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ACE reviews highlight inadequate clinical documentation in cath labs
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Two studies presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions reveal insufficiencies in clinical documentation and other quality metrics at cardiac catheterization labs that underwent Accreditation for Cardiovascular Excellence review.
The Accreditation for Cardiovascular Excellence (ACE) review teams found medical records missing key clinical information, cardiac catheterization reports lacking data needed to determine patient risk, and inconsistent use of random case reviews as a tool for ensuring quality and appropriateness. A significant amount of variation in documentation among sites was also found during these reviews, according to a press release.
Bonnie H. Weiner
Courtesy of SCAI
For one study, researchers gathered data on quality processes from the first 10 medical centers to undergo ACE review. They reviewed 441 medical records from patients who underwent cardiac catheterization, percutaneous coronary intervention or both. Overall, more than 93% of charts met the reporting requirements of the Joint Commission. However, certain areas needed improvement. Radiation exposure was documented in just 87% of records, and a combination of X-ray exposure time and absorbed radiation dose was documented in just 77.5%. In addition, documentation of angina class (28% of records), extent of risk associated with the patient’s CAD based on stress testing (8%) and NYHA class (21.8%) was low.
The second study included data from a review of 478 randomly selected angiograms and accompanying cath reports from the same 10 facilities. Adequate PCI results were found in 89% of cases. However, information on patient risk and appropriateness of PCI was often insufficient or unclear in the cath reports. Evidence of ischemia was documented in only 46% of patients. About 8% of patients had IVUS or another test to determine whether PCI was needed, but half of these studies were inadequate or indeterminate, and documentation was poor. Overall, only 66% of nonurgent PCIs could be deemed appropriate based on the angiogram and information available in the cath report. In 26% of cases, appropriateness of PCI was considered uncertain, primarily because of the limited documentation. Only 8% of procedures were deemed in appropriate, according to the release.
The cardiac catheterization laboratories in these studies volunteered to be the first to undergo ACE accreditation, Bonnie H. Weiner, MD, FSCAI, board chair and chief medical officer for ACE, said.
“It really comes down to the documentation. As physicians, we’re doing a good job taking care of the patients, but in terms of quality processes, we could do better,” Weiner said. “It is our responsibility to make sure the data we’re submitting [are] as valid, complete and authentic as we can possible make it.”
For more information:
- Weiner BH. Abstract B-015.
- Weiner BH. Abstract C-015. Both presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 9-12, 2012; Las Vegas.
Disclosure: Dr. Weiner reports receiving consulting fees and other remuneration from ACE.
Perspective
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Jeff Marshall, MD, FSCAI
The idea of accrediting cath labs is long overdue. In the past, we have accredited nuclear medicine laboratories and echocardiography laboratories, but it was not until a few years ago that SCAI, and later the American College of Cardiology, launched ACE, an independent organization that evaluates cath labs, accredits those that achieve pre-set quality benchmarks and helps cath lab teams both identify deficiencies and address them. This abstract shows two things: One, that review by an ACE team – simply the process of having someone from the outside come in and look at what we do and how we do it – reveals correctable deficiencies and, two, that most of the time people are undergoing cardiac catheterization and interventions for the right reasons, but we need to do a better job with the paperwork. The good news is that documentation insufficiencies can be addressed in a straightforward manner once you are made aware there is an issue. That is a real benefit to having your cath lab reviewed by ACE.
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