

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2011 STS Conference Slide Presentations

 Coming the last week of January 2012

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DASpecialists is an independent service company.  The above webinar is a compilation of the company's analysis and feedback reports developed for existing hospital clients and is based on guidelines outlined in the STS Registry Specification Manual.  DASpecialists, LLC does not represent the STS Registry.  All information is accurate and verifiable.