Kinsie Clarkson

A recent study published in the Medical Journal of Australia shows that longer ambulance offload times are associated with greater 30-day risks of death and ambulance re-attendance for people presenting to the emergency department with chest pain. 

The large population-based study analyzed a sample of patients who arrived at the ED with non-traumatic chest pain. The goal was to assess whether ambulance offload time "influenced the risks of death or ambulance re-attendance with chest pain within 30 days of the initial ED presentation.”

According to the study, increases in offload times have a direct impact on the outcomes of patients experiencing time-sensitive ailments—specifically chest pain symptoms, which may indicate a variety of cardiac issues. As a result, the study's authors recommend that "Improving the speed of ambulance-to-ED transfers is urgently required.”

Change is hard for everyone. It's difficult enough to enact across a single organization. So what do you do when change is not only necessary but needed across your entire region? 

These are questions that healthcare leaders from Colorado Springs, Colorado, and Des Moines, Iowa have recently grappled with. The Colorado Springs and Des Moines regions have a striking number of similarities. Both serve a population of around 700,000, have three health systems, and account for around forty EMS agencies. Both have also revolutionized their regional communication with Pulsara, which has allowed them to enable faster, better communication for their healthcare providers. 

Leaders from both regions recently hosted a webinar to share their challenges and successes in bringing a new communication system into their region, and what they learned in the process. In part 1 of our blog coverage, we reviewed six takeaways based on their experience. Watch the full webinar below, and check out these six additional takeaways for anyone considering how to approach change management across a region.

Change is hard for everyone. Very few people truly enjoy the process of changing the way things have always been done. As a result, establishing a new way of doing things can be an unpopular decision.

So what do you do when change is necessary? How do you make sure it's successful? Change is hard enough to enact across a single organization. How do you create successful change when it's necessary across your region? 

These are questions that healthcare leaders from Colorado Springs, Colorado and Des Moines, Iowa have recently grappled with. The Colorado Springs and Des Moines regions have a striking number of similarities. Both serve a population of around 700,000, have three health systems, and account for around forty EMS agencies. Both have also revolutionized their regional communication with Pulsara, which has allowed them to enable faster, better communication for their healthcare providers. 

Leaders from both regions recently hosted a webinar to share their challenges and successes in bringing a new communication system into their region, and what they learned in the process. Watch the full webinar below, and check out these six takeaways for anyone considering how to approach change management across a region.

When the COVID-19 pandemic first surged across the U.S., it created many new problems for EMS organizations everywhere. Some patients infected with COVID-19 urgently needed care at the hospital, while others were best served by staying home. It was difficult to tell which was which. Patients with other ailments were stuck at home, unable to receive regular needed medical care. And on top of that, the pandemic was a major provider safety issue; medics and hospital staff put their lives on the line daily to care for patients, constantly risking exposure to the virus.

Austin-Travis County EMS (ATCEMS) based in Austin, Texas, knew they needed to deploy an innovative solution, and fast. They responded by forming what came to be known as the C4 unit: the Collaborative Care Communication Center.

The C4 is an elite team of twelve EMS-trained clinicians who manage calls and connect patients with a variety of resources. At the start of the pandemic, they began using Pulsara, a healthcare communication, telehealth, and logistics platform, to build better communication with their teams. Through Pulsara, they sent alerts to the hospital about crews bringing in COVID-19 patients, giving hospital staff more time to prepare. And since the providers on-scene wore heavy PPE, making it difficult to communicate verbally, the C4 was able to use Pulsara to facilitate communication for them and manage the case remotely.

But as the pandemic evolved, so did the challenges faced by healthcare providers. By the time ATCEMS was facing its third wave of the pandemic in August 2021, local hospitals were maxing out capacity and lacked both the beds and the bandwidth to care for every patient that came through their doors. ATCEMS knew they needed a way to reduce the burden on emergency departments.

EMS admins: Have you ever wished for an easy way to view all of your units, along with any information about the patients they're currently caring for? What about having the ability to track their movements and view whether the hospital has acknowledged them, and even see which hospitals are available, all from one easy-to-use dashboard?

Pulsara is pleased to announce the release of Pulsara HQ, a new browser-based command center that enables supervisors to track units, access patient details, see hospital availability, and communicate with your team.

