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## Complete Summary

#### TITLE

Diagnosis and treatment of chest pain and acute coronary syndrome (ACS):
percentage of patients with chest pain symptoms in emergency department
(ED) receiving early therapy including intravenous (IV) access, oxygen,
nitroglycerin, morphine and a chewable aspirin on arrival.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Diagnosis and
treatment of chest pain and acute coronary syndrome (ACS). Bloomington
(MN): Institute for Clinical Systems Improvement (ICSI); 2006 Oct. 76 p.
\[121 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients with chest
pain symptoms in emergency department (ED) receiving early therapy
including intravenous (IV) access, oxygen, nitroglycerin, morphine, and
a chewable aspirin on arrival.

#### RATIONALE

The priority aim addressed by this measure is to increase the success of
emergency intervention for patients with high-risk chest pain.

#### PRIMARY CLINICAL COMPONENT

Chest pain; emergency department (ED); intravenous (IV) access; oxygen;
nitroglycerin; morphine; chewable aspirin

#### DENOMINATOR DESCRIPTION

Number of patients with chest pain seen in emergency department (ED)

#### NUMERATOR DESCRIPTION

Number of patients with chest pain symptoms in emergency department (ED)
receiving early therapy including intravenous (IV) access, oxygen,
nitroglycerin, morphine, and a chewable aspirin on arrival

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Diagnosis and treatment of chest pain and acute coronary syndrome
    (ACS).](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10227)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Emergency Medical Services\
Hospitals

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Age greater than 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness\
Timeliness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients greater than age 18 presenting to the emergency department (ED)
with chest pain symptoms

Identify patients seen in the ED with a diagnosis of chest pain. Medical
records can then be reviewed to determine if the patient received
chewable aspirin on arrival in the ED. A minimum sample of 15 to 20
randomly selected records should be reviewed for evidence of the patient
receiving chewable aspirin.

It is suggested that data is collected monthly.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients with chest pain seen in emergency department (ED)

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients with chest pain symptoms in emergency department (ED)
receiving early therapy including intravenous (IV) access, oxygen,
nitroglycerin, morphine, and a chewable aspirin on arrival

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Percentage of patients with chest pain symptoms in ED receiving early
therapy including IV, oxygen, nitroglycerin, morphine, and a chewable
aspirin on arrival.

#### MEASURE COLLECTION

[Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS)
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=6235)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2004 Nov

#### REVISION DATE

2006 Oct

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Diagnosis and Treatment of Chest Pain and Acute
Coronary Syndrome (ACS). Bloomington (MN): Institute for Clinical
Systems Improvement (ICSI); 2005 Oct. 78 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Diagnosis and
treatment of chest pain and acute coronary syndrome (ACS). Bloomington
(MN): Institute for Clinical Systems Improvement (ICSI); 2006 Oct. 76 p.
\[121 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of patients with chest pain
symptoms in ED receiving early therapy including IV, oxygen,
nitroglycerin, morphine, and a chewable aspirin on arrival,\" is
published in \"Health Care Guideline: Diagnosis and Treatment of Chest
Pain and Acute Coronary Syndrome (ACS).\" This document is available
from the [Institute for Clinical Systems Improvement (ICSI) Web
site](http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/).

For more information, contact ICSI at, 8009 34th Avenue South, Suite
1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web
site: [www.icsi.org](http://www.icsi.org/); e-mail:
<icsi.info@icsi.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI on February 25, 2005. This NQMC
summary was updated by ECRI on December 29, 2005 and again on January
24, 2007.

#### COPYRIGHT STATEMENT

This NQMC summary (abstracted Institute for Clinical Systems Improvement
\[ICSI\] Measure) is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be
downloaded by any individual or organization. If the abstracted ICSI
Measures are downloaded by an individual, the individual may not
distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization,
copies may be distributed to the organization\'s employees but may not
be distributed outside of the organization without the prior written
consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved
by the Institute for Clinical Systems Improvement, Inc. The Institute
for Clinical Systems Improvement, Inc. assumes no liability for any
adaptations or revisions or modifications made to the abstracts of the
ICSI Measures.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008