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Medical Center Improves STEMI Outcomes by Harnessing New Telehealth App

Background

Like most Emergency Departments (ED) in the country, Baystate Medical Center (a leading hospital in West Massachusetts) is often inundated with critically ill and severely injured patients. In addition to the acute care, as the region’s medical safety net, the ED often provides care to patients presenting with complex chronic diseases, as well as troubling health emergencies. Baystate is also responsible for more than 80% of all cardiac surgeries in western Massachusetts and is one of the top three busiest receiving hospitals in the state. Clinical leaders at Baystate have become hyper-focused on instituting best practices that result in optimal patient care.

According to the American College of Emergency Physicians (ACEP), Ischemic heart disease remains the leading cause of death worldwide. Multiple studies have concluded that the single most important factor in patient outcomes is time. Simply put, timely reperfusion is critical and the development of systems for rapid out-of-hospital triage and rapid in-hospital team activation are two of the most important factors in preserving cardiac muscle and preserving life and improving outcomes. Knowing these two important factors, coupled with the mounting pressures on the ED at Baystate and the constant flow of patients, physicians and leaders know that early triage and coordinated care of the most critical patients is essential. They also know that effective triage and care team coordination must begin with first medical contact by emergency medical services (EMS) in the field.

As a comprehensive urban medical center, Baystate Health has continuously invested in ensuring that the team of cardiac specialists have the technology and clinical expertise to deliver excellent care and drive optimal outcomes. Baystate’s quest to address these important factors was a priority jointly led by the cardiology, emergency and pre-hospital departments to identify and implement the right technology solution in order to help them improve team communications beginning with EMS and extending the in-hospital teams.

The recognized that technology can be disruptive and to make it effective they realized the need for an all-in-one system, that’s easy to use, with the flexibility to adapt to how each team operates now and with future changes. Baystate needed a highly configurable solution that allowed them to begin life-saving communications, and tracked case management that was easy to use on the care provider’s mobile device.  On top of that, the solution need to address a range illnesses, from general medical to time-sensitive acute care like STEMI, stroke, trauma, sepsis, mobile integrated healthcare (MIH), community paramedicine (CP) and more.

The solution

After careful evaluation, Baystate selected GD e-Bridge Mobile Telemedicine solution from General Devices.  This app based system would give Baystate Medical Center the opportunity to engage in seamless, secure communications from first medical contact, all the way through hospital treatment. e-Bridge is not a dedicated surgical instrument or piece of diagnostic equipment, but rather a modestly priced, highly configurable and innovative mobile telemedicine application.  With features like live video teleconferencing, event time stamping, secure messaging and real–time GPS ETA tracking, Baystate is now able to streamline care coordination and deliver more timely and effective care for their patients.

Initial deployment focused on patients presenting with S-T segment elevation myocardial infarctions (STEMI). It was deployed and integrated within the many EMS organizations that serve Baystate, as well as with the emergency and cardiology departments.  Baystate also opted to arm its ED patient flow managers with the GD e-Bridge application. Previously the ED flow managers and charge nurses at Baystate relied on a sometimes slow and cumbersome process for activating the STEMI and Cath lab teams.

The Results

Baystate’s recent implementation of the GD e-Bridge Mobile Telemedicine application is helping connect care teams and coordinate in a manner that is leading to measurable  improvement in care delivery and patient outcomes. In a short period, the GD e-Bridge solution has helped automate and streamline information flow, team activations, and the uses of Baystate protocols and processes as well as eliminate treatment times for EMS.

