Hannah Ostrem

We've been saying it from day 1: time is tissue. As such, your critical care team needs to be impeccably organized to consistently shave minutes off of STEMI and stroke cases and ultimately provide better outcomes for your patients. At Pulsara, we are dedicated to helping you do just that. 

But don't take our word for it! Erlanger Medical Center is an impressive facility in Chattanooga, TN, serving as the area's only level-one trauma center and boasting the fourth largest interventional stroke program in the country. Erlanger also shines in cardiovascular care, with an average time to intervention of just 62 minutes (versus the 90-minute national standard).

Whew! It may not be the weekend yet, but at least we made it through another Monday! Do you ever feel like work is taking a toll on your health? Sure, working in an office, school, or hospital naturally exposes us to more germs for prolonged periods of time, but we're talking about something more serious than the common cold. 

Dr. Zubin Damania is a physician who, like many of his peers, felt trapped in a system that was dictating every aspect of his caregiving for him - forcing him to spend the majority of his time on reporting and data entry rather than with patients.

As an activist and advocate for better healthcare that fits with the pace of the modern world, Dr. Damania has devoted his spare time to breaking down barriers doctors face that prevent them from providing optimal care through his entertaining, creative, and genius parody music videos. When he's not being "ZDoggMD," Dr. Damania is transforming the traditional healthcare experience into one that is focused on the patient, rather than on bureaucracy.

When you think about likely candidates for stroke, you probably don't picture a fit, healthy 24 year old woman. But, as this video from the American Heart Association shows, stroke can happen to anyone, anywhere, at any time. Luckily for Brianne Cassidy, her family (including her dog!) and the stroke team at Swedish Medical Center worked FAST to not only save her life, but also allow her to recover with no lasting deficits. 

EDITOR'S NOTE: This article was originally pubilshed on EMS1.com. EMS1 serves as the largest site for paramedics and EMTs to find expert industry-relevant content. 

Background:

St. Dominic Hospital is a 400 bed primary stroke center in Jackson, Miss. The soon-to-be comprehensive stroke center currently sees about 1100 stroke patients per year from all over the state, from transfers to “drip-and-ships.” These patients are treated for a variety of strokes including ischemic strokes, hemorrhagic strokes and TIAs.

Wendy Barrilleaux has been the director of the program for four years. The stroke team (some of whom are pictured below in the photo courtesy of Barrilleaux) includes six nurse practitioners, several neurologists and interventionalists, as well as emergency room and radiology staff. She recently adopted an innovative communication platform that allows all of the staff, as well as EMS providers, to connect with each other and share.

 Problem:

St. Dominic Hospital was looking to improve their door-to-needle time.  The previous year’s goal was to reduce the time to below 60 minutes, which was a success. While an average of less than 60 minutes is a praiseworthy time, when dealing with stroke patients, every second, let alone every minute, counts. Time is tissue is the oft-repeated mantra. In their effort to continually improve, this year St. Dominic aimed to reduce that time down to 45 minutes.

Here at Pulsara, we've been saying it all along: The future of healthcare is in mobile technology. But you don't have to take our word for it! 

According to a recent article published on Cloud Tweaks, mobile technology provides "faster communication and better collaboration" so that "clinicians can spend much less time handling medical devices and more time administering care to their patients."

Did you know that the NUMBER ONE cause of death in American women today is heart disease? With the higher-than-ever demands of women's professional, social, and family lives, it's tempting for women (men too!) to put their own health needs last. After all, it'll never happen to you ... right?

The American Heart Association released the following short film inspired by true stories of women who have suffered heart disease in hopes of educating others about the signs and symptoms of cardiovascular distress. Directed by Elizabeth Banks, who also stars in the short film, "Just a Little Heart Attack" sends a powerful message that's crucial for all of us, woman or man, to hear: despite the seemingly all-important demands of our lives, our heart health needs to come first. 

Memorial Healthcare System Improves Stroke and STEMI Case Times With New Technology

HOLLYWOOD, FL: Memorial Healthcare System has implemented a mobile application to simplify care coordination and improve outcomes for emergency patients at Memorial Regional Hospital’s Comprehensive Stroke Center in Hollywood, FL

When it comes to emergency conditions such as STEMI or stroke, time is a critical factor in determining patient outcome. Unfortunately, even the most advanced treatment centers experience delays when providing care as a result of outdated processes and archaic technologies that waste time and create chaos.

EDITOR'S NOTE: This article was originally published on EMS1.com. EMS1 serves as the largest site for paramedics and EMTs to find expert industry-relevant content. 

Background

In a rural area northeast of Texas, Good Shepherd Medical Center is a primary stroke center - one of only two in the relatively large area that they cover. As such, the 426-bed hospital receives a lot of transfers - EMS flying in or driving in patients from other facilities up to 60 miles away.

