Hospital physicians and nurses know all too well that time can make a difference when treating patients suffering from a heart attack or stroke. Unfortunately, gaps in communication between emergency responders and hospital staff is a persistent and common problem and can slow down the process of getting accurate, pertinent patient information from the field, such as the emergency medical technicians and paramedics on the scene, to the hospital staff.
To tackle these challenges, hospitals from two different health systems have partnered with each other and with a dozen local emergency medical services (EMS) agencies to use mobile technology to coordinate their care teams to accelerate time to treatment for critical care patients and to provide better care for stroke and heart attack patients.
Typically, when someone suffers a stroke in Colorado Springs, first responders from local fire departments and American Medical Response (AMR) provide initial care, and quickly notify the hospital. The hospital emergency department prepares to receive the patient and deliver the immediate care required when the patient arrives. And the stroke team mobilizes to treat and reverse the cause of the stroke as soon as possible.
However, those steps used to happen through a series of radio reports, phone calls, pages and other methods of communication, sometimes causing delays in care.
Sue Richardson, EMS manager at Penrose-St. Francis Health Services, a 522-bed hospital in Colorado Springs that is a part of Centura Health, says that communication process raised the potential for members of the team to receive incomplete or incorrect information, which increases the likelihood of mistakes that can negatively impact patient outcomes.
“As an example, one agency on a STEMI [ST-elevation myocardial infarction, or heart attack] would have the capability to blue tooth fax an ECG (electrocardiogram) in. It would get faxed into the machine, but it might not have the patient’s name, or it would just sit on the fax machine or get stuck to somebody else’s information and the information never necessarily got into the patient’s record or got to the ED physician or the charge nurse so they could look at it and then get to the cardiologist and call a STEMI alert.”
She continues, “When we call an alert, over the radio, we could give pertinent information but we couldn’t give patients’ names. So we couldn’t give identifying information that could help to get them pre-registered, which would enable a physician to go into a chart and notice that this person has had a STEMI before and this is what their normal ECG looks like now, and this is what we have now.”
According to Stephanie Schlenger, neurosciences program director at U.C. Memorial, a part of UCHealth, there were communications gaps for medical specialists as well. “Our neurologists used to get a page at home and not know anything more than that a stroke patient was coming in.”
“We know that there are gaps in communications between EMS and the hospitals. And then we have a huge gap, in the other direction, which is trying to get the information from the hospital back to the EMS about outcomes on patients,” E. Stein Bronsky, M.D., chief medical director for Colorado Springs Fire Department and El Paso County, Colorado, says.
To address these communication gaps, last year, healthcare executive leaders at UCHealth, a five-hospital system based in Denver with two hospitals serving Colorado Springs, and the Englewood Colorado-based Centura Health, a health system with 17 hospitals across Colorado and Kansas and one hospital serving Colorado Springs, collaborated on an initiative to deploy a mobile application to unify communication between first responders, emergency department personnel and medical specialists. The application, developed by Pulsara, a Bozeman, Mont.-based firm that offers regional care coordination services for acute care settings, runs on the smartphones and smart devices of the entire medical team. Bcause no information is stored on the user’s personal device, Pulsara is HIPAA compliant and secure, according to the company.
“We knew that if we could get this system up and running then we would be able to seamlessly tie all of this upstream and downstream communication together and it would benefit everybody,” Bronsky says. “Before, our medics were never sure if the person on the other end of the radio heard what we said correctly or had time to write it down. Now they know that the information they enter into the application can be viewed by everyone treating the patient.”
Using the app, a paramedic in the field who recognizes a stroke can tap a button on her phone that notifies everyone on the assigned hospital team that an ambulance is on its way with a stroke patient. As the paramedic enters more information, including the patient’s medical history and vital signs, every member of the team is instantly updated, according to Bronsky and Richardson.
Neurologists now get more information before they even see the patient, Schlenger says, and they also receive it directly from the EMS provider or emergency department staff who treated the patient, so there is less likelihood of communications errors.
“With a stroke patient, [EMS providers] have their name and last known well so that information can now be viewed on the app and we can get them pre-registered. When that patient gets to the hospital, they can they can go right to the ED and then to CT,” Richardson says, referring to the CT scanner, and she adds, “Time is tissue, and with this application, the communication is more seamless because we’re all on the same clock.”
In addition to notifying the entire team of basic information, the EMS provider or emergency department staff using the application can transmit ECGs, photos, such as a photo of a medication list, and even medical record numbers.
According to Richardson, the deployment and adoption of the mobile application has helped to reduce the “door to CT time” from nine minutes to six minutes at Penrose St. Francis Health Services. That time measures the time from ED arrival to initiation of brain imaging by computerized tomography (CT) scan, which provides critical information on the type of stroke a patient is having and helps clinicians determine whether tissue plasminogen activator (tPA) should be given. In January, EMS agency usage of the mobile application for all heart attack and stroke cases was above 90 percent, Richardson says.
There were a few minor challenges with deploying the mobile technology across all the EMS agencies and at hospitals from multiple health systems. “On the hospital side, with just our system alone, we handle 48 EMS and fire agencies in the community,” Richardson says, “the challenge there was getting the information out to them, getting them trained, getting them the opportunity to practice, getting them the opportunity to have enough patients to be familiar with using it. We’ve had to develop a consistent process of going back and working with them.”
“EMS, traditionally, is very siloed,” Bronsky says. “They are not worried about how, necessarily, their system interacts with outside technology; they just want to make sure their radios work and can communicate with the hospitals. It’s been an IT learning curve for EMS agencies too.”
Bronsky says the technology addresses some critical communication barriers. “[The EMS agencies] have really embraced it. They feel like they can get the information across; it’s reliable and the hospitals are better prepared to receive the patients. And, then they don’t have to deal with discrepancies anymore with times. Traditionally, there has always been, and it’s universal, this gap that we’ve never been able to close, between the hospitals and EMS, about when an alert was initiated. And so that’s resolved now.”
Additionally, when an alert is called in about a heart attack or stroke patient, the app uses GPS data to notify the hospital about an estimated time of arrival. This enables hospital staff to more efficiently use the CT rooms. “They are able to look at CT scanners and availability, and instead of opening one for a long time, they can work on getting other patients through,” Richardson says. And, the hospitals and EMS agencies now have closed loop communication in which the EMS agencies receive information about case outcomes as well as metrics that were tracked during the case.