 “When Dr. Lotfi and Alina engaged the EMS team to explore ways to improve STEMI systems of care I couldn’t have been happier. The primary mission of the Baystate Health Division of Prehospital & Disaster Medicine is to improve patient care throughout the region by engaging EMS Partners. This system has helped to do just that. We’re excited to help grow the project and begin improving care for other patient populations” – Nathan Stanaway, EMS Coordinator

When pre-hospital medical teams discover EKG changes suggesting a patient is having a STEMI, an electronic notification is triggered by the on-scene paramedics and EMTs via GD e-Bridge. Immediately, EMS teams begin to stabilize the patient, while 12-lead EKG tracing and other patient information can be sent to Baystate for confirmation. Although often busy with multiple other duties and challenges, the ED charge nurse can easily and simultaneously activate the cardiac catheterization lab team and ED STEMI teams 24 hours a day, 7 days a week with a simple GD e-Bridge notification.

Now the coordinated care of Baystate’s most complex cardiac patients starts long before the patient physically arrives at Baystate ED, as is evidenced by the unified case clock.  Throughout the activation and response phase of the team-based STEMI alert, team members can receive notifications and track the patient’s status and location through e-Bridge’s HIPAA-secure notifications. Not only text messages but vitals, photos, monitor data, event time-stamps, and live video conferencing enhance the experience.

For Baystate the proof is in the numbers. Since deployment of the GD e-Bridge Mobile Telemedicine Application, Baystate has seen remarkable decreases in the average Door-to-Balloon and Door-to- Leave times. These are key metrics for hospital accreditations as studies show they directly relate to outcomes.

GD e-Bridge has equated to a 17% elimination in average door-to-balloon time, a significant improvement.  Additionally Baystate has realized a 10% increase in the number of STEMI activations initiated by pre-hospital (EMS) ambulances.  This is in contrast to activating after arrival at the hospital which wastes precious time and time is heart muscle.  These metrics to further support the position of Baystate as the regions top choice for the care of heart attack patients.

Key Performance IndicatorBaselinePost Implementation e-Bridge
Door to Balloon Time (average)70 mins58 mins  (-17%)
Pre-hospital STEMI Activation30 %40 %   (+ 10 %)

The benefits offered by the GD e-Bridge Telemedicine Application does not stop when the patient arrives at the cath lab. Physicians, nursing leaders and EMS quality coordinators can share outcomes feedback.  They can also review case data on a minute-by-minute basis, generate reports, search events and information to assure that the care delivered and procedures used met the gold standard for the process workflows. This evidenced based approach to continuous quality improvement further leads to improved patient outcomes.

Conclusion

GD e-Bridge has been a game changer for Baystate’s STEMI program. Gone are the days of confusing call lists, paging, multiple phone calls and unsecure text messages to the STEMI team members, and sporadic EKG transmissions with no clinical context. Known as a clinical leader in the care of acute cardiopulmonary emergencies, Baystate’s investment in this new mobile telemedicine technology.  It has yielded immediate results for their team of leading cardiopulmonary resuscitation specialists and more importantly holds the potential for producing better outcomes for their patients experiencing life threatening events.

eBridge lives up to its name by helping create communication bridges between the different silos in our health system. It has given us a platform where EMS, the Emergency Department, and the Cath Lab can all collaborate with the same patient information and work together to move the patient to the cath lab faster than we have ever seen before. The app really shines when Paramedics in the field start the case and the whole team can receive a real time GPS based ETA, patient demographics, and EKGs before the patient is even placed into the ambulance,” says Baystate’s STEMI Coordinator Alina Capatina.

About Baystate

Baystate Health is a not-for-profit, integrated health care system serving over 800,000 people throughout western New England. With roots dating to the founding of Springfield Hospital in 1883, Baystate Health has been providing high-quality and compassionate health care in the Pioneer Valley for more than 140 years. To learn more about the excellent care being provided by Baystate and regional EMS partners, visit www.baystatehealth.org.

About GD (General Devices)

General Devices (GD) enables smarter patient care by empowering hospitals and emergency responders with the most comprehensive, interactive, configurable, affordable and integrated medical team communication and telemedicine solutions. Offering benefits unmatched in the industry including reduced costs and improved patient outcomes, GD’s innovative solutions help 15,000 patients’ lives daily. Learn more at www.general-devices.com. 

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