Chest Pain Centers

Breuckmann, Frank; Burt, David R.; Melching, Kay; Erbel, Raimund; Heusch, Gerd; Senges, Jochen; Garvey, J. Lee

doi:10.1097/hpc.0000000000000041

Cited by 26 publications

(6 citation statements)

References 19 publications

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“…So far, only Germany and the USA provide such widely adopted national programs for professional society accreditation as a CPU [18]. The implementation of standardized operating procedures represents a basic element to provide care that adhered to the guidelines.…”

Section: Discussionmentioning

confidence: 99%

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

et al. 2016

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Objectives: To analyze the current usage of transthoracic echocardiography (TTE) as a rapid, noninvasive tool in the early stratification of acute chest pain in certified German chest pain units (CPUs). Methods: A total of 23,997 patients were enrolled. Analyses comprised TTE evaluation rates in relation to clinical presentation, risk profile, left ventricular impairment, final diagnosis and invasive management. Critical times were assessed. Multivariable analyses for independent determinants for the use of TTE were performed. Results: TTE evaluation was available in CPUs in 70.1% of cases. It was associated with lower rates of invasive management in unstable angina pectoris (UAP) and with higher rates in patients with initially suspected non-cardiac origin of symptoms and/or reduced systolic function (p < 0.05). Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was an independent determinant favoring TTE evaluation [NSTE-myocardial infarction: odds ratio (OR) 1.62; UAP: OR 1.34; p < 0.001 for both]. Clinical signs of heart failure (OR 1.31; p < 0.001), referral by emergency medical service (OR 1.18; p < 0.001) and kidney failure (OR 1.16; p < 0.05) were independently associated with higher TTE rates. TTE did not delay door-to-balloon times. Conclusions: About two thirds of the patients admitted to certified CPUs received TTE evaluation, with the highest rates being in ACS patients, and thereby providing diagnostic information supporting or refuting further invasive management.

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Section: Discussionmentioning

confidence: 99%

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

et al. 2016

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“…Organised primary percutaneous coronary intervention (PCI) networks are associated with higher reperfusion therapy rates 8. The purpose of a chest pain centre (CPC) accreditation programme is to monitor and encourage organisations and clinicians to adopt standards for patients with chest pain, by identifying and then resolving real and perceived barriers 4–6 8–10…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of chest pain centre accreditation on the management of acute coronary syndrome: a retrospective study using a national database

Sun

Fang

et al. 2020

BMJ Qual Saf

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BackgroundLarge-scale real-world data to evaluate the impact of chest pain centre (CPC) accreditation on acute coronary syndrome (ACS) emergency care in heavy-burden developing countries like China are rare.MethodsThis study is a retrospective study based on data from the Hospital Quality Monitoring System (HQMS) database. This study included emergency patients admitted with ACS to hospitals that uploaded clinical data continuously to the database from 2013 to 2016. Propensity score matching was used to compare hospitals with and without CPC accreditation during this period. A longitudinal self-contrast comparison design with mixed-effects models was used to compare management of ACS before and after accreditation.ResultsA total of 798 008 patients with ACS from 746 hospitals were included in the analysis. After matching admission date, hospital levels and types and adjusting for possible covariates, patients with ACS admitted to accredited CPCs had lower in-hospital mortality (OR=0.70, 95% CI 0.53 to 0.93), shorter length of stay (LOS; adjusted multiplicative effect=0.89, 95% CI 0.84 to 0.94) and more percutaneous coronary intervention (PCI) procedures (OR=3.53, 95% CI 2.20 to 5.66) than patients admitted in hospitals without applying for CPC accreditation. Furthermore, when compared with the ‘before accreditation’ group only in accredited CPCs, the in-hospital mortality and LOS decreased and the usage of PCI were increased in both ‘accreditation’ (for in-hospital mortality: OR=0.86, 95% CI 0.79 to 0.93; for LOS: 0.94, 95% CI 0.93 to 0.95; for PCI: OR=1.22, 95% CI 1.18 to 1.26) and ‘after accreditation’ groups (for in-hospital mortality: OR=0.90, 95% CI 0.84 to 0.97; for LOS: 0.89, 95% CI 0.89 to 0.90; for PCI: OR=1.36, 95% CI 1.33 to 1.39). The significant benefits of decreased in-hospital mortality, reduced LOS and increased PCI usage were also observed for patients with acute myocardial infarction.ConclusionsCPC accreditation is associated with better management and in-hospital clinical outcomes of patients with ACS. CPC establishment and accreditation should be promoted and implemented in countries with high levels of ACS.

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“…Differences in healthcare system design across the globe are therefore an important factor in the discussions about impact and implications from heterogeneous external evaluation methods (Bracewell and Winchester, 2021). Comparisons of accreditation standards specifically may even not be possible to do due to differences in transparency, and some countries do not even reveal their accreditation standards to the public (Breuckmann et al. , 2015; Bracewell and Winchester, 2021).…”

Section: Discussionmentioning

confidence: 99%

Comparison of external evaluation policies and regulations for quality improvement and safety of health services in Norway and the United States

Øyri,

Bates,

Wiig

2023

IJHG

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Purpose The authors compare perspectives on external evaluation of health service provision between Norway and the USA. External inspection and accreditation are examples of internationally wide-spread external evaluation methods used to assess the quality of care given to patients. Different countries have different national policy strategies and arrangements set up to do these evaluations. Although there is growing attention to the impact and effects on quality and safety from external evaluation, there is still a gap in knowledge to how structures and processes influence these outcomes. Accordingly, the purpose of this article is to describe the structures and processes in external evaluation designed to promote quality improvement in Norway and the USA with attention to comparison of enablers and barriers in external evaluation systems.Design/methodology/approach Data collection consisted of documentary evidence retrieved from governmental policies, and reviews of the Joint Commission (the US), international guidelines, recommendations and reports from the International Society for Quality in Health Care, and the World Health Organization, and policies and regulations related to Norwegian governmental bodies such as the Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Norwegian Board of Health Supervision . Data were analyzed inspired by a deductive, direct content analytical framework.Findings The authors found that both accreditation and inspection are strategies put in place to ensure that healthcare providers have adequate quality systems as well as contributing to the wider risk and safety enhancing management and implementation processes in the organizations subjected to evaluation. The US and the Norwegian external regulatory landscapes are complex and include several policymaking and governing institutions. The Norwegian regulatory framework for inspection has replaced an individual blame logic with a model which “blames” the system for inadequate quality and patient harm. This contrasts with the US accreditation system, which focuses on accreditation visits. Although findings indicate an ongoing turning point in accreditation, findings also demonstrate that involving patients and next of kin directly in adverse event inspections is a bigger part of a change in external inspection culture and methods than in processes of accreditation.Research limitations/implications The message of this paper is important for policymakers, and bodies of inspection and accreditation because knowledge retrieved from the comparative document study may contribute to better understanding of the implications from the different system designs and in turn contribute to improving external evaluations.Originality/value Although there is a growing attention to the impact and effects on quality and safety from external evaluation, the implications of different regulatory strategies and arrangements for evaluation on quality and safety remain unclear.

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Chest Pain Centers

Abstract: Enhanced collaboration among international bodies interested in promoting high quality care might extend the opportunity for accreditation of facilities that treat cardiovascular patients, with national programs designed to meet local needs and local healthcare system requirements.

Cited by 26 publications

References 19 publications

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

Effectiveness of chest pain centre accreditation on the management of acute coronary syndrome: a retrospective study using a national database

Comparison of external evaluation policies and regulations for quality improvement and safety of health services in Norway and the United States

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