Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.740 - Definitions and Abbreviations Relating to ST-Segment Elevation Myocardial Infarction (STEMI) Centers

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment adds virtual reviews to the
				  definitions for STEMI centers.
(1) For the purposes of
				19 CSR
				30-40.750 and
				19 CSR
				30-40.760 the following terms shall mean-
(A) Acute-an injury or illness that happens
				or appears quickly and can be serious or life-threatening;
(B) Anesthesiologist assistant (AA)-a person
				who-
1. Has graduated from an
				anesthesiologist assistant program accredited by the American Medical
				Association's Committee on Allied Health Education and Accreditation or by its
				successor agency;
2. Has passed the
				certifying examination administered by the National Commission on Certification
				of Anesthesiologist Assistants;
3.
				Has active certification by the National Commission on Certification of
				Anesthesiologist Assistants;
4. Is
				currently licensed as an anesthesiologist assistant in the state of Missouri;
				and
5. Provides health care
				services delegated by a licensed anesthesiologist;
(C) Board-admissible/board-eligible-a
				physician who has applied to a specialty board of the American Board of Medical
				Specialties, the American Osteopathic Association Board of Osteopathic
				Specialists, or the Royal College of Physicians and Surgeons of Canada and has
				received a ruling that he or she has fulfilled the requirements to take the
				examinations. Board certification is generally obtained within five (5) years
				of the first appointment;
(D)
				Board-certified-a physician who has fulfilled all requirements, has
				satisfactorily completed the written and oral examinations, and has been
				awarded a board diploma in a specialty field by the American Board of Medical
				Specialties, the American Osteopathic Association Board of Osteopathic
				Specialists, or the Royal College of Physicians and Surgeons of
				Canada;
(E) Cardiac catheterization
				laboratory-the setting within the hospital where percutaneous coronary
				interventions are done. Specialized staff, equipment, and protocol must be in
				place;
(F) Cardiac catheterization
				team-physicians and clinical staff who perform percutaneous coronary
				interventions and who are part of the clinical STEMI team;
(G) Cardiogenic shock-a life threatening
				condition in which the heart muscle does not pump enough blood to meet the
				body's needs;
(H) Cardiologist-a
				licensed physician with appropriate specialty training;
(I) Cardiology Service-an organizational
				component of the hospital specializing in the care of patients who have had
				STEMIs or some other cardiovascular condition or disorder;
(J) Catchment area-the surrounding area
				served by the institution (the STEMI center);
(K) Certified registered nurse anesthetist
				(CRNA)-a registered nurse who-
1. Has
				graduated from a school of nurse anesthesia accredited by the Council on
				Accreditation of Educational Programs of Nurse Anesthesia or its
				predecessor;
2. Has been certified
				as a nurse anesthetist by the Council on Certification of Nurse Anesthetists;
				and
3. Has been licensed in
				Missouri pursuant to Chapter 335, RSMo;
(L) Clinical staff-an individual that has
				specific training and experience in the treatment and management of STEMI
				patients. Examples include physicians, registered nurses, advanced practice
				nurses, physician assistants, pharmacists, and technologists;
(M) Clinical team-a team of health care
				professionals involved in the care of the STEMI patient and may include, but
				not be limited to, cardiologists, interventional cardiologists, cardiovascular
				surgeons, anesthesiologists, emergency medicine, and other STEMI center
				clinical staff. The clinical team is part of the hospital's STEMI
				team;
(N) Contiguous leads-the
				electrical cables that attach the electrodes on the patient to the
				electrocardiograph recorder and which are next to one another. They view the
				same general area of the heart;
(O)
				Continuing education-education approved or recognized by a national and/or
				state professional organization and/or STEMI medical director;
(P) Continuing medical education (CME)- the
				highest level of continuing education for physicians that is approved by a
				national and/or state professional organization and/or STEMI medical
				director;
(Q) Core team-a subunit
				of the hospital STEMI team which consists of a physician experienced in
				diagnosing and treating STEMI (usually the STEMI medical director) and at least
				one (1) other health care professional or qualified individual competent in
				STEMI care as determined by the hospital (usually the STEMI program
				manager/coordinator);
(R)
				Credentialed or credentialing-a hospital-specific system of documenting and
				recognizing the qualifications of medical staff and nurses and authorizing the
				performance of certain procedures and establishing clinical privileges in the
				hospital setting;
(S)
				Department-the Missouri Department of Health and Senior Services;
(T) Door-to-balloon-time-the time from
				arrival at the hospital door to percutaneous coronary intervention balloon
				inflation for the purpose of restoring blood flow in an obstructed coronary
