UPSTREAM Site Suitability Assessment
If you think your emergency department / hospital would be appropriate for participation in UPSTREAM, complete this questionnaire. .  Participation in UPSTREAM is limited to sites in the United States only
Site Name *

Site City *

Site State *

Your Name *

Your Department *

Your Phone Number *

ED census CY2013

# ED visits primarily coded NSTEMI (ICD-9 410.7) in CY2013

Do you have a formal ED protocol concerning OAP use in NSTEMI?  (OAP=oral antiplatelet (ticagrelor, clopidogrel, or prasugrel))

Please give your best estimate of the % of patients with NSTE-ACS in your ED who receive OAP at least 4 hours prior to diagnostic angiography

Estimate the % of THOSE patients who receive the loading dose of OAP while physically still in the ED

Do you have ticagrelor in the ED Pyxis/SureMed?

Do you have an interventional cath lab on site?

Do you have one or more outlying hospitals that refer NSTEMI patients from their ED to your hospital for cath and/or PCI?

If you answered yes above, are those patients ever given OAP prior to transfer?

Is your hospital currently participating in any clinical trials that impact OAP choice?

If a patient with NSTEMI is stable and admitted from the ED to a bed before going to cath, is the admitting physician usually a cardiologist or a hospitalist? (estimate percentage for each if not all one or the other)

Do you use bedside troponins in the ED to direct NSTEMI treatment?

Do you use a standard/protocolized regimen for drawing serial troponin if ED troponin #1 is negative, or is subsequent draw frequency determined on a case-by-case basis?

This protocol qualified for expedited IRB review and generally requires patient consent only for the 30-day follow-up call.  Does your IRB offer expedited review?

Does your IRB allow verbal consent for telephonic follow-up, or is written consent always required?

Is your site participating in any other research or QI program that mandates telephonic follow-up of NSTEMI patients at 30 days post-discharge?

Thank you for your submission and we will get back to you as soon as we have had time to review your answers.
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