The American College of Cardiology has recognized the University Health System for its excellence in care for patients with a certain type of heart attack called a ST-Elevation Myocardial Infarction, or STEMI. This deadly type of heart attack is caused by prolonged blockage of blood supply to the heart, and it can be identified as a light peak on the ST segment of an electrocardiogram.
Dr. David Burt, director of the Medical Center's Chest Pain Center, uses a systematic, step by step approach to improve STEMI care.
“We aren’t making a new system, we’re simply improving on an existing one,” Burt said. “Some buy into systematic improvement and do well, while others don’t think it’s up to the system and they say [their] doctors know what they’re doing; they never get as good as they can be.”
Burt came up with the idea for Project UPSTART when he was working as an ER physician in Michigan. Project UPSTART is a compilation of forms, data sheets and educational information developed to perfect the basics of STEMI care.
“We thought having a checklist would be good, and putting a data sheet would allow us to collect feedback," Burt said. "Eventually, standardized training needed to be part of it, so we filmed some videos. Then I thought to put all these pieces together into a program and make all of this free to hospitals anywhere so that they can use it and adjust it to their needs."
Much research has gone into developing Project UPSTART, but nothing like typical laboratory research.
“It’s called implementation science," Burt said. "Billions of dollars of research go towards technology and finding new drugs, but what I’ve learned is that all of that really doesn’t matter; it’s about small unit education and having a plan.”
That plan for treating STEMI patients begins with training the people who interact with the patient first to do 12 leads, a type of electrocardiogram. Without running an ECG, doctors cannot assess ST elevation, the measurable elevated spike on the ECG — a fundamental part of STEMI. This critical recognition stage can catalyze the process or slow it down. Over time, doctors have perfected the process down to the minute.
“Your beginning point is an ECG, and that is infinitely measurable," Burt said. "You can get that at 9:50 or 10 o’clock. The end point is when the artery is open, called reperfusion, and can also be measured. So the time between recognition to reperfusion can be measured to the minute, and that’s why we get awards like this, because we just keep working the time down."
After recognition, Burt emphasized the need for a system in place to communicate information from a 12 lead to ER doctors, enabling them to decide whether to issue a STEMI alert and send the patient down to the catheterization lab, where diagnostic equipment is used to find and unblock the artery causing the heart attack.
“Each STEMI case is like a data point that we can use to improve the whole process, taking information from that case and returning it back to the people who cared for that patient,” Burt said.
Burt and the Health System have successfully collaborated with Martha Jefferson Hospital, Winchester Medical Center and Culpeper Regional Hospital to implement the same blueprint for STEMI care. Burt is now in the process of expanding Project UPSTART to include resources for strokes, sudden cardiac arrest and other acute cardiovascular emergencies.
“We’ve already implemented new packets here at U.Va. for strokes, sudden cardiac arrest and aortic emergencies in our ER," Burt said. "In the end, the trouble is getting this knowledge to people, so we want to put together a new website linked to Project UPSTART that would be the one stop shop for everything."
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