After streamlining communication for their stroke teams with Pulsara, Overlake Medical Center in Bellevue, WA reduced door-to-needle times for tPA patients by 31%.

Overlake Medical Center in Bellevue, Washington, is a 349-bed hospital serving the Puget Sound region since 1953. The hospital treats more than 245,000 outpatients and 18,000 inpatients each year, and is a Joint Commission-certified Advanced Stroke Center. 

As a thrombectomy-capable facility with a large staff of specialists, nurses, and more, Overlake Medical Center sees ~900 acute stroke cases per year. With this volume, providing time-sensitive care is of the utmost importance to producing positive patient outcomes. Overlake knew they needed a streamlined means of communication to help make existing stroke workflows more efficient. 

“With so many people in the system, unnecessary team members were being alerted for a stroke case, which added extraneous noise as they cared for patients,” said Overlake Medical Center’s Stroke Team leaders .

LewisGale Hospital Montgomery in Blacksburg, Virginia, recently achieved a record door-to-balloon time of 14 minutes for one of their STEMI patients—one of their fastest ever. 

LewisGale has been working to create clearer lines of communication between its team members. They implemented Pulsara to successfully create a streamlined process for team communication around potential heart attack patients. 

Dr. John Patterson, a cardiologist at LewisGale, described how Pulsara allows him to receive notifications and information about a new patient instantly: "With this platform, I have the ability to see the EKG and activate the cath lab. All of this happens immediately so that it shortens the length of time it takes from the time the patient starts having their heart attack to the time they arrive at our hospital, to the time that we fix it. All of these times get shortened significantly with a platform like this." 

In the wake of the global pandemic, hospitals worldwide are struggling to cope with many challenges—chief among them, severe staffing shortages. Two years of pandemic conditions have barraged hospital staff, bringing new and unyielding challenges to the whole care system. Clinicians are facing longer hours, fewer resources, more responsibilities stretched between fewer people, the relentless pressure of pandemic stressors and mitigation measures, lack of support or understanding from the general public, and ultimately higher rates of burnout.

As a result, hospitals are grappling with severe staffing shortages. According to a recent survey by Hospital IQ, 90% of the nurses in their survey sample are considering leaving the nursing profession within the next year, with 71% of nurses with over 15 years of experience considering leaving either immediately or very soon. 

While there will need to be an influx of new nurses to regain balance, not all strategies for coping with the shortage have to do with recruitment. Technology can help make complex and frustrating tasks more simple. And according to the Hospital IQ survey, that might just be the determining factor in whether or not nurses decide to stay in the profession.

By streamlining workflows, technology can save a great deal of time and energy for hospital staff, making cumbersome and stressful processes smooth and efficient. Here's how.

When first encountering a new patient, you have a lot of information to quickly relay to the rest of the care team. Thankfully, you've got the patient's driver's license, so that's one hurdle already overcome. But now comes the challenge of quickly entering all this information and passing it along to the rest of your team. 

But if you're using Pulsara, not to worry: we'd like to share with you a new feature that can make this process easy. Key identification data from a US driver's license can be automatically scanned into the patient channel using Driver's License Scanning. 

What if EMS could “see into the future," having access to critical details about a hospital's ED availability status—such as whether it was at capacity during a mass casualty event or whether its CT scanner was down—before they even reached the hospital? If EMS knew a hospital's ED availability ahead of time, they could quickly reroute their patients to the closest alternative available care, saving precious time for patients and care teams.

Now, they can. 

Introducing Pulsara's newest feature: ED Availability.

With this new feature, healthcare facilities and EMS agencies can now access ED Availability information directly from the platform. Specifically, critical details about a hospital’s capability to accept patients can be easily updated by each facility and will appear to EMS and Ambulance crews when choosing a destination. This means improved decision-making for EMS and faster, more efficient care for patients in their most critical moments. 

When EMS providers start a new patient case in Pulsara and go to select their destination, they'll now not only be able to see the available facilities in their area—they'll also be able to see the hospital's emergency department availability status, updated in real time by the facility. 

ED Availability allows healthcare facilities to post status updates about their Emergency Department's availability directly to the Pulsara platform. Hospitals that enable ED Availability can update their status in a matter of seconds, by switching out their icon and/or adding a brief comment. Read on to learn more!

