C.	Diagnosis and treatment for CHD
	Instructions: This section focuses on hospital processes and care of patients with AMI. For all questions, please reflect upon them during the 1-year period from 1/1/2011 to 12/31/2011.
C.1	Routine diagnostic test of CK for ACS patients after admission?
	○ No   ○ Yes, please specify the average time delay in reporting results: ______ ○ Unknown
C.2	Routine diagnostic test of CK-MB for ACS patients after admission?
	○ No   ○ Yes, please specify the average time delay in reporting results: ______ ○ Unknown
C.3	Routine diagnostic test of troponin for ACS patients after admission?
	○ No   ○ Yes, please specify the average time delay in reporting results: ______ ○ Unknown
C.4	Are patients who are stable after PCI admitted to an intensive care unit? SAMI-Q25
	○ Always   ○ Usually   ○ Sometimes   ○ Rarely ○ Unknown
C.5	Did your emergency department use a uniform protocol to care for patients who arrived to the emergency department with STEMI? SAMI-Q26
	○ No   ○ Yes   ○ Unknown
C.6	Did your emergency department use a uniform protocol to care for patients who arrived to the emergency department with Unstable Angina/NSTEMI? SAMI-Q27
	○ No   ○ Yes   ○ Unknown
C.7	Did your hospital use simulations (i.e., trial exercises, dry-runs) to practice any of the following AMI care processes? [Check all that apply] SAMI-Q28
	□ Door-to-balloon or door-to-drug protocols □ Chest pain in hospitalized patients □ Inpatient codes (e.g., cardiac arrest, respiratory failure) □ None above □ Unknown
C.8	To which patient care unit were patients who were stable with Unstable Angina/NSTEMI most likely admitted? SAMI-Q29
	○ CCU   ○ ICU   ○ Step-down unit   ○ Designated chest pain/telemetry/cardiology floor   ○ General medicine floor   ○ We did not have a routine method of assigning beds for patients with Unstable Angina/NSTEMI   ○ Unknown
C.9	Did all, or nearly all, patients with AMI have a cardiologist as their primary attending physician? SAMI-Q30
	○ No   ○ Yes [Skip to C11]   ○ Unknown
C.10	Were cardiology consults required for all patients with AMI? SAMI-Q30a
	○ No   ○ Yes   ○Unknown
C.11	In the intensive care unit, who was primarily responsible for the care of patients with AMI? [Check all that apply] SAMI-Q31
	□ Critical care physicians (i.e., intensivists) □ Cardiologist/s based exclusively in the unit □ Other cardiologists □ Other, please specify: ______ □ Unknown
C.12	Electronic medical record?
	○ No [Skip to C14]   ○ Yes, please specify when started: ______    ○ Unknown
C.13	Did your hospital use an electronic medical record (EMR) in the following areas? [Check all that apply]SAMI-Q34
	□ Emergency department □ Inpatient floors □ Critical care units □ Affiliated ambulatory offices/clinics □ None above
C.14	On the inpatient floors, did your hospital have the following electronic capabilities? [Check all that apply] SAMI-Q35
	□ Computerized assisted physician order entry □ Computer prompts to alert user to potential drug-drug interactions or allergies □ Computer prompts to alert user to potential errors in dosing and information □ Computer prompts to alert user to medication order expiration □ Computer prompts to improve adherence to core measures for AMI care (e.g., beta-blocker use) □ None above
C.15	In the emergency department, were prior ECG’s electronically available at the time of care? SAMI-Q36
	○ No   ○ Yes   ○ Unknown
C.16	Did physicians regularly use explicit protocols or clinical pathways for patients with AMI? SAMI-Q37
	○ No   ○ Yes   ○ Unknown
C.17	Did clinicians on the inpatient care units regularly use order sets (either paper-based or electronic) for patients with STEMI? SAMI-Q38
	○ No   ○ Yes   ○ Unknown
C.18	Did clinicians on the inpatient care units regularly use order sets (either paper-based or electronic) for with Unstable Angina/NSTEMI? SAMI-Q39
	○ No   ○ Yes   ○ Unknown
C.19	Which of the following types of physicians were at the hospital 24-hours/day and 7-days/week? [Check all that apply] SAMI-Q42
	□ Critical care physicians (i.e., intensivists) □ Non-interventional cardiologists □ Interventional cardiologists □ Cardiology fellows (including non-interventional and interventional) □ Hospitalists □ None above
C.20	Are there any protocols used to guide nurses on when to call the attending cardiologist for patients with AMI? SAMI-Q43
	○ No   ○ Yes   ○ Unknown
C.21	Patients with acute coronary syndrome who arrived by Emergency medical service (ambulance):
	○ None [Skip to C25]   ○ 1–25%   ○ 26–50%   ○ 51–75%   ○ 76–100%   ○ Unknown
C.22	Emergency medical service routinely gives pre-alert calls?
