An app to save precious time during a heart attack?

When a hemodynamicist is called upon at 2 a.m. to treat a heart attack, there is nothing more frustrating than being put on hold. “We know that telephone operators work short shifts at night and that they receive a lot of calls, but we also know that every minute counts and that it is a useless waste in our race against time,” says Dr. Jean-Philippe Pelletier. In his 20-year career, the current interim head of the hemodynamics department at the McGill University Health Center (MUHC) admits feeling frequently frustrated—and he's not the only professional involved in the care of patients with acute heart attacks who has to deal with this reality. Day and night, paramedics, emergency physicians, interventional cardiologists, nurses and technologists, and sometimes intensivists, depend on hospital operators in an emergency situation. Read: Myocardial infarction: aspirin reduces the risk of recurrence and death Their challenge is to confirm the diagnosis, mobilize the intervention teams then transport the patient to a centre specialized in advanced cardiac care where the patient's artery will be unblocked, all within a period of less than 90 minutes. “The longer you wait, the more the heart muscle is damaged. We must restore the artery as quickly as possible,” says Dr. Pelletier. Jeremy Levett observed these communication and organizational challenges during the internships he completed as part of his undergraduate doctorate in medicine at McGill University. The future cardiac surgery resident says he has witnessed many transfers of impaired patients. “It happens all the time,” he says, pointing to the outdated technologies (i.e., pagers, telephone operators, fax machines) on which urgent care trajectories are currently based. To correct these flaws, the technology enthusiast revamped an app he'd created called Stenoa, that was used to work on a decision support algorithm for cardiac surgeons. Read: New drug for heart failure now available in Canada He and his team developed a cloud computing platform that streamlines the coordination of critical care, facilitates and secures communications between the different stakeholders, collecting data in real time, then used to optimize trajectories. That data can then also be used to produce annual effectiveness reports to be sent to the Ministry of Health and Social Services and the National Institute of Excellence in Health and Social Services. Certified by the ministry since last February, the Stenoa app is deployed within MUHC where it has been tested and honed and is accessible on cell phones, tablets and computers, in French and English. The app is currently being implemented in several tertiary hospitals which collaborate with the MUHC, as well as in other hospitals in the province. “The Cooperative of Ambulance Technicians of Montérégie has also adopted it and we are in discussions with Urgences-santé which serves Montreal and Laval,” says Levett. “It helps us a lot, making our lives easier and removing frustration,” says Dr. Pelletier, one of Stenoa's first users. “It has undoubtedly improved our response times." Through the application, all parties involved can share information and communicate with each other securely, without going through telephone operators. First, the paramedics at the bedside of a heart attack patient transmit the electrocardiogram (ECG) that they have just performed to the emergency physician on call. “Before, we had to wait for it to be printed in the emergency room. Now the ECG is already digitized and available in better resolution,” says deputy head of Emergencies at the Montérégie-Ouest Integrated Health and Social Services Center (CISSSMO), Dr. Bernard Richard. He practises in the emergency room at the Suroît Hospital where the 23 emergency doctors have been using Stenoa for around six months. The paramedics also provide the patient's name, age, history, medication, condition and more. “Before, we didn't have this information because the paramedics couldn't give it to us over the phone due to data security issues,” says Dr. Richard. With this technology, the emergency doctor can contact the nearby hemodynamicists on call (whose schedules are linked to Stenoa), who then receive an alert on their cell phone. “This is a critical alert, much like Amber Alerts, which bypasses the vibrate or “do not disturb” modes to notify the guard teams,” says Levett. The clinician on call must then confirm that he has received the alert. If he doesn't do so, the app chases him down via text messages, email, pager or phone. Once the hemodynamicist has checked the ECG and validated that the patient is having a heart attack, he directs the paramedics to his facility and can mobilize the intervention team (nurses and technologists on duty, as well as the residents). “Before, we had to call them one by one. Now we activate them automatically while avoiding communication gaps,” says Dr. Pelletier. If everyone is responsive, this whole process takes less than five minutes. “We save time, we direct patients better and we make it easier to organize care,” says Dr. Richard. The data from each case is gathered on a platform for performance analysis and quality improvement. “Before, we had to enter this data manually. With Stenoa, they are compiled almost instantly. Each participant can feed the app using a push button. It’s very easy,” notes Dr. Pelletier. Since September 2021, nearly 500 patients suffering from a heart attack have been treated at the MUHC via Stenoa. A review of the time and cost reductions achieved through the application is underway. The results of this study will be presented next October at the Transcatheter Cardiovascular Therapeutics conference, the annual scientific symposium of the Cardiovascular Research Foundation to be held in San Francisco. “The data is under embargo, but it is very encouraging,” says Levett who sees his platform as the “Uber Eats of critical care,” announcing his intention to open it to stroke care, organ transplants or emergency surgeries, which also rely on timely coordination of care. “On Uber, you know when your order is accepted, when it is being prepared, you know the delivery time and the name of the delivery person," says Levett. "We are in 2023, the health network must reach the same level, because we are not talking about burgers, but about life and death." This article was translated from French and originally ran in our sister publication Profession Santé. PictuThe “Uber Eats of critical care”Since September 2021, nearly 500 patients suffering from a heart attack have been treated at the MUHC via Stenoa. A review of the time and cost reductions achieved through the application is underway. The results of this study will be presented next October at the Transcatheter Cardiovascular Therapeutics conference , the annual scientific symposium of the Cardiovascular Research Foundation to be held in San Francisco

An app to save precious time during a heart attack?

Register for free access or login.

Related Topics