The COVID-19 pandemic has lengthened response times for ambulance agencies worldwide, making it much more difficult to find placement for patients. A recent report released by Australia’s Ambulance Victoria confirmed that this trend has worsened significantly in the state of Victoria during the last three months of 2021, showing a significant increase in response times across the region.  

The new data from Ambulance Victoria shows that paramedics’ ability to respond to code 1 emergencies within the recommended standard of 15 minutes dropped by 12% over the previous 12 months, going from 79% in October to December of 2020 to 67% during the same period in 2021. This means that around one-third of code 1 emergencies waited more than 15 minutes for responders to arrive. Melbourne’s suburbs have been disproportionately affected by the delays, owing to distance. Towns like Melton and Cardinia averaged around 53%. 

Chaos is woven into the DNA of emergent care. Emergency care professionals face the unknown around every corner—from supporting a low acuity patient to managing a mass casualty event. You never know what you’re going to get. 

Sometimes, you have a day that’s more chaotic than others. Other times, the chaos lasts much longer than a day—it can become a lasting situation that extends into months and even years. Few seasons have been quite as chaotic as the COVID-19 pandemic. COVID has tested and tried our healthcare systems to the breaking point, introducing factors like virus spikes, hospitalization surges, burnout, and staffing shortages. 

To keep growing, keep improving, and keep adapting to the situation, some things will need to change. The problem is, it seems impossible to do anything about the situation while you’re treading water. It can feel like trying to bail out a rowboat as you continue to paddle—trying to do everything all at the same time. But if you can introduce a change that will help either paddle the boat or bail with less effort, the time and energy it takes to implement that change will ultimately help make the job easier for the long term. 

It has been a challenging year in healthcare. The second year of the COVID-19 pandemic has brought burnout, staffing shortages, and the continued struggles associated with trying to care for patients during a pandemic. 

In the midst of it all, many healthcare systems have risen to the challenge and devoted themselves to providing better, faster, and more efficient care for their patients. They've achieved amazing things in 2021, and, in spite of the setbacks and challenges, have found ways to continue to deliver top-notch care for their patients.

Join us as we take a walk through Pulsara's 2021 case studies, celebrate the stories of some of our partner organizations, and highlight the amazing results they've achieved this year!

Ouachita County Medical Center (OCMC) is a not-for-profit hospital with 99 beds, serving residents of the rural community surrounding the city of Camden in southern Arkansas, about 100 miles from Little Rock. As a smaller, non-PCI facility, OCMC often coordinates transfers for their STEMI patients to PCI facilities.

Previously, when a patient arrived in the OCMC emergency room with a STEMI, whether by ambulance or private car, staff would first page a cardiologist at the patient’s preferred receiving facility, then wait for the physician to call back. Only then could they start the process of transferring the patient to a percutaneous coronary intervention (PCI) facility that could provide critical care. “Then we had to get a bed confirmed, and then we had to wait to get our EMS service to take the patient. And then, usually, most of those patients at that time went to Little Rock, which is about an hour and a half from where we are,” explained Jennifer Ray, RN, OCMC’s ER and ICU manager. “So the timeliness of the patient getting in and out was very, very slow.” How slow? During 2017, the average door-in, door-out (DIDO) time was 72 minutes for the 19 STEMI patients who came into the OCMC ER—more than double the 30 minutes or less recommended by the American College of Cardiology Foundation and the American Heart Association.

The past two years have done a great deal to redefine the shifting identity of EMS. COVID-19 changed a lot about how we provide care, and some of the solutions we came up with have led to a watershed of self-discovery. With that, though, comes an equal number of questions. What does the shifting landscape of healthcare mean for EMS? What will the role of EMS be going forward? As the identity of EMS evolves and medics are given more agency, will they be able to help find solutions for problems like overcrowded emergency departments, while also giving patients both a better and more appropriate care experience? 

Corey Ricketson, Pulsara's Vice President of Strategic Accounts, recently had the opportunity to discuss these and other hot topics in EMS with Chris Cebollero on The Inside EMS podcast, hosted by EMS1. Corey shares his experiences visiting multiple EMS agencies throughout the country, as well as some top takeaways from how leading EMS agencies are finding solutions to issues like ED overcrowding. Chris and Corey talk community paramedicine, how EMS needs to adapt for the future, the importance of meeting patients where they are, and how interoperability, connection, and communication should be a main focus for EMS agencies.

