Improving on AUC Presenter Disclosure Information Cornelia Anderson BSN, RN To following relationships exist related to this presentation: No Disclosures Objectives Discuss History & Purpose of AUC Discuss key data collection points that affect AUC Indication Demonstrate knowledge of AUC Indications through participation with ARS Discuss areas of potential for quality improvement Discuss the relationship between PCI Indication and the AUC Indication 1
History of AUC History of AUC Focus of the AUC Appropriate use criteria are intended to assist patients and clinicians, but are not intended to diminish the acknowledged difficulty or uncertainty of clinical decision making and cannot act as substitutes for sound clinical judgment and practice experience. 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update pg 4 2
What is Appropriate? Coronary revascularization is appropriate when the expected benefits, in terms of survival or health outcomes exceed the expected negative consequences of the procedure. 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update pg 4 AUC Indication in JACC A = Appropriate U = Uncertain I = Inappropriate AUC Indication on the Dashboard 3
Patients WITHOUT ACS Over 70 variables reviewed for the AUC some of the most weighted are: CAD Presentation Anginal Classification Non-invasive testing Anti-Ischemic Therapy Coronary Anatomy disease Pre-procedure LVEF Case Study: AUC Indication 16 What is the CAD involvement? 4
What is the CAD Presentation? What is the Anginal Classification? What is the Risk/Extent of Ischemia? 5
What is the level of Anti-Ischemic therapy? Why is the procedure Uncertain? A clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update pg 3 What does it mean? Uncertain indications..reflect clinical scenarios that are reasonable for performing revascularization, but additional clinical factors should be considered or further research is needed to more definitively define the benefits of treatment for patients. 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update pg 3 6
What if we failed to CODE key information? What if critical info was OMITTED from the medical record? What if there was MORE to the story? 7
Did we document all CAD? Did we document all CAD? Was the correct Risk/Extent of ischemia identified? 8
Was the patient on additional Anti- Ischemic medical therapy? Focus Areas Work with medical staff to document consistently Education to the definitions Location of information in the medical record Code scenario s consistently Use the dashboard to review and understand procedure ratings Review and Evaluate patient need for PCI Patients WITH ACS The Link between Stable & Unstable and the AUC Indication 9
PCI Indications Stable or Unstable PCI >12hrs PCI for STEMI (Unstable Unstable, >12hrs from Sx onset) PCI for STEMI (Stable Stable, >12hrs from Sx onset PCI after Thrombolytics PCI for STEMI (stable after successful full-dose lytics) Rescue PCI for STEMI (after failed full-dose lytics) AUC definition of Unstable Persistent ischemic symptoms Severe HF Hemodynamic instability Electrical Instability AUC definition for Stable No recurrent ischemia No Heart Failure No Electrical Instability 10
Important! Pre-Procedure LVEF The Link between the PCI Indication and the AUC Indication PCI for STEMI >12hrs & AUC Persistent ischemic symptoms Hemodynamic instability Electrical Instability Severe HF 11
PCI for STEMI >12hrs & AUC No recurrent ischemia No Heart Failure No Electrical Instability PCI for STEMI after lytics & AUC Pre-Procedure Procedure LVEF 50% PCI for STEMI after lytics & AUC Pre-Procedure Procedure LVEF < 50% 12
Focus Areas Work with medical staff to document consistently Education to the definitions Location of information in the medical record Code scenario s consistently Use the dashboard to review and understand procedure ratings Accurately account for patient symptoms in the PCI Indication Review and evaluate patient need for PCI Plan * Act * Do 13