Part I: STEMI BootCamp The 5 “R’s” of Reperfusion”

David R. Burt, MDUniversity of Virginia

Part II: STEMI Fireside Chat

Dr. Mike Kontos

Dr. Pete O’Brien

Dr. David R Burt

The Big Picture

Provider of: STEMI System Blueprints…

3

www.virginiaheartattackcoalition.org

The Virginia Heart Attack Coalition (VHAC) is a volunteer collaboration dedicated to improving care of heart attack patients throughout Virginia via the implementation and promotion of Mission: Lifeline guidelines and by fostering

cooperation and coordination among the Commonwealth's STEMI care providers.

….In Virginia …

Today: The 5 Essential Elements Today: The 5 Essential Elements of STEMI System Optimizationof STEMI System Optimization

R1R1 RelationshipsRelationshipsR2R2 RecognitionRecognitionR3R3 ReperfusionReperfusionR4R4 Real-time data collectionReal-time data collectionR5R5 Reassessment & refinementReassessment & refinement

AHA: STEMI System Blueprints

Mission: Lifeline Recommendations for Criteria for STEMI Systems of Care

The criteria are divided into: Non-PCI Hospital/STEMI Referral Center PCI Hospital/STEMI-Receiving Center sectio

ns  

EMS STEMI Systems of Care

D2B: PCI Engineering

1. ED physician activates cath laba. Via Field Interpretationb. Via Referral Interpretationc. Via ED Interpretation

2. One call activates the cath lab3. Cath lab team ready in 20-30 minutes4. Prompt data feedback5. Senior management commitment6. Team-based approach

STEMI Builder’s Toolkit

www.projectupstart.com

Hot off the Press: System Delay and Mortality in STEMI Patients

Long term mortality based on total systems time (time from first contact to reperfusion) was determined in 3 high volume Danish PCI centers

Total of 6209 patients from 1/02 to 12/08 undergoing primary PCI within 12 hours of symptom onset

median follow up was 3.4 years Each hour of delay time was independent predictor of MI

– Pre-hospital systems delay OR 1.1 (95% CI 1.02-1.18, p=0.02)

– Door to balloon delay OR 1.14 (95% CI 1.05-1.24, p=0.001)– Total systems delay OR 1.1 (95% CI 1.04-1.16, p=0.002)

Terkelsen CJ JAMA 2010;304:763-771

System Delay and Mortality in STEMI Patients

15.4

23.3

28.130.8

0

5

10

15

20

25

30

35

Mortality, %

0 to 60 min 61 to 120min

121 to 180min

181 to 360min

Terkelsen CJ JAMA 2010;304:763-771

Same old Story!

Think Always: Recognition Think Always: Recognition (Or First (Or First Medical Contact)Medical Contact)…. to Reperfusion (R…. to Reperfusion (R22R) R)

Not Just D2B!Not Just D2B! RR22R: The time interval from STEMI R: The time interval from STEMI

Recognition on ECG Recognition on ECG (regardless of (regardless of location)location) to final Reperfusion to final Reperfusion (regardless (regardless of the strategy)of the strategy)!!

System Goal: How can we minimize RSystem Goal: How can we minimize R22R R on each patient?on each patient?– Earlier Recognition at any STEMI “portal”Earlier Recognition at any STEMI “portal”– Earlier Reperfusion -including thrombolytics!Earlier Reperfusion -including thrombolytics!

Endpoints: Recognition and Reperfusion

All attempts at reducing STEMI treatment times must ultimately focus on improving one (or both) of these endpoints.

The goal: (very) early Recognition followed by early Reperfusion.

The Golden Rule: Once a STEMI The Golden Rule: Once a STEMI is Identified it is Identified it MustMust Trigger a Clear Trigger a Clear

Response Downstream!Response Downstream!

Rapid Rapid RecognitionRecognition of STEMI on ECG will only of STEMI on ECG will only improve the process IF improve the process IF RecognitionRecognition leads to leads to a concrete action occurring downstreama concrete action occurring downstream

Recognition allows early Reperfusion… but Recognition allows early Reperfusion… but does not guarantee it!does not guarantee it!

