• System reasons for delay are not acceptable, regardless of any linkage to the delay in PCI/reperfusion.
  • Equipment-related (e.g., unavailability, malfunction)
  • Staff-related (e.g., waiting for cath lab staff)
  • Consultation with other clinician
  • Cath lab unavailability (e.g., no open cath lab)
• Documentation must be made clear somewhere in the medical record that (1) a “hold,” “delay,” or “wait” in doing PCI/reperfusion/cath/transfer to cath lab actually occurred, AND (2) that the underlying reason for that delay was non-system in nature. Abstractors should NOT make inferences from documentation of a sequence of events alone or otherwise attempt to interpret from documentation. Clinical judgment should not be used in abstraction.
  • Examples of ACCEPTABLE documentation:
    -“Hold on PCI. Will do TEE to r/o aortic dissection.”
    -“Patient waiting for family and clergy to arrive - wishes to consult with them before PCI.”
    -“SVG Angiojet cath did not cross lesion. XMI catheter successfully crossed the stenosis. Flow reestablished after 30 min. delay.”
    -“PCI delayed due to intermittent hypotensive episodes when crossing lesion.”
  • Exceptions: Both cardiopulmonary arrest within 90 minutes after hospital arrival and initial patient/family refusal of PCI/reperfusion/cath/transfer to cath lab are acceptable reasons for delay that do NOT require documentation that a “hold,” “delay,” or “wait” in doing the PCI actually occurred. In order for cardiopulmonary arrest within 90 minutes after hospital arrival to be considered an automatic acceptable reason for delay, documentation that it occurred within 90 minutes after hospital arrival must be CLEAR. Consider all physician/APN/PA documentation of cardiopulmonary arrest activity and use the earliest time in confirming whether cardiopulmonary arrest occurred within 90 minutes after arrival. (Determining the exact point in time the cardiopulmonary arrest occurred is not necessary.)
• If unable to determine whether a documented reason is system in nature, select “No.”
• Reasons for a delay in PCI should be collected regardless of how soon after arrival it was ultimately done or how minimal the delay.

PHYSICIAN/APN/PA DOCUMENTATION ONLY

• Code sheet (if signed by physician/APN/PA)
• Consultation notes
• Diagnostic test reports
• Discharge summary
• Emergency department record
• History and physical
• Operative notes
• Physician orders
• Procedure notes
• Progress notes

Excluded Data Sources:
Any documentation dated/timed after discharge, except discharge summary and operative/procedure/diagnostic test reports (from procedure done during hospital stay)