According to a recent study published in JACC: Cardiovascular Interventions, activating the cath lab for patients with STEMI diagnosis before their arrival at the hospital led to significantly shorter wait times, shorter door-to-device times, and ultimately reduced mortality.
A review of the study in MedPage Today stated: "Activating the cardiac catheterization laboratory at least 10 minutes before an ST-segment elevation MI (STEMI) patient arrived at the hospital was associated with less reperfusion delay -- and possibly better in-hospital survival, a large registry study showed.
Among patients with a pre-hospital diagnosis of STEMI who were transported by ambulance to a percutaneous coronary intervention (PCI) center, 41% had the cardiac cath lab activated more than 10 minutes before hospital arrival. Compared to cases with later cath lab activation, these patients were more likely to (P<0.001 for all):
- Be transported directly to the cath lab (23.3% versus 5.3%)
- Spend less time between hospital arrival and cath lab arrival (median 17 versus 28 min)
- Have shorter door-to-device time (40 versus 52 min)
- Achieve first medical contact-to-device times of 90 min or less (76.6% versus 68.6%)
In-hospital mortality was less common with early cath lab activation (2.8% versus 3.4%, P=0.01), though the association missed statistical significance after adjustment for other factors (adjusted OR 0.87, 95% CI 0.75-1.01).
'We have known for years ... that pre-transport ECG's can save 1 hour of time to reperfusion. Now these investigators show that this practice can be done across the country and in fact does save lives,' commented William O'Neill, MD, of Henry Ford Hospital in Detroit."
This evidence suggests that a simple protocol like pre-activating the cath lab can have monumental effects on patient outcomes. But is this practice actually simple when it could take multiple radio attempts to get one that the hospital team can fully hear and understand? And then, the ED staff often has to make multiple phone calls to get ahold of the entire cath lab team. And THEN, they have to make MORE calls once the patient arrives, trying to figure out whether the cath team is ready. Considering all of this, it's no wonder pre-activating the cath lab isn't a ubiquitous and automatic step in STEMI care.
But it could be. With a tap in the Pulsara platform, EMS can tell the ED they have a STEMI patient on the way, and can send the ECG for verification. Another tap, and the nurse can have the cardiologist confirm the diagnosis, and then can activate the cath lab. One more tap, and she can message EMS back, instructing them to bypass the ED and go directly to the cath lab. Finally, she can see the instant the cath lab team is assembled and ready -- all they have to do is switch a toggle on to indicate their status.
A process that used to take 10-15 minutes, plus a ton of extra steps and effort, simplified into a few taps over a matter of seconds. The future of healthcare communication is connected teams.