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.
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