STEMI 2012: “60 is the New 90”STEMI 2012: “60 is the New 90”

<30 Minutes <30 Minutes : First Medical Contact : First Medical Contact (Recognition) to Thrombolytic administration(Recognition) to Thrombolytic administration

<90 Minutes <90 Minutes : First Medical Contact to on-site : First Medical Contact to on-site PCI (AHA/ACC recs) ?????PCI (AHA/ACC recs) ?????

<90 Minutes<90 Minutes : First Medical Contact followed by : First Medical Contact followed by inter-facility transferinter-facility transfer to a PCI-capable facility to a PCI-capable facility

***BUT realistically <60 Minutes should be the ***BUT realistically <60 Minutes should be the goal for Contact/Recognition to Reperfusion @ a goal for Contact/Recognition to Reperfusion @ a STEMI Receiving Facility (PCI Center)!STEMI Receiving Facility (PCI Center)!

Luckily, Each Local STEMI System…Luckily, Each Local STEMI System…

Serves just three STEMI cohorts:Serves just three STEMI cohorts:

1) Patients that walk up to the front 1) Patients that walk up to the front door of that facility… (walk-ins)door of that facility… (walk-ins)

2) Patients brought in by EMS (from 2) Patients brought in by EMS (from the field)the field)

3) Patients received from a Non-PCI 3) Patients received from a Non-PCI facility or those sent to a PCI facility facility or those sent to a PCI facility (inter-facility transfers)(inter-facility transfers)

Key Concept: STEMI ConduitsKey Concept: STEMI Conduits

Each possible STEMI treatment Each possible STEMI treatment pathway within a systempathway within a system

Three types of STEMI conduits:Three types of STEMI conduits:– Internal, (no EMS involvement)Internal, (no EMS involvement)– Mixed (EMS field involvement)Mixed (EMS field involvement)– Inter-facility (EMS - inter-facility Inter-facility (EMS - inter-facility

transport)transport)

Example I: The University Example I: The University of Virginia Systemof Virginia System

The University of Virginia – a PCI hub The University of Virginia – a PCI hub hospital (R2R goal: 60 minutes)hospital (R2R goal: 60 minutes)

18 EMS agencies (more or less) 18 EMS agencies (more or less) Culpeper Regional, a non-PCI hospitalCulpeper Regional, a non-PCI hospital Augusta Medical Center, a non PCI hospitalAugusta Medical Center, a non PCI hospital Page Memorial, a non PCI hospitalPage Memorial, a non PCI hospital

Example II: The Culpeper Example II: The Culpeper Regional HospitalRegional Hospital

Culpeper Regional, a non-PCI hospital with Culpeper Regional, a non-PCI hospital with 14 ED beds that is 44 miles from a PCI 14 ED beds that is 44 miles from a PCI centercenter

The University of Virginia, a PCI hub The University of Virginia, a PCI hub hospital (Rhospital (R22R goal: 60 minutes)R goal: 60 minutes)

6 EMS agencies (more or less)6 EMS agencies (more or less)

Local STEMI Local STEMI systems (usually) Overlap…systems (usually) Overlap…

So, improving each one internally So, improving each one internally will improve the entire region…statewill improve the entire region…state

PageCulpeper

AugustaUVA

Minnesota

Wisconsin

Iowa

Rochester

Minneapolis/St. Paul

0 100 200

The Mayo Clinic Network

Ting HH, et al. Circulation 2007;116:729-736

“Joe the STEMI Patient”

STEMI Systems Engineering:

“Optimize Average”(standardization)

& Measure it!(real-time data collection)

Again: The 5 Essential Elements Again: The 5 Essential Elements of STEMI System Optimizationof STEMI System Optimization

R1R1 RelationshipsRelationshipsR2R2 RecognitionRecognitionR3R3 ReperfusionReperfusionR4R4 Real-time data collectionReal-time data collectionR5R5 Reassessment & refinementReassessment & refinement

