Culpeper Regional Hospital (CRH) is a rural non-PCI center 42 air miles from a major PCI center (UVA.) However, air and ground transport difficulties (traffic, topography and weather) often present real-time barriers to achieving a 90 minute (or less!) recognition to PCI interval on any given STEMI transfer patient. This is in spite of a well organized STEMI recognition and interfacility transfer protocol.
Therefore the Culpeper STEMI ALERT Packet emphasizes emergent transport by air –- but only if it’s immediately available. If air transport is not available or is delayed, Culpeper automatically defaults to on-site thrombolytics for STEMI patients that meet thrombolytics criteria. After thrombolytics, patients are then transferred to UVA for repeat evaluation and further treatment.
Today at Culpeper (as at all UPSTART sites) the automatic staff first response to a STEMI is to open a STEMI ALERT Packet and follow instructions.
The Culpeper Physician Checklist guides the physician through the entire reperfusion decision process, based on what works best at Culpeper. This may be either transfer for PCI or on-site thrombolytics. This decision is made rapidly -- and then executed. A thrombolytics screening protocol is attached to the physician checklist for quick reference.
Data Sheet A (along with the 3 checklists) stays at Culpeper and cycles back to their QI person (Karen), via a mailbox drop. This gives them immediate access to real-time, accurate quality improvement data, even though the patient is long gone.
Data Sheet B accompanies the patient to the accepting PCI facility (UVA.) Once the case is complete Data Sheet B is sent to the QI person at UVA for case evaluation. This information is then sent back to the ED director at CRH (Dr. Rosen) as part of the STEMI quality improvement feedback loop involving the two institutions.
Note I: Each time a STEMI case occurs at occurs at Culpeper, the individual data sheets go to two different people at two different institutions. This guards against lost data and also prevents Culpeper from having to wait for quality improvement data on their portion of the process.
Note II: The two data sheets are completed in real-time, not later on. Their function is to provide “bare bones” data for process improvement. This small amount of information is completely adequate to provide QI data, but minimal enough to insure compliance in a busy ED during a stressful STEMI ALERT.