Transcript Title Here - Project UPSTART

An Introduction
www.projectupstart.com
Project UPSTART
The Use of Procedural Standardization to
Reduce “Recognition to Reperfusion” (R2R)
Time in STEMI
“Excellence in R2R”
www.projectupstart.com
A Framework for Improvement
Project UPSTART is an unique quality
improvement program that lets you quickly
and easily improve the care of your patients
suffering from STEMI.
A toolbox for building systems of care for
STEMI
Avoid reinventing the wheel!
www.projectupstart.com
A Tool Kit for STEMI Systems…
Provides forms, protocols, templates provider
education and other necessary “components”
Designed to improve locals systems of care
Facilitates inter-facility collaboration and data
sharing
Compliant with the concepts and principles
endorsed within the American Heart
Associate and its Mission: Lifeline Initiative
www.projectupstart.com
Mission: Lifeline
(The Big Picture)
National, community-based initiative
Goals
•
•
www.projectupstart.com
5
…Think of
Project UPSTART as a
Mission: Lifeline-compliant
“Recognition to Reperfusion”
Toolbox!
www.projectupstart.com
Optimizes Recognition and
Reperfusion
All attempts at reducing STEMI
treatment times must ultimately
focus on improving one (or both) of
these endpoints.
The goal: early recognition followed
by early reperfusion.
“
www.projectupstart.com
Example #1
Large Community PCI
hospital
Multiple cardiology
groups, etc
Current reperfusion
mean (door to PCI)
+/_ 52 Minutes
(stable over last three
years)
www.projectupstart.com
Example #2
A Large University PCI
Center
UPSTART go-live:
9.11.06
Reperfusion (DTB)
times declined from 83
minutes to 58 minutes
within one month of
implementation
www.projectupstart.com
Quiz: Have These Issues
Occurred in Your STEMI system?
A veteran nurse working triage neglects to obtain an ECG
on an “atypical” STEMI patient?
Your temporary ED physician forgets to immediately call
EMS, delaying inter-facility transport?
A thrombolytic checklist was not instantly available when
needed to assess a patient?
A STEMI patient was sent to the PCI lab without an IV?
Important STEMI QI data has not been routinely available
for quality improvement analysis?
www.projectupstart.com
History Repeats…Unless you
Learn from Previous Mistakes!
Project UPSTART incorporates many best
practice concepts directly into a simple,
repeatable approach to STEMI care that is
based on just 4 key actions:
Error-proof your providers by error-proofing the
system!
www.projectupstart.com
STEMI System Theory: A Review
To efficiently improve your local STEMI system:
First, you must first define who your local STEMI
system actually involves and its physical
boundaries…..
Next, you must define what processes are most
important within that system
Finally, you must fix what needs fixing!
www.projectupstart.com
Luckily we can help you!
The next few slide discuss important concepts
in helping you define your local Elemental
STEMI Subsystem (ESS) system and
outlining the Essential Elements of
Reperfusion that must be the focus of your
improvement efforts.
This has all been done before, by someone!
www.projectupstart.com
Key Concept: The “Elemental STEMI
Subsystem” (ESS)
??
The smallest combination of EMS and STEMI
treatment facilities that can function “alone” as a self
functioning “STEMI system of care”
By definition, the ESS is the “elemental building
block” of all STEMI systems –no matter how large
that “system” may be
www.projectupstart.com
An Individual ESS…
Has only three basic components:
1) All EMS organizations that transport STEMI
patients to or from a facility
2) That facility and its internal “in house” STEMI
management processes
3) “Outside” facilities that either send or receive
STEMI patients to or from that facility….
www.projectupstart.com
A Typical Elemental STEMI Subsystem
www.projectupstart.com
Elemental STEMI
Subsystems (usually) Overlap…
So, improving each one internally will improve the
entire region!
Non-PCI
PCI
PCI
www.projectupstart.com
Non-PCI
Take Home Point?
Define your local ESS and concentrate on
improving each important process within
its boundaries
Non-PCI
PCI
PCI
!Your ESS!
www.projectupstart.com
STEMI Optimization = Perfecting
the Basics!
Now you know where you need to concentrate
your efforts: your ESS.
So, what do you fix first?
In other words, where can you get the most
“bang for your buck?”
www.projectupstart.com
The 5 R’s: The 5 Essential
Elements of STEMI System
Optimization
R1
R2
R3
R4
R5
Relationships
Recognition
Reperfusion
Real-time Data Collection
Reassessment & Refinement
www.projectupstart.com
Concentrate on the “5R’s”
In order to improve your system in a time
efficient manner you must improve each one
of these critical process until they are running
smoothly.
Project UPSTART was designed to help you in
this process!
www.projectupstart.com
Four Key Steps
www.projectupstart.com
Would your institution make that same
mistake on a busy Friday night?
www.projectupstart.com
Let check: Please answer the following
questions to assess Recognition at
your institution:
1)
2)
3)
4)
5)
Do you have a written “Screening ECG Protocol” for
your institution?
Is it visibly posted in your ED and triage areas?
Do ED and triage staff follow it 24/7?
Have you trained your staff regarding their role (and
importance) in the screening ECG?
Do you have multiple backup pathways in place to
ensure that the screening ECG gets done during
busy times?
www.projectupstart.com
How did you do?
