Pulsara Blog

I was sitting next to one of our Lead QA Engineers at Pulsara and as he was looking through our app's use statistics. He made an observation that piqued my interest: "We have consistently fewer users on the weekends! I wonder if there is decreased incidence of time-sensitive emergencies on those days?" 

Intrigued by the thought that emergency conditions like STEMI and stroke—which are highly unpredictable in nature—could be somehow pinned down to a day-of-the-week trend, I decided to delve in deeper and see if there was any literature to back up the hunch. Here's what I found:

A recent survey conducted by Infinite Convergence Solutions shows that the majority of healthcare institutions in the United States are using messaging apps and services that do not meet enterprise-grade standards for HIPAA and security regulations.

According to FierceMobileHealthcare, Infinite Convergence's CEO, Anurag Lal, said "CIOs and IT leaders in healthcare institutions need to make available an official ... messaging platform to their employees which also allows them to implement administrative, physical and technical safeguards that HIPAA requires." 

If your wife wanted you to pick up some milk on your way home, would she send you a fax or a page? Would she have her assistant call your answering service who will then let you know that you need to call her to tell you she needs some milk? 

Sounds ridiculous, right? In reality, your wife will simply text you. In 2 seconds, she can relay the simple message to you, you get it in real time, and can quickly type back "got it." It's simple, fast, effective communication that just makes sense. 

Unfortunately, when lives are on the line, we are still doing communications in the backwards, roundabout, convoluted way described in the first paragraph of this post and by Pulsara's CEO Dr. James Woodson in The Disaster Podcast's latest episode. 

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. 

You hear the mantra everywhere: Time is Tissue. And while it's crucial to minimize the amount of time it takes to get a stroke patient to treatment, we also need to be focusing on another time metric: the accuracy of the Last Known Well (LKW). After all, our treatment options depend on the LKW.

According to a recent study, a whopping 74% of patients had discrepancies between the preliminary LKW time and revised LKW, where 58% had later preliminary LKW than revised, and 16% had earlier LKW than revised. These disparities have grave implications for stroke patients - had the preliminary LKW times

been used for treatment decision making, 58% of patients may have been approved for thrombolysis outside of the appropriate time window, increasing the chances of complications. Furthermore, 16% of patients would have been potentially excluded from rt-PA inappropriately, providing them with less than the best possible treatment.

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.

Pulsara has been awarded the EMS Top Innovation Award, as announced at the September 2015 EMS World Expo in Las Vegas. This award is presented to the most innovative products of the year, as judged by a panel from the EMS World Expo Faculty and EMS World Editorial Advisory Board.

Pulsara is a platform that performs like an app to coordinate and simplify the care process for STEMI and stroke. The Pulsara story starts at a dinner party in late 2011, when a group of dedicated medical professionals who were part of Leading Edge Medical Associates (LEMA) came together to discuss a challenge: “How can we improve patient care in our facilities? How can we help our healthcare system pursue value based healthcare – providing improved quality of care at a lower cost?”

According to a recent preliminary study detailed by HealthDay News, it is still all too common for stroke victims to experience delays in getting transferred from regional hospitals to comprehensive stroke centers. Over the course of one year, the study examined 70 patients who had been taken to "hospitals not equipped to handle all levels of stroke" and later had to be transferred to "major stroke centers."

The time it took to complete the transfers alone ranged from 46 to 133 minutes - times that, even at the shorter end, were longer than it would have taken to drive the patient to the comprehensive centers in the first place. 

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.

Lions, Tiger and Bears... OH MY!

Do you ever feel like Dorothy from the Wizard of Oz? Only your chant is "Guidelines, Influence, Data... OH MY!"

These three words describe the life of a Stroke Coordinator.

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.  

Do you believe that “time is tissue?”

Two million brain cells die every minute when your patient is having a stroke. With that knowledge, how can we decide on an “acceptable” treatment time? Is it the 60-minute national benchmark? What about a 45-minute treatment time? Perhaps even 30 minutes? Think about that math for a second and how many neurons you could spare by cutting your treatment times for stroke. Similarly, how much cardiac tissue could be spared by reducing STEMI times?

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.