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

STEMI ALERT Process

How it Works with the STEMI ALERT Packet

The basic concepts of the STEMI ALERT process are straightforward. When a STEMI is recognized, a “STEMI ALERT” occurs and the entire treatment process is mobilized -similar to a trauma alert. Resources are instantly focused on preparing the patient for eventual reperfusion therapy.

A successful STEMI ALERT process must be clearly designed and focused on action. Design of the alert process is important - crucial decisions are discussed beforehand and are then incorporated in the process. This careful planning leaves the focus of actual future STEMI ALERTS as the efficient execution of a pre-determined plan - guided of course, by individual patient considerations.

ST-Elevation MI is not a common presentation. Most emergency department staff and physicians treat these patients infrequently. Under these circumstances it’s difficult to remember the exact steps necessary to treat a STEMI patient efficiently; this is exacerbated by the stress of the situation. Yet each step must be done precisely- without delay! How do we provide guidance for this process?

To address this issue, Project UPSTART has incorporated the concept of a carefully designed “STEMI ALERT Packet” into the process. When a STEMI is recognized, the first key action is to open a STEMI ALERT Packet, clearly displayed in the emergency department. This simple action serves as the “reperfusion trigger.” Once opened, the information within the packet guides the STEMI ALERT Process.

Each STEMI ALERT Packet contains carefully developed checklists and data collection sheets that guide the ED physician and staff in providing the most efficient and rapid STEMI care possible. The use of detailed checklists minimizes error and cumulative delays. The division of the treatment process into clearly defined roles allows essential patient care tasks to occur simultaneously, with a minimum of oversight, thus allowing the physician to spend more time on critical decision making.

The checklists within the STEMI ALERT Packet follow certain general principles, but are carefully adapted to each specific facility. The details they contain are clear and precise, presented in simple language. Each checklist focuses that provider on their key tasks.

Each packet also contains two data sheets that collect basic data during the STEMI ALERT -without interfering with patient care. Data collected (on each STEMI patient) includes total time to reperfusion -even if they are transferred between facilities. This data can then be rapidly reviewed - facilitating quality improvement.