Recognizing the growing volume and complexity of cardiovascular procedures being performed in the ambulatory space, the ACC is working to assist sites in staying at the cutting-edge of care delivery while ensuring high-quality patient care.

New Cardiac Cath Lab Accreditation designations developed by ACC Accreditation Services for freestanding outpatient facilities like Ambulatory Surgical Centers (ASCs) and the new NCDR CV ASC Registry Suite provide the capability for ASCs to measure and compare their patient care and outcomes to similar procedures from the hospital outpatient setting.

"Quality improvement is essential to ensure that the expansion of cardiovascular care into the ambulatory space maintains the highest standards," says Steven B. Deitelzweig, MD, MMM, FACC, chair of the ACC's Accreditation Oversight Committee. "As this shift continues, ACC Accreditation Services remains committed to evolving our standards, offering data-driven insights, and supporting both ASCs and hospital systems with tools and guidance tailored to their unique environments."

Corewell Health Heart and Vascular Surgery Center – Grand Rapids (CHHVSC – Grand Rapids), a new ASC coming to Grand Rapids, MI, the first to earn Cardiac Cath Lab Accreditation with PCI and EP devices for outpatient centers, is a perfect example of this commitment in action. With Michigan state regulations requiring accreditation for ambulatory centers performing interventional cardiovascular procedures, accreditation coordinators at the ACC, care transformation experts from MedAtlas CV (a joint venture between MedAxiom and Atlas Healthcare Partners), and clinicians onsite worked to establish a culture of quality improvement from the beginning of the facility's operation.

Navigating a New Frontier

Kim Showers, BSN, RN, CEO at CHHVSC – Grand Rapids, considers cardiovascular ASCs to be a "rapidly evolving landscape" in health care delivery. Standing at the forefront of this frontier, she applauds the knowledge sharing that played an integral role in laying the groundwork for the accreditation of this new ASC.

"It's the ideal synergy – leveraging Atlas's extensive experience in the ASC space alongside MedAxiom's expertise in cardiovascular care," says Showers.

While same-day discharge in the hospital setting for select cardiovascular procedures is not new, providing the same level of care in the ambulatory setting presents its own set of considerations and potential challenges.

"We've proven for more than 15 years that same-day discharge is safe. It's exciting to bring that to an ambulatory surgical setting that's streamlined and more convenient for patients," Showers says.

The team plans to perform diagnostic and interventional catheterization, pacemaker and ICD implantations, and other procedures at the facility. In their commitment to delivering the highest quality care to every patient, clinicians at Corewell Health and partners at MedAtlas CV have defined clear standards of care as well as the tools and metrics they will use to ensure those standards are consistently met in practice.

Paired with the guidance and resources available through ACC's accreditation program, their work not only helps to meet the Certificate of Need requirements in their state but also commemorates their continued commitment to cardiovascular quality and efficiency with ACC's seal of approval.

"It's going a step above to have a third party come in and validate the work you're doing," says Showers. "You know you're on the right track to providing high-quality care to patients in the most efficient manner possible."

Establishing a Structure

To demonstrate the work necessary to achieve ACC's Cardiac Cath Lab Accreditation, representatives from both MedAxiom and Atlas came together to establish protocols for monitoring procedural performance and standards for emergency readiness.

"The process has required significant policy review and implementation with key stakeholders – engaging not only our leaders but also frontline staff to be part of the journey," says Kathryn Garry, vice president of Operations at Atlas Healthcare Partners.

Guided by the cardiovascular expertise of ACC Accreditation Services and MedAxiom staff, the team identified two projects to monitor closely from the beginning, focusing on start times for the lab – a more operations-specific standard – and the absence of vascular complications – an outcomes-related metric.

"It's all enveloped with the ACC Accreditation standards – translated into policies that ensure patients, their families and providers that we have the highest expectations for the safety and appropriateness of procedures that are performed," says Denise Busman, MSN, RN, CPHQ, FACC, vice president of Care Transformation Services at MedAxiom.

Acknowledging the importance of timely execution throughout a day's caseload, they set a goal to have an on-time start for the first case of the day at least 75% of the time. They are also aiming for a vascular complication rate of zero, which Busman admits is an "aspiringly high" goal. She notes that "maintaining safe vascular access is even more important outside of the hospital."

Armed with these goals, the team is now ready to apply these standards, protocols and quality monitoring projects to their day-to-day work.

Garry praises the accreditation process in helping clinicians and administrators alike prepare to deliver high-quality care in their new facility, stating, "It's highlighted areas we are thriving in, and areas where we want to give additional focus to ensure we are providing the highest level of care."

Staying the Course

Going forward, stakeholders will communicate with ACC Accreditation staff through regular check-ins. Following the official site review that made their accreditation status official, Showers and fellow team members acknowledge that the work has just begun.

"It's not a relationship that ends when you get your plaque," says Showers. "It's about continually making sure that you're staying on track and then adjusting when necessary, when we learn new things and need to shift."

ACC's CV ASC Registry Suite will be a critical tool in providing data-driven insights to inform their work and support continuous improvement. By contributing their PCI and device implant data, CHHVSC – Grand Rapids will also help inform national benchmarks. This opportunity to move the field forward is an exciting prospect to those involved at the facility.

"By participating in the registry, we are focusing significantly on the safety, quality and outcomes of the care provided in our facility," adds Garry. "Participation means that we are accountable to more than just the facility and community at large. We are helping develop benchmarking standards for cardiovascular ASCs across the country."

Deitelzweig sees the pathway this first ASC took to become accredited as a shining example of what future ambulatory centers can do to bolster the quality and safety of their cardiovascular programs. Touting accreditation's benefits, he says: "We hope ASCs gain a structured framework for continuous quality improvement, enhanced patient safety and alignment with national best practices. Accreditation also supports a culture of excellence and transparency that benefits patients, providers and payers alike."

Milestones in HeartCARE

Tallahassee Memorial Hospital (TMH) in Florida earned ACC's distinguished HeartCARE Center of Excellence designation in May, following completion of Cardiac Cath Lab Accreditation earlier this year.

"Achieving our HeartCARE Center of Excellence designation, gives our facility a competitive edge in the health care market," says Daniel Cavallo, TMH's heart and vascular service line administrator. "It helps further differentiate us as a leader in the field of cardiovascular care, which will attract new patients and partnerships."

Learn more about ACC's accreditation programs, including the College's ultimate reward for quality care: HeartCARE Center of Excellence.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Cardiology Magazine, ACC Publications, Quality Improvement, Percutaneous Coronary Intervention, Delivery of Health Care, Patient Care, Registries, Accreditation, ACC Accreditation