The “5 R’s of Reperfusion”:The “5 R’s of Reperfusion”:

True “Essential Elements” of STEMI care True “Essential Elements” of STEMI care Perfection of each of these will optimize Perfection of each of these will optimize

any local STEMI Systems of Careany local STEMI Systems of Care They provide focus points for immediate They provide focus points for immediate

improvementimprovement True “Pareto Points” of STEMI Care!True “Pareto Points” of STEMI Care! Efficient improvement with less effort!Efficient improvement with less effort!

Optimize each R! Optimize each R!

A focus on optimizing each of the “5 A focus on optimizing each of the “5 R’s” will allow rapid improvement of R’s” will allow rapid improvement of any local STEMI system in the most any local STEMI system in the most efficient manner possible efficient manner possible

A precise application of the Pareto A precise application of the Pareto Effect (the 80/20 rule)!Effect (the 80/20 rule)!

Optimizing Each Essential Optimizing Each Essential Element is Critical Element is Critical

Failure to optimize each of the 5 R’s will Failure to optimize each of the 5 R’s will lead to delay at some later timelead to delay at some later time

Each step is critical to sustainable successEach step is critical to sustainable success

Implementation of systematic change sets Implementation of systematic change sets the stage for provider gap closure the stage for provider gap closure

An optimized system minimizes provider An optimized system minimizes provider delays and enhances provider excellencedelays and enhances provider excellence

The 5 R’s: The 5 Essential Elements of The 5 R’s: The 5 Essential Elements of STEMI System OptimizationSTEMI System Optimization

R1R1 RelationshipsRelationshipsR2R2 RecognitionRecognitionR3R3 ReperfusionReperfusionR4R4 Real-time Data CollectionReal-time Data CollectionR5R5 Reassessment & RefinementReassessment & Refinement

Relationships: The Most Important R!Relationships: The Most Important R!

Without question, the most Without question, the most important factors in successful important factors in successful optimization of a local STEMI optimization of a local STEMI systems is development of systems is development of strong relationships at all levels, strong relationships at all levels, -both formal and informal -both formal and informal

Remember the RRemember the R22R Continuum?R Continuum?

Cemented by Relationships!Cemented by Relationships! EMS first contact personnelEMS first contact personnel ED triage personnelED triage personnel ED nursing staffED nursing staff ED physician ED physician EMS transfer staffEMS transfer staff Paging system personnelPaging system personnel Cath lab staffCath lab staff CardiologistCardiologist Quality Improvement staffQuality Improvement staff

Reperfusion!

Recognition!

Relationships

The 5 R’s: The 5 Essential Elements The 5 R’s: The 5 Essential Elements of STEMI System Optimizationof STEMI System Optimization

R1R1 RelationshipsRelationshipsR2R2 Recognition (where it all begins)Recognition (where it all begins)R3R3 ReperfusionReperfusionR4R4 Real-time data collectionReal-time data collectionR5R5 Reassessment & refinementReassessment & refinement

Recognition:Recognition:

Implement an optimal STEMI screening Implement an optimal STEMI screening process at each “STEMI portal”process at each “STEMI portal”

Goal: Goal: Each Each qualifying patient receives qualifying patient receives a timely screening ECG!a timely screening ECG!

All portals -fixed or floatingAll portals -fixed or floating

“Fred Sanford Syndrome”…

Look Familiar?Look Familiar?

Recognition…Recognition…

Print ItPrint It Post ItPost It Expect ItExpect It Measure ItMeasure It

The 5 R’s: The 5 Essential Elements The 5 R’s: The 5 Essential Elements of STEMI System Optimizationof STEMI System Optimization

R1R1 RelationshipsRelationshipsR2R2 RecognitionRecognitionR3R3 ReperfusionReperfusionR4R4 Real-time data collectionReal-time data collectionR5R5 Reassessment & refinementReassessment & refinement

ReperfusionReperfusion

A precision reperfusion plan in place for A precision reperfusion plan in place for each STEMI portal each STEMI portal

A “STEMI ALERT Process for every portal”A “STEMI ALERT Process for every portal”

-including pre-hospital portals-including pre-hospital portals

-including in-house recognition-including in-house recognition

-including inter-facility transfers-including inter-facility transfers

1) Design a STEMI ALERT Plan for 1) Design a STEMI ALERT Plan for Each “Fixed” Portal!Each “Fixed” Portal!