				artery in the cardiac catheterization lab. This term is commonly abbreviated as
				D2B;
(U) Door-to-device-time-the
				time from patient arrival at the hospital to the time the device is in the
				affected cardiac blood vessel;
(V)
				Door-to-needle-time-the time from arrival at the hospital door to initiation of
				lytic therapy to restore blood flow in an obstructed blood vessel;
(W) Electrocardiogram (ECG/EKG)-a recorded
				tracing of the electrical activity of the heart. The heart rate, heartbeat
				regularity, size and chamber position, presence of any prior heart attack,
				current injury, and the effects of drugs or devices (i.e., pacemaker can be
				determined). An abnormal ECG pattern is seen during a heart attack because
				damaged areas of the heart muscle do not conduct electricity
				properly;
(X) Emergency medical
				service regions- the six (6) regions in the state of Missouri which are defined
				in
				19 CSR
				30-40.302;
(Y) First medical contact-a patient's initial
				contact with a health-care provider either pre-hospital, which could be contact
				with emergency medical service personnel or another medical provider, or in the
				hospital;
(Z) First medical contact
				to balloon or device time-the time from a patient's first medical contact with
				a health-care provider to the time when the balloon is inflated or the device
				is in the affected cardiac blood vessel;
(AA) First medical contact to hospital door
				time-the time from a patient's first medical contact with a health-care
				provider to the time when the patient arrives at the hospital door;
(BB) Hospital-an establishment as defined by
				section 197.020.2, RSMo, or a hospital
				operated by the state;
(CC)
				Immediately available (IA)-being present at bedside at the time of the
				patient's arrival at the hospital when prior notification is possible and no
				more than twenty (20) minutes from the hospital under normal driving and
				weather conditions;
(DD) In-house
				(IH)-being on the hospital premises twenty-four (24) hours a day;
(EE) Intermediate care unit-the functional
				division or facility of the hospital that provides care for STEMI patients
				admitted to the STEMI center;
(FF)
				Interventional cardiologist-a licensed cardiologist with the appropriate
				specialty training;
(GG) Lytic
				therapy (fibrinolysis/thrombolysis)-drug therapy used to dissolve clots
				blocking flow in a blood vessel. It refers to drugs used for that purpose,
				including recombinant tissue plasminogen activator. This type of therapy can be
				used in the treatment of acute ischemic stroke and acute myocardial
				infarction;
(HH) Mentoring
				relationship-a relationship in which a high volume percutaneous coronary
				interventions operator, often described as performing one hundred fifty (150)
				or more procedures per year, serves as a mentor for an operator who performs
				less than eleven (11) primary percutaneous coronary interventions per
				year;
(II) Missouri STEMI registry-a
				statewide data collection system comprised of key data elements as identified
				by the Department of Health and Senior Services used to compile and trend
				statistics of STEMI patients both pre-hospital and hospital, using a
				coordinated electronic reporting method provided by the Missouri Department of
				Health and Senior Services;
(JJ)
				Multidisciplinary team-a team of appropriate representatives of hospital units
				involved in the care of the STEMI patient. This team supports the care of the
				STEMI patient with the STEMI team;
(KK) Patient-an individual who is sick,
				injured, wounded, diseased, or otherwise incapacitated or helpless, or dead,
				excluding deceased individuals being transported from or between private or
				public institutions, homes, or cemeteries, and individuals declared dead prior
				to the time an ambulance is called for assistance;
(LL) Peer review system-is the process the
				STEMI center establishes for physicians to review STEMI cases on patients that
				are admitted to the STEMI center, transferred out of the STEMI center, or die
				as a result of the STEMI (independent of hospital admission or hospital
				transfer status);
(MM) Percutaneous
				coronary intervention (PCI)-is a procedure used to open or widen narrowed or
				blocked blood vessels to restore blood flow supplying the heart. A primary
				percutaneous coronary intervention is one that is generally done on an
				emergency basis for a ST-elevation myocardial infarction (STEMI). Treatment
				occurs while the blood clot is still forming-usually within twenty-four (24)
				hours of onset, but ideally within two (2) hours of symptoms onset. An elective
				percutaneous coronary intervention is one that is done on a non-urgent basis to
				reduce signs and symptoms of angina;
(NN) Percutaneous coronary intervention
				window-the time frame in which percutaneous coronary intervention is most
				advantageous and recommended;
(OO)
				Phase I cardiac rehabilitation-an inpatient program that provides an
				individualized exercise and education plan for patients with cardiac
				illnesses;
(PP) Physician-a person
				licensed as a physician pursuant to Chapter 334, RSMo;
(QQ) Promptly available (PA)-arrival at the
				hospital at the patient's bedside within thirty (30) minutes after notification
