Project UPSTART: the Use of Procedural Standardization to Reduce Recognition to Repferfusion (R2R) Time in ST-Elevation Myocardial Infarction (STEMI)

Frequently Asked Questions

1. What exactly is “Project UPSTART?”

Project UPSTART is a quality improvement tool designed to help individual hospitals or systems design and implement efficient STEMI treatment programs. It provides a generalized approach that is then adapted to each institution, according to their specific needs. To facilitate this process, it also provides a large number of standardized processes, protocols and educational resources

2. Where was Project UPSTART developed?

Project UPSTART (in its final form) was developed at the University of Virginia as a cooperative effort between emergency medicine, cardiology, EMS and the department of quality improvement. In addition it utilizes ideas and concepts from many other systems. Our goal was to integrate as many “best practice” ideas as possible directly into the program.

3. How much does it cost? Is it compatible with other initiatives, etc?

Project UPSTART is a free public service project. Any interested individual hospital, system or organization may use it. We do not charge participation fees or benefit monetarily. It is not associated with any one organization. However, it was carefully designed to complement STEMI improvement initiatives and facilitates measurement of key data points (including AMI core measures).

4. What makes Project UPSTART unique?

The basic essentials of efficient STEMI management (early identification, process measurement, etc) are actually well known. The difficulty is in consistent application of these principles in a simplified, consistent manner! Project UPSTART provides a complete, systematic, proven method of incorporating these principles in the most efficient manner possible. It offers a simplified, reproducible, “modular” approach that incorporates solutions to many difficult problems directly into the process, before they even become an issue.

5. Is it difficult to use? Will it increase our paperwork load?

No and no. Project UPSTART was expressly designed to simplify and streamline the STEMI treatment process, not complicate it. By providing a generalized (yet customizable) approach, UPSTART minimizes “reinventing the wheel.” By standardizing forms, protocols, and education (where possible) it increases efficiency. An emphasis is placed on minimizing paperwork while still collecting valuable quality improvement data. You can’t improve what you don’t measure!

6. Can UPSTART be used at non-PCI sites or by multi-site systems?

The generalized UPSTART approach works equally well at PCI and non-PCI sites or those facilities that utilize inter-facility transfer of patients. Whatever particular treatment strategy a site utilizes is incorporated into the process. The project focus is on optimizing that process and measuring the results; this data is then used to facilitate ongoing improvement. An emphasis on accurate measurement of R2R (recognition to reperfusion) time for every STEMI patient facilitates regional approaches and inter-facility cooperative efforts.

7. How has this program been validated? How well does it work?

The Project UPSTART approach was developed in actual emergency departments over a several-year period of trial and error. All its major concepts and processes have been constantly “field tested” and continuously refined. Since initiation it has been utilized in multiple hospitals and systems and has been extremely effective in reducing median time to reperfusion and minimizing standard deviation. We are currently collecting additional data.

8. How difficult is implementation?

It's true -- changes takes time! Project UPSTART focuses on making the implementation process as simple and efficient as possible. Not only is the entire process standardized and tested, but each site has free access to a wide variety of tools to simplify the process, including form templates, instructional manuals and videos, a state-of-the-art website, an internet-based multimedia staff education module and a complete implementation package.

9. How long is the implementation process? What is involved?

Complete implementation usually takes about 3-5 weeks. The initial steps including appointing a site coordinator and completing a short data collection sheet. Next, the basic UPSTART forms are customized to each site. Once this is done, ED staff is notified of the process and are directed to the “Provider Training Module” at (or via DVD) for education. Finally, STEMI ALERT Packets are placed in the ED. You are now ready.

10. Where can additional information be obtained?

Please visit our project UPSTART website at or email us at The website contains additional materials, provides access to the provider training module, and shows examples of the project paperwork, etc.