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STEMI Leader

UVA Among Nation’s Best for Speed of STEMI Treatment

For the close to 400,000 Americans who suffer an ST-segment elevation myocardial infarction (STEMI) annually, rapid reperfusion through a primary percutaneous coronary intervention (PCI) is key to preventing serious heart damage or death. Performance guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) recommend STEMI patients receive PCI within 90 minutes.

According to data from the most recent fiscal year, 95 percent of patients arriving at the University of Virginia Health System receive PCI within 90 minutes, placing UVA in the 97th percentile of U.S. hospitals for the speed of its STEMI treatment.

UVA’s effective treatment for STEMI patients is driven by a team approach that seamlessly integrates an interdisciplinary group of care providers in UVA’s Emergency Department, nationally accredited Chest Pain Center and Heart and Vascular Center. “It’s the whole system – the collaboration between the emergency room, the cardiac catheterization lab and the nurses. You have to have the whole system in place to make it work,” says cardiologist Michael Ragosta, M.D.

This experienced team constantly refines a detailed treatment protocol for STEMIs developed by UVA emergency medicine physician David R. Burt, M.D. Known as Project UPSTART (The Use of Procedural Standardization to Reduce Recognition to Reperfusion Time in STEMI), the protocol is now used in dozens of hospitals across the country.

Quality STEMI Care Available Around the Clock
Members of UVA’s STEMI alert team are on call around the clock to provide effective treatment. Any patient arriving at UVA with a suspected STEMI is immediately moved to UVA’s Chest Pain Center to determine the cause of their chest pain and develop a treatment plan.

More than half of UVA’s STEMI patients in 2008 were transferred from other hospitals. Referring physicians seeking to transfer a STEMI patient can reach a cardiology fellow 24/7 to arrange care and begin the STEMI alert process. For patients coming from other hospitals, the STEMI alert also notifies UVA’s Bed Coordination Center to ensure a bed is available for the patient once they’re admitted, says Pattie Downer, R.N., the Quality Improvement Coordinator for STEMI care at UVA.

UVA has also worked with Culpeper Regional Hospital to develop a regional STEMI alert process to streamline the transfer of STEMI patients to the cardiac catheterization lab at UVA, Burt says.

“Anywhere in the region, patients will get the best treatment possible for their situation,” Burt says.

Following a PCI, patients receive comprehensive care in UVA’s Coronary Care Unit, complete with round-the-clock physician monitoring of patients. UVA also works with the patient’s referring physician or primary care physician to discuss any needed follow-up care once the patient is discharged from UVA.

Constant Improvements to Treatment Protocol
UVA’s STEMI team examines and reviews every case that comes to UVA to look for ways to improve the care process, Downer says. Every step in the treatment process is tracked and timed to make sure the process is as efficient as possible, she says. The STEMI team meets monthly to review every case and identify areas where the process can be improved, Burt says.

One recent time-saving change was made to the STEMI alert process on nights and weekends, when the STEMI team is on call and reports to UVA as needed. When UVA is alerted that a STEMI patient is on the way, a nursing supervisor will set up the needed equipment in the cardiac catheterization lab and perform the required quality-assurance checks on the equipment, Ragosta says, saving valuable time once the STEMI team and the patient arrive.

“It’s a real team effort,” he says. “The cardiac catheterization lab nurses and catheterization lab technicians do a great job of getting in here and getting things set up quickly.”

As national standards for treatment of STEMI patients are updated – recent additions to the ACC/AHA treatment guidelines include referrals to cardiac rehabilitation programs and evaluations of left ventricular systolic function – UVA plans to make any necessary changes to stay on the leading edge of STEMI care.

“We’re always early adaptors to those guidelines,” Ragosta says.

To speak with a member of UVA’s STEMI team, call UVA Physician Direct at 800.552.3723.