				of a patient's arrival at the hospital;
(RR) Protocol-a predetermined, written
				medical care guideline, which may include standing orders;
(SS) Qualified individual-a physician,
				registered nurse, advanced practice registered nurse, and/or physician
				assistant that demonstrates administrative ability and shows evidence of
				educational preparation and clinical experience in the care of STEMI patients
				and is licensed by the state of Missouri;
(TT) Regional outcome data-data used to
				assess the regional process for pre-hospital, hospital, and regional patient
				outcomes;
(UU) Repatriation-the
				process used to return a STEMI patient to his or her home community from a
				level I or level II STEMI designated hospital after his or her acute treatment
				for STEMI has been completed. This allows the patient to be closer to home for
				continued hospitalization or rehabilitation and follow-up care as indicated by
				the patient's condition;
(VV)
				Reperfusion-the process of restoring normal blood flow to an organ or tissue
				that has had its blood supply cut off, such as after an ischemic stroke or
				myocardial infarction;
(WW)
				Requirement (R)-a symbol to indicate that a standard is a requirement for STEMI
				center designation at a particular level;
(XX) Review-is the inspection of a hospital
				to determine compliance with the rules of this chapter;
(YY) ST-elevation myocardial infarction
				(STEMI)-a myocardial infarction for which the electrocardiogram shows
				ST-segment elevation, usually in association with an acutely blocked coronary
				artery. A STEMI is one type of heart attack that is a potentially lethal
				condition for which specific therapies, administered rapidly, reduce mortality
				and disability. The more time that passes before blood flow is restored, the
				more damage that is done to the heart muscle;
(ZZ) STEMI call roster-a schedule that
				provides twenty-four (24) hours a day, seven (7) days a week cardiology service
				coverage. The call roster identifies the physicians or qualified individuals on
				the schedule that are available to manage and coordinate emergent, urgent, and
				routine assessment, diagnosis, and treatment of the STEMI patients;
(AAA) STEMI care-education, prevention,
				emergency transport, triage, acute care, and rehabilitative services for STEMI
				that requires immediate medical or surgical intervention or
				treatment;
(BBB) STEMI center-a
				hospital that is currently designated as such by the department to care for
				patients with ST-segment elevation myocardial infarctions.
1. A level I STEMI center is a receiving
				center staffed and equipped to provide total care for every aspect of STEMI
				care, including care for those patients with complications. It functions as a
				resource center for the hospitals within that region and conducts
				research.
2. A level II STEMI
				center is a receiving center staffed and equipped to provide care for a large
				number of STEMI patients within the region.
3. A level III STEMI center is primarily a
				referral center that provides prompt assessment, indicated resuscitation, and
				appropriate emergency intervention for STEMI patients to stabilize and arrange
				timely transfer to a Level I or II STEMI center, as needed.
4. A level IV STEMI center is a referral
				center in an area considered rural or where there are insufficient hospital
				resources to serve the patient population requiring STEMI care. The level IV
				STEMI center provides prompt assessment, indicated resuscitation, appropriate
				emergency intervention, and arranges and expedites transfer to a higher level
				STEMI center as needed;
(CCC) STEMI identification-a diagnosis is
				made on a basis of symptoms, clinical examination, and electrocardiogram
				changes, specifically ST-segment elevation;
(DDD) STEMI medical director-a physician
				designated by the hospital who is responsible for the STEMI service and
				performance improvement and patient safety programs related to STEMI
				care;
(EEE) STEMI program-an
				organizational component of the hospital specializing in the care of STEMI
				patients;
(FFF) STEMI program
				manager-a qualified individual designated by the hospital with responsibility
				for monitoring and evaluating the care of STEMI patients and the coordination
				of performance improvement and patient safety programs for the STEMI center in
				conjunction with the physician in charge of STEMI care;
(GGG) STEMI team-a component of the hospital
				STEMI program which consists of the core team and the clinical team;
(HHH) Symptom onset-to-treatment time- the
				time from symptom onset to initiation of therapy to restore blood flow in an
				obstructed blood vessel;
(III)
				Thrombolytics-drugs, including recombinant tissue plasminogen activator, used
				to dissolve clots blocking flow in a blood vessel. These thrombolytic drugs are
				used in the treatment of acute ischemic stroke and acute myocardial infarction;
(JJJ) Transfer agreement-a
				document which sets forth the rights and responsibilities of two (2) hospitals
				regarding the inter-hospital transfer of patients; and
(KKK) Virtual review-a type of review
				conducted through the use of secure virtual video and audio conferencing and
				secure file transfers in order to determine compliance with the rules of this
				chapter.