This is a copy of the STEMI ALERT Packet currently in use at the University of Virginia (UVA). UVA offers on-site PCI for STEMI. Note that the basic UPSTART STEMI ALERT Packet has been carefully modified to fit the exact needs of UVA, including UVA-specific cath lab activation criteria and a new form to facilitate collection of pre-hospital ECGs for integration into the quality improvement process.
Today at UVA (as is true at all UPSTART sites) the automatic staff response to each STEMI case includes opening a STEMI ALERT Packet.
The UVA Physician Checklist facilitates a quick initial evaluation of the patient and then explains exactly how to activate the cath lab –down to the exact dialogue the physician should use when talking to the operator. It also prompts early notification of cardiology, rapid medication administration and other important actions.
Data Sheet A (along with the 3 checklists) cycles back to Barbara the next day via her mailbox. Barbara does QI. The checklists usually have case specific comments that really help the QI process. Attached to Data Sheet A is a simple form for collecting pre-hospital ECG’s so they don’t get misplaced. This is a recent change.
Data Sheet B is partially completed in the ED and is then laid on the gurney next to the patient. It will then be completed by Cath Lab staff at which point it will contain time records of the entire reperfusion chain -from time of first ECG to time of final reperfusion. Data sheets B then makes its way via mailbox to Sandra for quality improvement analysis at the cath lab level.
Note that the two data sheets go to two different people, one in the ED and the other in the cath lab. This guards against lost data and also prevents the ED from having to wait for important QI data to “come to them” from the Cath Lab at some later date.
This “dual sheet” system makes QI very efficient and allows UVA to easily connect and measure the entire STEMI treatment continuum from EMS arrival to cath lab reperfusion. Since this data is available the next day, QI can occur rapidly. Having the data all on one sheet negates a time consuming “chart biopsy” of each case.
With this system, changes can be made very quickly without altering the basic