-carefully customized to each specific “portal”-carefully customized to each specific “portal”-instantly accessible-instantly accessible-simple-simple-incorporates real-time data collection (more on -incorporates real-time data collection (more on that later)that later)

GOAL:GOAL:Neutralize the effects of chaos theory, paralysis Neutralize the effects of chaos theory, paralysis by analysis and other STEMI system maladies!by analysis and other STEMI system maladies!

2) Work with EMS to Design a Pre-2) Work with EMS to Design a Pre-hospital STEMI ALERT Protocolhospital STEMI ALERT Protocol

Consider EMS a floating “STEMI portal”Consider EMS a floating “STEMI portal” Up to 50% of STEMI patients may use this Up to 50% of STEMI patients may use this

“pre-hospital portal system”“pre-hospital portal system” Simple protocols will address most needsSimple protocols will address most needs More on this laterMore on this later

The 5 R’s: The 5 Essential Elements The 5 R’s: The 5 Essential Elements of STEMI System Optimizationof STEMI System Optimization

R1R1 RelationshipsRelationshipsR2R2 RecognitionRecognitionR3R3 ReperfusionReperfusionR4R4 Real-time Data CollectionReal-time Data CollectionR5R5 Reassessment & RefinementReassessment & Refinement

The “5 R’s”: Essential ElementsThe “5 R’s”: Essential Elements

Real-time Data Collection:Real-time Data Collection:

Data collected during each STEMI Data collected during each STEMI ALERT to continually measure the ALERT to continually measure the process process

You can’t improve what you don’t You can’t improve what you don’t measuremeasure

Sample Data Sample Data Sheet for STEMISheet for STEMI

Date ED Attending:

Patient Name ED Resident:

Patient MR # CCU Fellow (pic #1309):

ED Nurse: ED Team Manager Phone #: 531-5839Cath Lab: 2-0976 CCU: 4-2582

Time of Onset of CP Symptoms

Time ECG Read by ED Attending

Time Cath Lab Activated

CCU Fellow Arrival Time

Attending Arrival Time

Lido Time

Access time

Time of 1st wire across lesion

Time of 1st Balloon Inflation

FORM TO STAY IN ED. Place in Mailbox of Barbara Craighead. DO NOT SEND WITH PATIENT.Comments / Suggestions:

ED Copy (Yellow) Time Study for STEMI Alerts STAYS IN ED

Patient Sticker

Time Cath Lab Team Calls for Patient

Time Patient Arrived ED

Time of 1st EKG

Time Patient Left ED

ED

Co

mp

lete

s

Time CCU Fellow Responds to Page

If not, Time CCU Fellow Paged

NOT PART OF THE MEDICAL RECORD

Time Patient Arrived in Cath Lab Room

Ca

th L

ab

Co

mp

lete

s

TIME

Time ED STEMI Alert Initiated

INDICATOR

Did ED Attending Activate Cath Lab? Y N (circle one)

Date ED Attending:

Patient Name ED Resident:

Patient MR # CCU Fellow (pic #1309):

ED Nurse: ED Team Manager Phone #: 531-5839Cath Lab: 2-0976 CCU: 4-2582

Time of Onset of CP Symptoms

Time ECG Read by ED Attending

Time Cath Lab Activated

CCU Fellow Arrival Time

Attending Arrival Time

Lido Time

Access time

Time of 1st wire across lesion

Time of 1st Balloon Inflation

FORM TO STAY IN ED. Place in Mailbox of Barbara Craighead. DO NOT SEND WITH PATIENT.Comments / Suggestions:

