Diversion of ST-elevation myocardial infarction patients for primary angioplasty based on wireless prehospital 12-lead electrocardiographic transmission directly to the cardiologist's handheld computer: a progress report

Clemmensen, Peter; Sejersten, Maria; Sillesen, Martin; Hampton, David; Wagner, Galen S.; Loumann-Nielsen, Søren

doi:10.1016/j.jelectrocard.2005.06.035

Cited by 38 publications

(14 citation statements)

References 15 publications

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“…The prehospital primary diagnosis of STEMI is usually 39 based on the medical history, the physical examination and by telephone, which is decoded to a standard ECG on a 54 computer in a cardiac centre [3], where everything is disease [4][5][6][7], in the management of out-of-hospital chest 60 pain emergencies [8,9] and for the detection of atrial TTECG. In these cases, the PCI centre was given only a brief 161 notice about the patient transfer via the regular telephone.…”

mentioning

confidence: 99%

Transtelephonic electrocardiography in the management of patients with acute coronary syndrome

Pápai

Rácz

Czuriga

et al. 2014

Journal of Electrocardiology

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mentioning

confidence: 99%

Transtelephonic electrocardiography in the management of patients with acute coronary syndrome

Pápai

Rácz

Czuriga

et al. 2014

Journal of Electrocardiology

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“…Unfortunately, such technology is not available in most Brazilian hospitals, particularly within primary hospitals where faxing an ECG by phone is the main mode of transmission of an ECG to a PCI center. The quick transmission of an ECG to a PCI center is well known to reduce time from FMC-to-balloon catheter inflation at a PCI center [60]–[64].…”

Section: Discussionmentioning

confidence: 99%

System Dynamics Modeling in the Evaluation of Delays of Care in ST-Segment Elevation Myocardial Infarction Patients within a Tiered Health System

et al. 2014

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BackgroundMortality rates amongst ST segment elevation myocardial infarction (STEMI) patients remain high, especially in developing countries. The aim of this study was to evaluate the factors related with delays in the treatment of STEMI patients to support a strategic plan toward structural and personnel modifications in a primary hospital aligning its process with international guidelines.Methods and FindingsThe study was conducted in a primary hospital localized in Foz do Iguaçu, Brazil. We utilized a qualitative and quantitative integrated analysis including on-site observations, interviews, medical records analysis, Qualitative Comparative Analysis (QCA) and System Dynamics Modeling (SD). Main cause of delays were categorized into three themes: a) professional, b) equipment and c) transportation logistics. QCA analysis confirmed four main stages of delay to STEMI patient’s care in relation to the ‘Door-in-Door-out’ time at the primary hospital. These stages and their average delays in minutes were: a) First Medical Contact (From Door-In to the first contact with the nurse and/or physician): 7 minutes; b) Electrocardiogram acquisition and review by a physician: 28 minutes; c) ECG transmission and Percutaneous Coronary Intervention Center team feedback time: 76 minutes; and d) Patient’s Transfer Waiting Time: 78 minutes. SD baseline model confirmed the system’s behavior with all occurring delays and the need of improvements. Moreover, after model validation and sensitivity analysis, results suggested that an overall improvement of 40% to 50% in each of these identified stages would reduce the delay.ConclusionsThis evaluation suggests that investment in health personnel training, diminution of bureaucracy, and management of guidelines might lead to important improvements decreasing the delay of STEMI patients’ care. In addition, this work provides evidence that SD modeling may highlight areas where health system managers can implement and evaluate the necessary changes in order to improve the process of care.

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“…Such systems, however, typically focus on the remote monitoring of the patient heart and/or other vital signs in order to allow the cardiologist at a CCU or a hospital to track his/her condition and prepare for his/her arrival. Examples are the monitoring of arrhythmias in moderate-risk patients [29, 30] and the early classification of AMI patients during their transportation to a hospital with CCU [31, 32]. AToMS, in contrast, although allowing such patient remote monitoring, is meant to support prehospital real-time decision making by teleconsultation .…”

Section: Discussionmentioning

confidence: 99%

AToMS: A Ubiquitous Teleconsultation System for Supporting AMI Patients with Prehospital Thrombolysis

Correa

Gonçalves

Teixeira

et al. 2011

International Journal of Telemedicine and Applications

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The latest population-based studies in the medical literature worldwide indicate that acute myocardial infarction (AMI) patients still experience prolonged delay to be rescued, which often results in morbidity and mortality. This paper reports from a technological standpoint a teleconsultation and monitoring system named AToMS. This system addresses the problem of prehospital delivery of thrombolysis to AMI patients by enabling the remote interaction of the paramedics and a cardiologist available at a Coronary Care Unit (CCU). Such interaction allows the diagnosis of the patient eligibility to the immediate application of thrombolysis, which is meant to reduce the delay between the onset of symptoms and the eventual application of proper treatment. Such delay reduction is meant to increase the AMI patient's chances of survival and decrease the risks of postinfarction sequels. The teleconsultation is held with the support of wireless and mobile technologies, which also allows the cardiologist to monitor the patient while he/she is being taken to the nearest CCU. All exchanged messages among paramedics and cardiologists are recorded to render an auditable system. AToMS has been deployed in a first stage in the city of Rio de Janeiro, where the medical team involved in the project has conducted commissioned tests.

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Diversion of ST-elevation myocardial infarction patients for primary angioplasty based on wireless prehospital 12-lead electrocardiographic transmission directly to the cardiologist's handheld computer: a progress report

Cited by 38 publications

References 15 publications

Transtelephonic electrocardiography in the management of patients with acute coronary syndrome

Transtelephonic electrocardiography in the management of patients with acute coronary syndrome

System Dynamics Modeling in the Evaluation of Delays of Care in ST-Segment Elevation Myocardial Infarction Patients within a Tiered Health System

AToMS: A Ubiquitous Teleconsultation System for Supporting AMI Patients with Prehospital Thrombolysis

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