Unless you answered “yes” to all five questions,
your institution is at risk at missing that same
ECG. If not today, then next Friday.
Solution: Improve your STEMI recognition
process
www.projectupstart.com
Solution:
The Project UPSTART
“Screening ECG Protocol”
-Print it’
-Post it’
-Use it’
-Reinforce it
-Educate staff at: www
.projectupstart.com!
www.projectupstart.com
Benefits of UPSTART
Builds on the experience of others –no need to
“reinvent the wheel”.
Offers a variety of tools, forms and instructions
for rapid improvement of existing processes
Carefully designed for ease of implementation
Connects all links of the “STEMI chain” together
from EMS to the cath lab
www.projectupstart.com
Four Key Steps
www.projectupstart.com
STEP 1: Optimize STEMI
Recognition!
Provide a tool
The Screening ECG Protocol
Post it everywhere
Teach compliance (via education)
End result?
Minimize missed STEMI!
www.projectupstart.com
2: Open a STEMI ALERT Packet
for every STEMI
“Got STEMI –Open Packet!”
Opening the packet serves as a focus
for action
Staff automatically open a packet for
every STEMI
www.projectupstart.com
The STEMI ALERT Packet
A carefully designed
STEMI ALERT Packet is
the key to success
It places all the required
information for a
successful “STEMI
ALERT” instantly at your
fingertips
www.projectupstart.com
The STEMI ALERT Packet
A carefully designed
STEMI ALERT Packet is
the key to success.
All the required
information for success is
instantly at your fingertips.
www.projectupstart.com
A standard STEMI Alert Packet
includes three checklists:
Physician Checklist
Nurse Checklist
www.projectupstart.com
STEMI Scribe Checklist
And two Data Collection Sheets
Data Sheet A
Data Sheet B
www.projectupstart.com
How it works…..
Prior to implementation, each site decides what
is the generalized best approach to treating
STEMI at that particular institution. All
important details are then incorporated into
the checklists within the STEMI ALERT
Packet.
www.projectupstart.com
What type of details?
Medications
Phone numbers
Treatment algorithms
Patient assessment prompts
ED cath lab activation criteria
Thrombolytics checklists
Cath lab preparation tasks
**Whatever is felt important!
www.projectupstart.com
Now put your packets somewhere
visible
The next time a STEMI occurs, your staff
should know to open the packet!
Put conditioning to work for you!
www.projectupstart.com
Physician
Checklist
Sample PCI
with details
Who to call
Medications
Assessment
Phone numbers
Memory prompts
www.projectupstart.com
Nurse
Checklist
Sample PCI
site
Focus?
-patient
preparation for
additional
treatment or
transfer
www.projectupstart.com
Stemi Scribe
Recording times
Data collection
Monitoring communication
www.projectupstart.com
Next: No measurement = No
improvement!
The function of Data Sheets A and B are to
measure key intervals during the STEMI alert.
This data drives ongoing improvement
Data Sheet B always follows the patient and
contains a record of total time from
recognition to reperfusion
Data Sheet A stays in the ED
www.projectupstart.com
Step 3: Complete Data Sheets A & B
during each STEMI ALERT
www.projectupstart.com
Date Sheet A
Stays in the ED
Provides information
for efficient feedback
www.projectupstart.com
Data Sheet B:
Sent to the cath lab
or to the receiving facility
Provides data on arrival
When completed has data
points from the entire case
www.projectupstart.com
Step 4: Data Management!
After the STEMI ALERT is complete, Data
sheets A and B are delivered to their
respective sites. “A” stays in the ED and “B”
follows the patient.
This accurate data is very helpful
Our standard is to measure R2R times on each
patient!
www.projectupstart.com
Same 4-step process at every
facility! Data sheet B links
them together!
www.projectupstart.com
Review the “Four Key
Steps”
www.projectupstart.com
Can you do these 4 steps at your
facility?
Then you can implement UPSTART!
-STEMI Alert Packet forms are easily
customized
-All other forms are from templates as well
-When possible, items are standardized
-Staff education can be done via the internet
www.projectupstart.com
Implementation
1) Develop an individualized STEMI ALERT Packet
for your institution
2) Train your staff at www.projectupstart.com
3) Place the STEMI ALERT Packets in your ED
4) Go live! The process will continue improving using
the data collection loops built into the process
www.projectupstart.com
Provider Education
Train all ED staff prior to “go live’
Takes one hour or less
A combination of a written tutorial, on-line video
and short written test
Available at www.projectupstart.com
www.projectupstart.com
The Project UPSTART website:
Your link to the UPSTART world!
www.projectupstart.com
Links to all required forms
More Powerpoints! Training videos!
The common access point for provider training
Simple and clear information in an easily
accessibly form
www.projectupstart.com
Example: Additional forms…….
ED Activation of the Cath Lab
ED Thromblytics Guide
EMS Guide Sheet
Cath Lab Checklist
Implementation Manual
UPSTART Follow-up Sheet
www.projectupstart.com
www.projectupstart.com
www.projectupstart.com
Questions?
www.projectupstart.com
David R. Burt, MD
University of Virginia
[email protected]
(434) 924-2428
www.projectupstart.com