ED Copy (Yellow) Time Study for STEMI Alerts STAYS IN ED

Patient Sticker

Time Cath Lab Team Calls for Patient

Time Patient Arrived ED

Time of 1st EKG

Time Patient Left ED

ED

Co

mp

lete

s

Time CCU Fellow Responds to Page

If not, Time CCU Fellow Paged

NOT PART OF THE MEDICAL RECORD

Time Patient Arrived in Cath Lab Room

Ca

th L

ab

Co

mp

lete

s

TIME

Time ED STEMI Alert Initiated

INDICATOR

Did ED Attending Activate Cath Lab? Y N (circle one)

Real-time Real-time datadata

SimpleSimple EasyEasy

Collected in Collected in every STEMIevery STEMI

Inter-facility

Real-time data in action!

UPSTARTInter-facility Data

Sheet B

Real-Time Data at Lynchburg!

PartnerSites

The 5 R’s: The 5 Essential Elements The 5 R’s: The 5 Essential Elements of STEMI System Optimizationof STEMI System Optimization

R1R1 RelationshipsRelationshipsR2R2 RecognitionRecognitionR3R3 ReperfusionReperfusionR4R4 Real-time data collectionReal-time data collectionR5R5 Reassessment & RefinementReassessment & Refinement

The “5 R’s”: Essential ElementsThe “5 R’s”: Essential Elements

Reassessment and Refinement:Reassessment and Refinement:

You now have a standardized, You now have a standardized, accessible process that is carefully accessible process that is carefully measured each time it occursmeasured each time it occurs

And, a standardized process + ongoing And, a standardized process + ongoing measurement allows for measurable, measurement allows for measurable, rapid and sustainable rapid and sustainable improvement!improvement!

STEMI Continuum RelationshipsSTEMI Continuum Relationships

Allow for rapid improvementAllow for rapid improvement

and sustained resultsand sustained results

If periodically maintainedIf periodically maintained

Reperfusion!

Recognition!

Relationships

Review: The 5 Essential Elements Review: The 5 Essential Elements of STEMI System Optimizationof STEMI System Optimization

R1R1 RelationshipsRelationshipsR2R2 RecognitionRecognitionR3R3 ReperfusionReperfusionR4R4 Real-time Data CollectionReal-time Data CollectionR5R5 Reassessment & RefinementReassessment & Refinement

……R1R1 Relationships (again)Relationships (again)

Let’s Have Some Fun with This!Let’s Have Some Fun with This!

Consider “Relationships” – the most Consider “Relationships” – the most important Essential Element…important Essential Element…

Do some of the following questions Do some of the following questions look familiar?look familiar?

Questions That Drive Questions That Drive Relationship DevelopmentRelationship Development

Is your hospital a part of a formal regional Is your hospital a part of a formal regional STEMI system?STEMI system?

Do regularly scheduled meetings occur Do regularly scheduled meetings occur involving EMS providers and reps from all involving EMS providers and reps from all facilities within your regional STEMI facilities within your regional STEMI system?system?

Can you name your partner facilities?Can you name your partner facilities?Does your hospital have a contact person Does your hospital have a contact person

within each of these facilities?within each of these facilities?

Relationships….Relationships….

Do you have mechanisms (such as an EMS STEMI Do you have mechanisms (such as an EMS STEMI Story Board) to constantly let EMS know about Story Board) to constantly let EMS know about cases gone right?cases gone right?

Do you involve patient advocates (STEMI survivors) Do you involve patient advocates (STEMI survivors) to help improve your STEMI system?to help improve your STEMI system?

Do you provide regular written feedback to EMS Do you provide regular written feedback to EMS providers within your system?providers within your system?

Does your system have a formalized method of Does your system have a formalized method of providing case-specific feedback to providers of the providing case-specific feedback to providers of the entireentire STEMI care continuum? STEMI care continuum?

Relationships….Relationships….