Problem

Being the primary stroke center for such a large area is no easy task, even with excellent facilities and a well-trained staff. Good Shepherd faced the same challenges as any hospital: there was no good way to keep everyone on the same clock - and on the same schedule - when it came to stroke patients. The lack of a consistent synchronized clock - with some using a watch, others a computer clock, and still others using a cell phone - meant a whole lot of uncertainty. Staff faced the challenge of not knowing whether everyone else had the same information, if they were on the same schedule, or if they were ready for the next stage of the care process. It also presented challenges in sharing information between teams.

What do Nelly, Justin Timberlake, Sepsis, and readmission rates have in common? The answer is a few very clever physicians with maybe just a liiiittle too much time on their hands. The result is immensely entertaining and even somewhat educational! Check out ZDoggMD's "Readmission" and Kern Medical Center's "Sepsy Back" below. 

You've heard it before: "Time is tissue."

When it comes to heart attack, this statement is painstakingly true. Only a few years ago, it was standard for patients to wait two hours before cardiologists were able to get their blood flowing again. Now, thanks in large part to national goals set forth by the American College of Cardiology, the standard for case completion of heart attacks is 90 minutes. 

According to a recent article in the New York Times, a small community hospital in the town of Camden, New Jersey was able to reduce its average STEMI treatment times from 93 minutes in 2007 to 71 minutes in 2011 to 50 minutes currently.

Interventional approaches to treating stroke involve inserting a clot-removing device into the afflicted vessel to physically grab and remove the blockage. This therapy has shown great promise for stroke patient outcomes and several studies analyzing intervention have been stopped early due to efficacy of the treatment.

Take a look at neurointervention up close and personal - from two different perspectives. Covidien and Stryker are two companies leading the way in intervention with their respective Solitaire and Trevo devices. And since a picture is worth a thousand words, we thought we'd go a step further and show you video of how each actually works inside the brain. Enjoy! 

There's a sweet new way to combat your risk of having a stroke. According to a recently published article examining more than 20,000 adults, eating chocolate could lower the risk of having stroke by a whopping 23%. Those who consumed around 100g of chocolate per day - compared with people who had no chocolate - also had an 11% lower risk of cardiovascular disease along with a 25% lower risk of associated death.  

EDITOR'S NOTE: Special thanks to our guest blogger, Bob Sullivan. Bob Sullivan, MS, NRP, is a paramedic instructor at Delaware Technical Community College. He has been in EMS since 1999, and has worked as a paramedic in private, fire-based, volunteer, and municipal EMS services, and is an ally to Pulsara. 

Sepsis is the third leading cause of death in the United States [1], and survival depends on early recognition and treatment. Here are 10 things you need to know about sepsis to save lives: 

1. Sepsis is an overreaction to infection that can progress to shock.

Sepsis is a body-wide inflammatory response to infection that injures tissues and organs. Harm from this immune response is often worse than damage from the actual infection. Sepsis can be triggered by relatively minor infections, and can continue after the invading microbes are neutralized.

Sepsis causes blood clots to form in the microvasculature, which inhibits oxygen delivery and causes vital organs to fail. Severe sepsis also causes systemic vasodilation and increased capillary permeability, which causes hypotension and fluid leakage out of the vascular space. This causes septic shock, which further inhibits perfusion to vital organs. Forty percent of patients diagnosed with severe sepsis die.[1]

The successful care of STEMI cases is dependent on members of EMS, the ED charge nurse, the ED physician, the cath lab, the rapid/house RN, and the cardiologist all working together in sync to deliver the most efficient care possible in order to save time and tissue. However, this process often breaks down as the care team struggles with common pain points and system pitfalls including: 

• Late notifications
• Inability to contact other team members
• Difficulty accessing the ECG
• Incorrect call list
• Inability to manage door-in/door-out benchmarks
• The list goes on …

Ultimately, these frustrations not only cost ghastly amounts of hospital dollars but also patient tissue.

TAKE A LOOK AT OUR STEMI PITFALLS INFOGRAPHIC:

EMS, Charge Nurse, ED Physician, Stroke Team, Radiology Tech, Radiologist ... each of these roles is critical to the successful care of stroke cases, yet each is often on their own page with their own list of pain points and system failures.

• Late notifications
• Inability to contact other team members
• Not knowing when the patient will be ready for CT
• Inability to track down old charts 
• The list goes on …

Ultimately, these frustrations not only cost ghastly amounts of hospital dollars but also patient tissue.

TAKE A LOOK AT OUR STROKE PITFALLS INFOGRAPHIC:

...You know there is! EMS World recently published an article which highlights the changing technologies and protocols for managing stroke care. New embolectomy studies such as MR. CLEAN, ESCAPE, EXTEND IA, SWIFT-PRIME, and REVASCAT (see Pulsara's previous post for more details) have shown incredible promise in that patients who recieved the various embolectomy treatments were roughly twice as likely to experience a positive outcome compared to those patients who received IV tPA alone. In fact, all of these studies were stopped early due to efficacy. 

According to a publication in JAMA Neurology on May 4th, patients who suffer a stroke while already in the hospital for other conditions, wait significantly longer to get treatment than those for whom stroke symptoms present while outside of the hospital. 

Pulsara is very pleased to announce the release of our newest module! Check out the attached flyer for more information ... oh, and happy April 1st!