September 18, 2009 – Roger Burke, 35, was working at a remote logging site in Madison County several weeks ago when he began sweating profusely and felt intense pain in his chest and arm – classic heart attack symptoms. His boss was alarmed enough to call the local emergency squad and drove Burke to a nearby convenience store to meet the ambulance.
Before starting the 35-minute trip to the University of Virginia Medical Center, the ambulance crew performed an electrocardiogram, which confirmed that Burke was having a ST-elevation myocardial infarction, or STEMI, a major heart attack. They faxed the reading to U.Va.'s emergency department and, by doing so, set into motion a series of processes that would unfold with clockwork precision and enable Burke to begin artery-opening treatment within minutes after his arrival at the hospital. The treatment was successful and Burke is now recovering.
Dr. David R. Burt, director of the Chest Pain Center in U.Va.'s emergency department, says the hospital was able to treat Burke so rapidly because of Project UPSTART, a quality improvement initiative designed to improve care and increase survival rates of STEMI patients.
"As soon as we received Mr. Burke's EKG via fax, we went into Project UPSTART mode and opened one of our STEMI Alert kits. It prescribed what needed to be done in the ER and laid out the steps for opening the cardiac catheterization lab so everyone in the treatment pathway was ready to offer fast, accurate care to our patient," he says.
For the past three years, Burt has focused on developing and refining Project UPSTART (an acronym for "The Use of Procedural Standardization to Reduce Recognition to Reperfusion Time in STEMI"), which combines medical best practices with the principles of systems engineering and crisis management. The program, which Burt is sharing with other hospitals at no cost, is now helping emergency room staffs around the country optimize their processes for diagnosing and treating patients who are having a STEMI heart attack.
While the highly publicized and successful national Door-to-Balloon initiative has reduced treatment times for ST-elevation heart attack patients to 90 minutes or less at hospitals that perform angioplasty, STEMI care remains inconsistent in many places. "A common point of failure is lack of attention to STEMI care basics," Burt said.
Project UPSTART addresses that shortcoming by helping hospitals optimize the underlying processes of STEMI care. "Our basic premise is that when hospitals use clear, simple, easily learned and consistently applied processes, their emergency care teams perform with a high level of competency in treating STEMI patients," Burt explained. "Project UPSTART provides hospitals with the information and materials needed to create a streamlined, consistently applied system for diagnosing STEMI patients and preparing them for artery-opening treatments."
Project UPSTART helps hospitals define processes for each step in their STEMI treatment pathway, from diagnostic electrocardiogram readings performed in ambulances (prior to hospital arrival) to strategies for rapidly preparing patients for reperfusion, or artery-opening therapy. All program materials are customizable and include information packages, checklists, flow charts, data sheets, an Internet-based provider training module and an introductory video accessible via YouTube.
Burt encourages hospitals participating in Project UPSTART to track reperfusion times for all STEMI patients and to use the information to drive continuous improvements in their treatment systems. Ultimately, he says, it will be important to develop a quality improvement system to ensure that STEMI patients receive the post-treatment care and support they need to recover and stay well.
"We need to do a better job of making sure they stop smoking, begin exercising, improve their diet, lose weight and take their medicines," Burt said.
Burt, an assistant professor of emergency medicine, has taught numerous "STEMI Boot Camp" training sessions around the county. These sessions focus on teaching the basics of STEMI care and the use of Project UPSTART materials.
Burt is a member of the Society of Chest Pain Centers and serves on its Chest Pain Center Accreditation Review Committee. He also serves on the American Heart Association's Mission: Lifeline ECC Committee.
This story originally appeared on the U.Va. Health System Web site.