Do you feel comfortable contacting Do you feel comfortable contacting each facility to discuss STEMI issues each facility to discuss STEMI issues and/or individual cases?and/or individual cases?

Do you know the names of the EMS and Do you know the names of the EMS and transport provider organizations within transport provider organizations within your area?your area?

Do you invite EMS personnel to your Do you invite EMS personnel to your AMI quality improvement meetings?AMI quality improvement meetings?

Relationships at All Levels!Relationships at All Levels!

STEMI AMI meetingsSTEMI AMI meetingsEMS STEMI Story BoardEMS STEMI Story BoardPrompt data feedbackPrompt data feedbackEMS personnel visiting the Cath LabEMS personnel visiting the Cath LabCardiologists on EMS ride-alongsCardiologists on EMS ride-alongsCardiologists to ED physician Cardiologists to ED physician “customer updates”“customer updates”

First Contact Provider EducationFirst Contact Provider Education

Relationships… At All Levels!Relationships… At All Levels!

STEMI AMI meetingsSTEMI AMI meetings EMS STEMI Story BoardEMS STEMI Story Board Prompt data feedbackPrompt data feedback EMS personnel visiting the cath labEMS personnel visiting the cath lab Cardiologists on EMS ride-alongsCardiologists on EMS ride-alongs Cardiologists to ED physician phone callsCardiologists to ED physician phone calls Cold beverages in a restaurant…….Cold beverages in a restaurant…….

Another Example: RecognitionAnother Example: Recognition

Quiz Question: As far as any Quiz Question: As far as any potential STEMI patient is potential STEMI patient is

concerned, who is theconcerned, who is the most most important personimportant person in your STEMI in your STEMI

Care Continuum?Care Continuum?

!Whoever Does That First ECG!!Whoever Does That First ECG!

Would Your Institution MISS This?Would Your Institution MISS This?

Maybe... Who Wins the ECG Maybe... Who Wins the ECG Race Friday at 3am?Race Friday at 3am?

STEMI?

STEMI?? STEMI???

Recognition: How is Recognition: How is YourYour Hospital Doing? Hospital Doing? Take This Short Quiz, Please!Take This Short Quiz, Please!

1)1) Do you have a written “Screening ECG Protocol” Do you have a written “Screening ECG Protocol” at your institution?at your institution?

2)2) Is it visibly posted in your ED & triage Is it visibly posted in your ED & triage 3)3) Do ED and triage staff follow it 24/7?Do ED and triage staff follow it 24/7?4)4) Have you trained your staff regarding their key Have you trained your staff regarding their key

role in the screening ECG?role in the screening ECG?5)5) Do you have multiple backup pathways in place Do you have multiple backup pathways in place

to ensure that the screening ECG gets done to ensure that the screening ECG gets done during busy times?during busy times?

6)6) Is each ECG immediately shown to a physician?Is each ECG immediately shown to a physician?

How Did You Do?How Did You Do?

Unless you answered “yes” to all Unless you answered “yes” to all questions, your institution is at risk of questions, your institution is at risk of overlooking the previous ECG. If not overlooking the previous ECG. If not today, then next Friday.today, then next Friday.

Solution:Solution: Work on optimizing Work on optimizing Recognition until you can answer yes Recognition until you can answer yes to all six questions -24/7 to all six questions -24/7

The Project UPSTART“Screening ECG Protocol”

…..Easily utilized at STEMI portals Everywhere!

Combine with processoptimization to ensure RecognitionSuccess!

How about Pre-hospital Recognition?

Recognition (Pre-hospital)Recognition (Pre-hospital)

11) ) Yes/NoYes/No Do your EMS providers utilize pre-hospital ECGDo your EMS providers utilize pre-hospital ECG to identify a STEMIto identify a STEMI

22) What percent of your EMS providers are trained to ) What percent of your EMS providers are trained to obtain a 12 Lead ECG? obtain a 12 Lead ECG? 3)3) What percent of your EMS vehicles are ECG-capable? What percent of your EMS vehicles are ECG-capable? 4)4) How is the activation of “STEMI Alert” usually made on How is the activation of “STEMI Alert” usually made on pre-hospital ECG’s done within your system? pre-hospital ECG’s done within your system?

