Real-Time Data Collection

You Can't Improve What you Don't Measure

Each STEMI systems of care needs to make real-time data collection an integral action within their "STEMI Culture." Recently, Drs. Pete O'Brien, Mike Kontos and David Burt (all from Virginia) teamed up to conduct a STEMI BootCamp Webinar. Please follow links for hints and materials to help you fine-tune your STEMI data collection highway.

Real Time Data Collection at the University of Virginia David R. Burt, MD

At UVA we have a real-time data collection loop based on Project UPSTART. During each STEMI Alert, ED staff complete two very simple and nearly identical color-coded data sheets: Data Sheet A and B. This only takes about 45 seconds. After the STEMI Alert, Data Sheet A (.doc) stays in the ED (for later review) and Data sheet B (.doc) is transferred with the patient when they go the cath lab. Data Sheet B is completed in the cath lab; it will then contain all important time intervals from first Recognition to final Reperfusion. This makes QI very easy. If one sheet is lost we also have a backup! This simple sheet lets us do immediate feedback; no need to wait for a "chart biopsy." We also use an Excel Spreadsheet (.xls) to present this data at our monthly STEMI conference. This process also works for interfacility transfers. Culpeper Regional Hospital has a site-customized Project UPSTART STEMI ALERT Packet; they send their data sheet (.pdf) with the patient to UVA and it makes its way to me. Note on this sample, how easily we can calculate the patients total R2R interval: 85 minutes! Data Sheet B started in Culpeper and ended up in my email -- about 7 hours later.

Real Time Data Collection at Lynchburg General Hospital Peter O'Brien, MD

The Centra D2B sheet (.doc) is a simple, one page form that allows for real-time data collection and prompt feedback to providers after each STEMI case at Centra. It is started in the ED at Centra Lynchburg General Hospital (or the referring hospital ED for transfers) and travels with the patient to the cardiac cath lab. It is completed by the cath lab staff and then signed off on by the Interventionalist at the end of the case. The final D2B and/or E2B time is then communicated to the referring providers and EMS. The sheet is then left for the STEMI QI coordinator, and sent electronically to the those involved in the case within 24-48 hours. We have also attached our Centra Universal STEMI Transfer Protocol (.pdf).

Things to Think About:

Note that UVa and Lynchburg General Hospital both utilize a real time data collection sheet that starts with the patient and ends at the site of reperfusion. Thus, they both track all key intervals in the Recognition to Reperfusion timeline (R2R). Thus, form follows function. Evolutionary biologists call this convergent evolution... Bats, insects, and birds all have wings. We just say "Don't reinvent the wheel!"

Real Time Data Collection at Virginia Commonwealth University Michael Kontos, MD

At VCU, Emergency Department Feedback for primary PCI is performed within 24 hours. We present 2 slides: one demonstrating the ECG, and another with the individual time elements (Figure 1).

For EMS a similar data feedback form is also completed within 72 hours. In addition to the hospital time elements, we include EMS time points as well (Figure 2). This includes Recognition to Reperfusion (Time from EMS arrival to reperfusion; R2R for as specified by Mission:Lifeline), ECG (pre-hospital identification by ECG) to Reperfusion, and the standard D2B (hospital arrival to reperfusion).

In addition to the time elements, a file that contains the EMS ECG and ED ECG (if available), initial and final cath images are also included for teaching purposes. These identify the key ECG findings, as well as location of the lesion on cath.

At our quarterly STEMI meetings, the hospital time elements are presented in bar graph form (Figure 3). Each time element is evaluated. CCL to balloon time can be affected by difficulties in obtaining arterial access, patient complications necessitating delays (e.g. placement of a temporary pacer or balloon pump) or crossing the lesion. In contrast, CCL to lidocaine time is a measure of how long it takes to prep the patient and may provide a more objective measure than CCL to balloon time.

Things to Think About, II:

(Tentative) Notice how use of a real time data collection sheet provides the fuel for feedback. Note how the slides provided above by Dr. Kontos readily utilize this data.