Listen to the podcast below, and read on for part 2 of the interview! (If you missed part 1, check it out here.)

The past two years have done a great deal to redefine the shifting identity of EMS. COVID-19 changed a lot about how we provide care, and some of the solutions we came up with have led to a watershed of self-discovery. With that, though, comes an equal number of questions. What does the shifting landscape of healthcare mean for EMS? What will the role of EMS be going forward? As the identity of EMS evolves and medics are given more agency, will they be able to help find solutions for problems like overcrowded emergency departments, while also giving patients both a better and more appropriate care experience? 

Corey Ricketson, Pulsara's Vice President of Strategic Accounts, recently had the opportunity to discuss these and other hot topics in EMS with Chris Cebollero on The Inside EMS podcast, hosted by EMS1. Corey shares his experiences visiting multiple EMS agencies throughout the country, as well as some top takeaways from how leading EMS agencies are finding solutions to issues like ED overcrowding. Chris and Corey talk community paramedicine, how EMS needs to adapt for the future, the importance of meeting patients where they are, and how interoperability, connection, and communication should be a main focus for EMS agencies.

Listen to the podcast below, and read on for part 1 of the full interview! 

Baptist Health in Little Rock, Arkansas, is using new technology to reduce treatment times and deliver better patient care. Dr. Wendell Pahls, Medical Director of Emergency and Transfer Services at Baptist Health, spoke to The Vine about how Pulsara is helping them streamline communication and cut down treatment times. 

"It's really cool," said Dr. Pahls. "We've taken a very fundamental concept, which is that the sooner that we can treat you for time-sensitive illnesses—like strokes, heart attacks, and things like that—the sooner we can get you into definitive care, the better off you'll be. Everybody these days carries around one of these: a cell phone," he said. With Pulsara's communication and logistics platform, Baptist Health has been able to link all their different providers together on one patient channel, facilitating better communication around each patient—and, as a result, better, faster patient care. 

Check out the video interview here! 

In April of 2021, New Zealand Health Minister Andrew Little announced plans to abolish the 20 district health boards (DHBs) and replace them instead with a single organization called Health New Zealand, which will be responsible for hospitals across the country. 

The unexpected announcement was a major indicator of changes to come in New Zealand's health system. As the system reforms its organizational and decision-making structure, they are also looking for a solution to a fragmented data system in health IT. 

New Zealand has struggled with a fragmented process for transmitting patient data for many years. Current processes don't allow for the seamless, secure transmission of patient data between facilities.

It has been a rough eighteen months for all disciplines within healthcare. Since the start of the pandemic, call volumes have increased. More people need help. And yet, as the pandemic drags on, there are fewer and fewer providers still on the job. Emergency services agencies around the world are experiencing staffing shortages. Headline after headline after headline has demonstrated that the problem is both severe and widespread.

Many factors have contributed to staffing shortages in EMS across the United States, as well as ambulance services in the UK and Australia. These factors will need to be addressed soon. In the meantime, however, those still on the job are left looking for ways to continue providing care for their patients. Staffing shortages are hard enough but are made even worse for those left behind when the lack of providers starts to impact the level of care they can provide. 

Over the past year, telehealth became a favored tool in non-emergent care for helping clinicians treat patients from a distance. However, many EMS agencies are now discovering that leveraging telehealth as a part of normal practice can actually help save time, preserve resources, and increase the output of smaller crews. 

If you're struggling with staffing shortages, here are a few ways telehealth may be able to help you work with the resources you have. 

As a tertiary care center and Level I trauma facility in Colorado Springs, Colorado, the trauma team at UCHealth Memorial Hospital Central had their patient care process dialed in. However, there was one part of their process they weren’t satisfied with: their communication system.

The team was receiving notifications through an alarm dispatch system, which ran through the hospital operators and was then manually managed by each individual service line. UCHealth’s Associate Nurse Manager, Nikki Schroeder, BSN, RN, CEN, TCRN, described their process: “Prehospital providers would call in to our ED charge nurse, relay pertinent information, and then the ED charge nurse would determine what level of activation was required. To notify our hospital team, the charge nurse would give the information to our unit clerk, and our unit clerk would page our 811 paging system. That’s how the trauma surgeon, the ICU, and the whole trauma team got notified.”