Yes/NoYes/No ECG interpretation is done by EMS personnel ? ECG interpretation is done by EMS personnel ? Yes/NoYes/No Determination of STEMI primarily based on Determination of STEMI primarily based on machine algorithm interpretation?machine algorithm interpretation? Yes/NoYes/No ECG transmitted for physician over-read? ECG transmitted for physician over-read?

5)5)Yes/NoYes/No Do pre-hospital providers immediately contact Do pre-hospital providers immediately contact an ED physician once they obtain an ECGan ED physician once they obtain an ECG suspicious for STEMI?suspicious for STEMI?

Reperfusion: A Reperfusion Plan at Reperfusion: A Reperfusion Plan at Every STEMI PortalEvery STEMI Portal

Each time a STEMI is recognized (either pre-Each time a STEMI is recognized (either pre-hospital or in-hospital) a carefully developed plan hospital or in-hospital) a carefully developed plan specific to that site should be reflexively specific to that site should be reflexively triggered. It should be simple, precise, written triggered. It should be simple, precise, written down and instantly accessible.down and instantly accessible.

No rocket science allowedNo rocket science allowed

Example: Open a STEMI ALERT Example: Open a STEMI ALERT Packet for every STEMI Packet for every STEMI

A trigger for reperfusionA trigger for reperfusion

““Got STEMI =Open Packet!”Got STEMI =Open Packet!”

Education meets conditioningEducation meets conditioning

Fully teachable to all ED staff Fully teachable to all ED staff and (most) ED physicians!and (most) ED physicians!

Real time Data Collection…

Mandatory for optimization!

Hint: Hardwire it into your basic STEMI ALERT Process and minimize your workload…

Reassessment and Refinement…

Hold a meeting

Have people show up

Present Data

Act on the Data

Hint: Publicize your successes loudly and correct your failures quietly!

The 5 R’s: A ReviewThe 5 R’s: A Review

R1 Relationships:R1 Relationships: Working within the Working within the STEMI care continuumSTEMI care continuum

R2 Recognition:R2 Recognition: Fine tune the Recognition Fine tune the Recognition processprocess

R3 Reperfusion:R3 Reperfusion: A STEMI ALERT Process at A STEMI ALERT Process at every portalevery portal

R4 Real-time Data Collection:R4 Real-time Data Collection: Real-time Real-time measurement of each STEMImeasurement of each STEMI

R5 Readjustment and Refinement:R5 Readjustment and Refinement: On- On-going process adjustment based on going process adjustment based on accurate dataaccurate data

You Have Now Come Full CircleYou Have Now Come Full Circle

Optimizing the 5 Essential Elements Optimizing the 5 Essential Elements will allow you to quickly improve care will allow you to quickly improve care in your entire local STEMI System of in your entire local STEMI System of CareCare

The system you create will maintain The system you create will maintain a standardized process and ongoing a standardized process and ongoing data collection, allowing you to data collection, allowing you to efficiently maintain your process.efficiently maintain your process.

The 5 R’s Made Easy (Easier)….The 5 R’s Made Easy (Easier)….

www.projectupstart.comwww.projectupstart.com

A no-cost quality improvement tool A no-cost quality improvement tool developed to efficiently improve developed to efficiently improve

local-level STEMI care via local-level STEMI care via optimization of the five Essential optimization of the five Essential

Elements of ReperfusionElements of Reperfusion

www.projectupstart.comwww.projectupstart.com

All Questions Accepted!All Questions Accepted!

David R. Burt, MDAssistant ProfessorDepartment of Emergency Medicine University of Virginia Health Systemdavidrburt@virginia.eduOffice: 434.924.2428

Now, The Main Event!

Dr. Mike Kontos

Dr. Pete O’Brien

Dr. David R Burt