Texas Health Dallas Implements Web-Based System to Diagnose Heart Attacks Before Patients Arrive|
DALLAS — Texas Health Presbyterian Hospital Dallas has begun using a new Web-based wireless technology that sends the results of EKG tests on possible heart attack victims directly from paramedics in the field to the hospital.
Paula Spencer, R.N., a nurse supervisor in Texas Health Dallas ER, has been instrumental in the implementation of the new EKG system.
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The system allows paramedics and other EMS personnel to instantly transmit an EKG (electrocardiogram) from the scene of an accident or medical emergency to computers at Texas Health Dallas. The readout is automatically printed and wirelessly sent to the smart phones of doctors and nurses in the ER and cardiac unit.
The system, called LIFENET, is the first of its kind, and doctors on the medical staff at Texas Health Dallas expect it to help reduce — by up to 20 minutes — the time it takes to assess and treat heart attack patients. The system is especially designed to quickly identify a type of heart attack known as a STEMI (ST elevation myocardial infarction). STEMIs are identified through EKGs, which measure the electrical activity of the heart. Electrical pulses help the heart contract and pump blood throughout the body.
“Speed is of the essence when treating this kind of heart attack,” said Dr. Sean Black, an emergency medicine physician on the medical staff at Texas Health Dallas. “In a matter of minutes, the heart attack can permanently damage the cardiac muscle, causing major health problems and even death. The quicker patients receive treatment the more likely they are to have a positive outcome.”
Many times, the best way to treat the heart attack is with an interventional cardiac catheterization procedure that involves inserting a tiny wire into a leg artery. The wire is guided through blood vessels to the site of the blockage. A tiny balloon at the tip of the wire is then inflated to open the coronary artery, and a small metal stent or mesh is often inserted into the artery to help it stay open. The procedure, called percutaneous coronary intervention, is not offered at all hospitals.
The amount of time that elapses from the moment of arrival to the time the balloon is inflated to restore blood flow is called door-to-balloon (D2B) time.
“We think this new system will help us achieve our goal to further reduce door-to-balloon times and better care for North Texans suffering from heart attacks,” said Dr. James Park, an interventional cardiologist on the medical staff at Texas Health Dallas and medical director of the hospital’s cardiac cath lab. “The beauty of this system is that it allows paramedics in the field and physicians and nurses in the hospital to focus on diagnoses, treatment decisions and patient care. And we can begin taking those steps long before the patient ever arrives here at the hospital.”
Modems transmit the results of the patient’s EKG test to a computer in the Texas Health Dallas ER. The computer sends out a high-priority page to nurses and doctors on the medical staff who specialize in treating heart attacks. Doctors review the EKG readout and determine whether they’re having a heart attack; a STEMI would prompt the activation of the hospital’s emergency cardiac team.
Having this new system will enable clinicians at Texas Health Dallas to better meet the door-to-balloon goal of 90-minutes or less, said Paula Spencer, R.N., a nurse supervisor in the Emergency Department.
The new system goes beyond just transmitting a 12-lead ECG to the hospital. It helps manage care for STEMI patients by alerting care teams and transmitting diagnostic-quality EKGs via a secure web-based STEMI alert system to everyone involved in the patient’s care, she said.
“The appropriate emergency department and cardiac cath lab team members can get ready for the patient to arrive while the patient is being transported,” Spencer said. “We’ve already shown that our program is strong, with door-to-balloon times averaging about 60 minutes, but this new system will give us additional tools to reduce those times even further.”
In addition to quicker treatment for some patients, the system also prevents wasted time in the emergency room before treatment and helps avoid false cath lab activation.
“The goal is to utilize technology to reduce door to balloon times and ultimately save lives,” Park said.
The American Heart Association estimates that nearly 400,000 people in the United States experience a STEMI every year. Studies have reported a significant relationship between pre-hospital 12-lead EKGs and shorter D2B times, with two recent studies showing the effect was strongest when the cath lab was activated while the patient was still en route to the hospital (Circulation, 2006). The Journal of the American College of Cardiology (2006) reported that mortality for acute cardiac events has been shown to increase 40 percent if D2B time stretches from 90 minutes to 120 minutes. It is critical that STEMI patients are taken to facilities with the ability to perform angioplasty and insert stents. However, fewer than 25 percent of hospitals can provide this treatment (Circulation, 2007).
About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 898-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. U.S. News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit TexasHealth.org/Dallas.