	○ No   ○ Yes   ○ Unknown
C.23	Patients with acute coronary syndrome who undergo ECG en route to hospital:
	○ None    ○ 1–25%   ○ 26–50%   ○ 51–75%   ○ 76–100%   ○ Unknown
C.24	Emergency medical service routinely tell your hospital the results of ECG?
	○ No   ○ Yes   ○ Unknown
C.25	Formal training of triage staff for assessing acute coronary syndrome?
	○ No   ○ Yes   ○ Unknown
C.26	Dedicated space in triage area for immediate ECG?
	○ No   ○ Yes   ○ Unknown
C.27	Written criteria for immediate ECG in emergency department?
	○ No   ○ Yes   ○ Unknown
C.28	Expected interval between patients’ arriving and ECG?
	○ ≤ 5min   ○ 6–20 min   ○ >20 min   ○ No expected time   ○ Unknown
C.29	Dedicated ECG technicians in emergency department?
	○ No   ○ Yes, only some shifts   ○ Yes, always   ○ Unknown
C.30	Thrombolysis for AMI patients in hospital?
	○ No [Skip to C38]   ○ Yes, please specify when started: _____
C.31	Does your hospital have a set protocol to identify eligible patients for thrombolysis?
	○ No   ○ Yes   ○ Unknown
C.32	Does your hospital have a set protocol to assess contraindications of thrombolysis?
	○ No   ○ Yes   ○ Unknown
C.33	Who makes the decision about thrombolysis in your hospital?
	○ Emergency medicine physician alone ○ Emergency medicine physician with a cardiac consultation ○ Only Cardiologist ○ Unknown
C.34	In your hospital, where do patients with AMI receive thrombolysis?
	○ In the emergency department ○ In the cardiology department (or general medicine department) ○ In the ICU or CCU ○ Unknown
C.35	Where are the thrombolytic medicines stored and prepared?
	○ Stored and prepared in the department where thrombolysis is done ○ Prepared in the department where thrombolysis is done, but stored in another location ○ Stored and prepared in some location other than the department where thrombolysis is done ○Unknown
C.36	Informed Consent before thrombolysis?
	○ Not necessary ○ Only orally obtained informed consent is needed ○ One written informed consent form is needed ○ More than one written informed consent form is needed ○ Unknown
C.37	Prepayment before thrombolysis?
	○ No ○ Yes, please specify the average amount approximately: ___ (“−1” if unknown) ○ Unknown
C.38	Primary PCI was performed in your hospital for STEMI patients?
	○ No [Skip to C60]   ○ Yes, please specify when started: ___
C.39	Activation of catheterization laboratory on weekdays?
	○ Emergency medicine physician with cardiologist ○ Cardiologist alone ○Emergency medicine physician alone ○ Unknown
C.40	Activation of catheterization laboratory at night and on weekends?
	○ Emergency medicine physician with cardiologist ○ Cardiologist alone ○Emergency medicine physician alone ○ Unknown
C.41	Process for activating catheterization team?
	○ After communicating with the emergency department, interventional cardiologist activates catheterization laboratory by calling staff or a central page operator ○ Emergency department makes at least two calls: one to the interventional cardiologist and another to a central page operator, who pages catheterization laboratory staff ○ Emergency department makes a single call to a central page operator, who then pages interventional cardiologist and catheterization laboratory staff ○ No standard approach ○ Other ○ Unknown
C.42	Activation of on-call staff for catheterization laboratory?
