STOP STEMI©-A Novel Medical Application to Improve the Coordination of STEMI Care

Abstract

Objective:The objective of our study was to evaluate the effect of the STOP STEMI© medical application on door-to-balloon (D2B) time in patients arriving to our emergency department with an acute ST Elevation Myocardial Infarction (STEMI). STOP STEMI© is a novel medical application developed by physicians to improve the coordination and communication tasks essential to rapid assessment and care of the patients suffering from a STEMI.Methods:We conducted a retrospective before and after review of the Good Shepherd Health System STEMI quality assurance/improvement dashboard for a 10-month period between November, 2012 and September, 2013 (4 months before STOP STEMI© and 6 months after). Data was collected using a standard data collection form and entered on the dashboard by a STEMI coordinator blinded to study objectives. We calculated the average D2B times before and after initiation of STOP STEMI© along with the improvement in the benchmarks of D2B less than 90 min and D2B less than 60 minutes. A subgroup analysis of Center for Medicare and Medicaid services (CMS) reportable cases was conducted to evaluate these benchmarks in the subset of patients meeting the criteria for CMS reporting by our facility.Results:During the study period, we received 155 STEMI patients, average 0.5 patients per day. One hundred twelve of the patients underwent percutaneous coronary intervention (PCI), 37 preSTOP STEMI©, and 75 postSTOP STEMI©. Of the 112 PCI cases, 7 were excluded leaving 105 cases for analysis, 36 preapplication and 69 postapplication. We found a 22% reduction in the average door-to-balloon time after implementing the STOP STEMI© application (91–71 minutes) respectively, the average difference of 20 minutes P = 0.05 (95% CI, -1–40minutes). In the analysis of CMS reportable cases (n = 64 cases), we observed a decrease in the average D2B of 15 minutes (68–53 minutes), a 22% reduction P = 0.03 (95% CI 1–29min). In the CMS reportable cases, we saw an improvement in the D2B time less than 90 minutes from 78–95% and less than 60 minutes D2B improvement from 56–80%. We also observed an appropriate absolute reduction in PCI resource utilization by 11%.Conclusions:In this cohort of patients, the utilization of STOP STEMI© decreased the average door-to-balloon times by 22% in the patients with acute STEMI arriving at our emergency department. This effect was maintained when looking at the subset of all STEMI cases reportable to CMS. We also observed modest improvements in meeting the less than 60-minute, less than 90-minute benchmarks, and improvements in the resource utilization.

Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care

“…These results are likely due to the known concerns of current informal systems 13,47 that would be addressed by the proposed system, and that both hospitals were familiar with other technology-based communication used for health care (e.g., acute telemedicine services). During implementation, benefits were emphasised 46 and issues raised were addressed initially with education, demonstrations of app functionality, hands-on training with a demonstration version, and with data being fed back to provide evidence of improved patient treatment times when the system was used-first with published United States of America data, [19][20][21] and then local data 48 once available.…”

“…While many smartphone apps and technological solutions exist for information transfer between paramedic and hospital staff, 18 having one app which is a single communication tool that supports multidisciplinary communication across multiple organisations and different hospital departments is a novel solution. The clinical effectiveness of these apps is emerging with preliminary evidence indicating faster assessment, clinical decision making and patient treatment times 19–21 . However, it is unknown how these systems were effectively implemented, and if they were simultaneously implemented across multiple healthcare organisations.…”

“…The clinical effectiveness of these apps is emerging with preliminary evidence indicating faster assessment, clinical decision making and patient treatment times. [19][20][21] However, it is unknown how these systems were effectively implemented, and if they were simultaneously implemented across multiple healthcare organisations.…”

Design and deployment of ODISEA, an application for the myOcarDial infarction SafEtytrAnsfer of patients

“…Compared to state-of-the-art, two applications need to be mentioned. The first one is STOP STEMI, proposed by Dickens et al [10] and developed to enhance the coordination and management of STEMI patients. Once a case is activated, the application alerts all the members of the STEMI care team giving access to the patient electrocardiogram and other relevant information.…”

“…Park et al [9] evaluated how the use of a smartphone social network system in a regional STEMI network can reduce the ischemic time. Focused on STEMI management, Dickson et al [10] proposed STOP-STEMI an application to improve the coordination of STEMI care and Krishnamoorth [11] proposed an HIPAA compliant app for the transfer of patients with STEMI.…”