Registration

Enter username and password you want. They are used to login your D2B account after you become a member.

Required Login Information

Username:

*

Password:

*

Confirm Password:

*

First Name:

*

Last Name:

*

Email Address:

*

Contact Information

Contact Name:

*

Contact Position:

*

Contact Email:

*

Hospital Name:

*

Hospital Address:

Hospital City

*

Hospital State:

*

Hospital Zip:

Hospital Phone:

Enter health system(s) your hospital belong to

To which health system does your hospital belong?

If your hospital participates with the ACC-NCDR®, please enter your ACC-NCDR® participant ID:

Hospital Demographics

Does your hospital perform Percutaneous Coronary Interventions ? (Required)

YesNo

How do you categorize your institution (Check all that apply)?

Urban
Suburban
Rural
Academic
Community
Community Teaching

Does your institution have an onsite Catheterization lab?

YesNo

How many PCI procedures does your institution perform annually?

< 15
15 - 50
51 - 100
101 - 250
251 - 400
> 401

Identification of Key Personnel

Please identify the key personnel in each role who will help implement the evidence-based strategies within your hospital:

Cardiologist:

*

ED Physician:

*

Chief Quality Officer:

*

Nursing Champion

*

Commitments/Expectations

As a participant in GAP-D2B: An Alliance for Quality, I agree that my hospital will attempt to implement each of the recommended tier I evidence-based strategies. (Required)

YesNo

I permit the ACC to use my hospital’s name in its public list of participating hospitals and in any promotional effort related to GAP-D2B. (Required)

YesNo

I agree to complete three periodic (enrollment, 6 months and 12 months post-enrollment) D2B participant surveys to provide information on the processes my hospital is using to reduce door-to-balloon times. (Required)

YesNo

I agree to participate in the D2B online community by sharing with other participating hospitals stories, successes, barriers, experiences, tools and/or resources . (Required)

YesNo

I understand that ACC will not identify hospitals when it publishes information on door-to-balloon times, unless expressly permitted by the hospital. (Required)

YesNo