	○ Page operator is not used ○ Page operator is used; confirmation of page receipt is required ○ Page operator is used; no confirmation of page receipt is required ○ No standard approach ○ Unknown
C.43	First physician notified after STEMI diagnosis in emergency department?
	○ Cardiologist   ○ Interventional cardiologist   ○ Patient’s primary care physician   ○ Other or variable   ○ Unknown
C.44	Laboratory and radiographic results are needed to activate catheterization laboratory?
	○ Yes   ○ No   ○ No standard approach   ○ Unknown
C.45	Process after emergency medical service transmits ECG results?
	○Emergency department waits for patient to arrive at hospital to determine whether catheterization laboratory should be activated ○ Emergency department contacts cardiologist while the patient is en route to determine whether catheterization laboratory should be activated ○ Emergency department activates catheterization laboratory while the patient is still en route to the hospital ○ No standard approach or variable approach ○ Not applicable because ECG data not transmitted en route ○ Not applicable because ECG never performed en route ○ Unknown
C.46	Expected interval between page and arrival of staff in catheterization laboratory?
	○ ≤20 min   ○ 21–30 min   ○ >30 min   ○ No expected time   ○ Unknown
C.47	Expected interval between page and arrival of interventional cardiologist
	○ ≤20 min   ○ 21–30 min   ○ >30 min   ○ No expected time   ○ Unknown
C.48	Someone is always available to transport patients from emergency department to catheterization laboratory?
	○ No   ○ Yes   ○ Unknown
C.49	Initiation of patient transport from emergency department to catheterization laboratory?
	○ After catheterization laboratory notifies emergency department it is ready ○ A set interval after the decision is made regarding PCI ○ No standard approach ○ Other approach ○ Unknown
C.50	Minimum number of nurses and technicians required in catheterization laboratory before patient is transported from emergency department?
	○ Interventional cardiologist must be present ○ Interventional cardiologist may not be present but need presence of 1 staff person ○ Interventional cardiologist may not be present but need presence of 2-4 staff person ○ No set number ○ Unknown
C.51	Elective catheterization cases rescheduled for emergency PCI?
	○ Yes   ○ No   ○ It depends   ○ Unknown
C.52	If interventionalist is present, number of staff required to begin PCI?
	○ 1   ○ 2   ○ 3   ○ 4   ○ Unknown
C.53	Catheterization laboratory is left so that next PCI can begin promptly?
	○ Yes   ○ No   ○ No standard policy   ○ Unknown
C.54	Cardiology fellows participate in performing PCI?
	○ No   ○ Yes   ○ Unknown
C.55	Staff in critical care area are routinely cross-trained to cover catheterization laboratory?
	○ No   ○ Yes   ○ Unknown
C.56	Location of catheterization laboratory?
	○ Elevator required to travel from emergency department ○ Same floor as emergency department
C.57	An attending cardiologist is always at the hospital?
	○ No   ○ Yes   ○ Unknown
C.58	Informed Consent before primary PCI?
	○ Not necessary ○ Only orally obtained informed consent is needed ○ One written informed consent form is needed ○ More than one written informed consent form is needed ○ Unknown
C.59	Prepayment before primary PCI?
	○ No ○ Yes, please specify the average amount approximately ___ (“−1” if unknown) ○ Unknown
C.60	Does your hospital measure the following time intervals? [Check all that apply]
	□ Door to ECG □ Door to needle □ Door to balloon □ None above □ Unknown
C.61	Do your hospital feedback the time intervals to someone? [Check all that apply]
	□ No □ Yes, to physician staff involved in the care □ Yes, to nursing staff involved in the care □ Yes, to pharmacy staff involved in the care □ Yes, to other staff involved in the care □ Unknown
C.62	Do your hospital report the analyze results about the time intervals regularly? [Check all that apply]
	□ No □ Yes, to departments involved in the care (the emergency department, the cardiology department) □ Yes, to other department in your hospital □ Yes, to other institutions outside your hospital □ Unknown