Author(s): The UPMC East Experience with Accreditation for Cardiovascular Excellence (ACE)
Laurie Rieger, RT(R)(CV), Manager of Cardiovascular Services at the University of Pittsburgh Medical Center East, Monroeville, Pennsylvania (UPMC East), kept checking her email inbox on July 16, 2014. The exceptions committee from the Commonwealth of Pennsylvania was meeting and the decision to grant an exception to perform elective percutaneous coronary intervention (PCI) without open-heart surgery on site for their cardiac catheterization lab at UPMC East was
imminent. The decision by the Commonwealth to provide the exception was based on UPMC East’s successful approval for accreditation by the Accreditation for Cardiovascular Excellence (ACE). “I have gotten emails from all our cardiologists and the cath lab team,” Laurie said. “They all say the same thing: did you hear from the exceptions committee yet? Are we approved?”
It is usually much easier to get ACE accreditation for the cardiac catheterization lab. But UPMC East is the first to go through a special application and review process for ACE accreditation after a decision made in January 2014 by the Commonwealth of Pennsylvania. The decision stated that Pennsylvania cardiac catheterization laboratories that wish to provide elective PCI services without on-site open-heart surgery at their facilities must be accredited. The accrediting organization must be state department-approved, with standards at least equal to those of ACE.
The process really began in 2001, when the Pennsylvania Department of Health (PADOH) granted four Pennsylvania hospitals without on-site cardiac surgery an exception to perform elective PCI. The four hospitals were required to meet specific conditions regarding physician operators, quality oversight, and reporting. In 2005, PADOH added the requirement that hospitals requesting the exception participate in the CPORT-E1 clinical trial, a multicenter noninferiority trial. The CPORT-E trial randomly assigned 18,867 patients to compare the outcomes of PCI performed at hospitals without and those with on-site cardiac surgery (Table 1). “Unfortunately, we were never part of the CPORT-E trial. It ended before we opened in July 2012, so we were not able to participate,” noted Laurie. “However, the state did give us an exception to perform emergency PCI.”