Project UPSTART -- STEMI BootCamp

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The Essential 5Rs of Reperfusion

Refine each one within your system

(R1) Relationships
The establishment of solid relationships within the boundaries of an ESS is the single most important Essential Element. Forming relationships (of all sorts) within the STEMI care continuum of an ESS is an absolutely essential process and ultimately is the key to sustainable success. These relationships are numerous and can be classified as formal or informal. This includes regular STEMI-specific provider education.
(R2) Recognition
The first step towards reperfusion is recognition of a STEMI on an ECG. Therefore, each STEMI portal, whether fixed (hospital) or mobile (EMS vehicle) must carefully adhere to a standardized screening ECG protocol on a continuous basis. Lapses in this crucial action are often responsible for late or missed STEMI diagnosis.
(R3) Reperfusion
Each STEMI Portal, both fixed and mobile (EMS) must have a carefully developed reperfusion plan in place. This STEMI ALERT plan must be carefully adapted to that STEMI portal and must be instantly available to STEMI care providers when a STEMI is diagnosed.
(R4) Real-time data collection
Collecting accurate information on each STEMI ALERT (as it occurs) is necessary for continuing improvement. This data should be recorded by STEMI caregivers as the process occurs and recorded on a standardized data collection sheet that can be easily collected for quality improvement analysis.
(R5) Reassessment & Refinement
Constant process improvement is facilitated by accurate data collection followed by timely data analysis. Without a process in place to act on this data quality improvement can be limited, however. Therefore it is important that each institution and local system have a vigorous process in place for ongoing quality improvement.

Focusing effort on systematic improvement of each of these essential elements is the most efficient method of systematically improving STEMI care in any local system.