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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Push Notifications Reduce Emergency Department Response Times to Prehospital ST-segment Elevation Myocardial
Mathew Goebel1, Joseph Bledsoe2
1University of California San Diego School of Medicine, Department of Emergency Medicine, San Diego, California.
Insights
Implementing a push notification system for emergency departments significantly reduced delays in activating the cardiac catheterization lab for ST-segment myocardial infarction (STEMI) patients. This system improved the consistency of activation times, leading to faster treatment for STEMI.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Informatics
Background:
- Prehospital electrocardiograms (ECGs) aid ST-segment myocardial infarction (STEMI) treatment.
- Optimal hospital practices for STEMI management after prehospital ECG acquisition are not well-established.
- This study investigates a novel push notification system to streamline STEMI care.
Purpose of the Study:
- To evaluate the impact of a push notification system on reducing delays in cardiac catheterization lab (CCL) activation for prehospital STEMI.
- To assess the effect of real-time alerts on the efficiency of emergency department (ED) response to STEMI cases.
Main Methods:
- Prospective before-and-after study design.
- Implementation of a push notification system for prehospital STEMI ECG alerts in the ED.
- Comparison of time intervals from ECG receipt to CCL activation before and after system implementation.
Main Results:
- The interval from ECG receipt to CCL activation decreased from 9.1 minutes (SD 5.7) to 3.33 minutes (SD 1.63) for pre-arrival activations (p < 0.01).
- This represents a significant reduction in delay by 5.8 minutes and increased consistency (SD reduction, p < 0.01).
- No significant change in activation times was observed for post-arrival activations.
Conclusions:
- Push notifications effectively reduce ED response times for prehospital STEMI.
- The system enhances the consistency and efficiency of cardiac catheterization lab activation.
- This technology shows promise for improving STEMI patient care pathways.
Introduction:
Prehospital acquisition of electrocardiograms (ECG) has been consistently associated with reduced door-to-balloon times in the treatment of ST-segment myocardial infarction (STEMI). There is little evidence establishing best hospital practices once the ECG has been received by the emergency department (ED). This study evaluates the use of a push notification system to reduce delays in cardiac catheterization lab (CCL) activation for prehospital STEMI.
Methods:
In this prospective before-and-after study, we collected prehospital ECGs with computer interpretation of STEMI from May 2012 to October 2013. Push notifications were implemented June 1, 2013. During the study period, we collected timestamps of when the prehospital ECG was received (email timestamp of receiving account), CCL team activation (timestamp in paging system), and patient arrival (timestamp in ED tracking board). When prehospital ECGs were received in the ED, an audible alert was played via the Vocera WiFi communication system, notifying nursing staff that an ECG was available for physician interpretation. We compared the time from receiving the ECG to activation of the CCL before and after the audible notification was implemented.
Results:
Of the 56 cases received, we included 45 in our analysis (20 cases with pre-arrival CCL activation and 25 with post-arrival activation). For the pre-arrival group, the interval from ECG received to CCL activation prior to implementation was 9.1 minutes with a standard deviation (SD) of 5.7 minutes. After implementation, the interval was reduced to 3.33 minutes with a SD of 1.63 minutes. Delay was decreased by 5.8 minutes (p < 0.01). Post-implementation activation times were more consistent, demonstrated by a decrease in SD from 5.75 to 1.63 min (p < 0.01). For patients with CCL activation after arrival, there was no significant change in mean delay after implementation.
Conclusion:
In this small, single-center observational study, we demonstrated that the use of push notifications to ED staff alerting that a prehospital STEMI ECG was received correlated with a small reduction in, and increased consistency of, ED CCL activation.
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