Mayo Clinic, a nonprofit medical practice and medical research group based in Rochester, MN, was looking for ways to improve the response time in treating stroke patients. Specifically, they wanted to determine if it would be feasible to assess a stroke patient from the ambulance while in transit. Everbridge CMO Ranya Habash — also an Ophthalmologist at Bascom Palmer Eye Institute in Miami — was one of the researchers and took time recently to speak with Health IT Outcomes about the Mayo study and more.
A number of methods have been attempted across the U.S. to allow neurologists to conduct stroke assessments with a patient in-transit, including special ambulances called mobile stroke units and using video-enabled robots. These solutions tend to cost millions of dollars and are cumbersome to use. Mayo realized these roadblocks would limit availability and usability for EDs and ambulance teams, so another key goal became establishing a cost-effective solution that was simple, intuitive, and accessible to the entire care team.
Mayo Clinic, a nonprofit medical practice and medical research group based in Rochester, MN, was looking for ways to improve the response time in treating stroke patients. Specifically, they wanted to determine if it would be feasible to assess a stroke patient from the ambulance while in transit. Everbridge CMO Ranya Habash — also an Ophthalmologist at Bascom Palmer Eye Institute in Miami — was one of the researchers and took time recently to speak with Health IT Outcomes about the Mayo study and more.
Q: What were the goals of the Mayo Clinic study and how was it set up?
Habash: Treatment for strokes is highly time-sensitive. Patients lose 1.8 million brain cells per minute while having a stroke, so every minute counts. Mayo Clinic was looking for ways to improve response time in treating patients. Specifically, they wanted to see if it was feasible to assess a stroke patient while in transit, from the ambulance. If they could do that, it would shorten the time needed to assess and treat the patient upon arrival to the Emergency Department (ED). So we studied the feasibility of performing the NIH Stroke Scale assessment with a Mayo neurologist, while the ambulance was still en route. This required the ability for the neurologist to visually assess the patient and to communicate easily with the paramedics.
A number of methods have been attempted across the U.S. to allow neurologists to conduct stroke assessments with a patient in-transit, including special ambulances called mobile stroke units and using video-enabled robots. These solutions tend to cost millions of dollars and are cumbersome to use. Mayo realized these roadblocks would limit availability and usability for EDs and ambulance teams, so another key goal became establishing a cost-effective solution that was simple, intuitive, and accessible to the entire care team.
Mayo Clinic decided to deploy Everbridge’s CareConverge solution which allowed their neurologists, ambulance teams, and EDs to communicate securely over smartphones and tablets. This included the ability to notify the ED and neurology teams about in-bound stroke patients, to communicate patient information via secure text and audio, and to perform real-time video assessments while the patient was still in transit.
Q: What were the results?
Habash: The team at Mayo evaluated a number of factors, but probably the most important measurement was door-to-needle time (DTN). This measures the time from when a stroke patient arrives at the ED to when they receive a clot-busting medicine (tPA). This study improved door-to-needle time by 7.45 minutes, the equivalent of about 13.4 million brain cells. That’s the difference between a patient walking out of the hospital, or being wheeled out. Mayo also demonstrated a reduced length of stay in the hospital — at about $2,300 a day, those savings add up fast. Interestingly, the results were also compared against the million-dollar mobile stroke units and robots. Those technologies actually slowed the door-to-needle time by 8 minutes because they were inaccessible and cumbersome to use. So overall, the solution we used was 16 minutes faster and a million times less expensive.
Q: How does pre-arrival triage assist an ED with patient management?
Habash: Pre-arrival triage helps ED care teams in a number of ways. It allows physicians to assess a patient’s condition while still in transit. This reduces triage time once the patient arrives and allows us to get orders started. The necessary clinical teams are assembled, consults are placed, imaging is ordered, and operating rooms can be prepped. Many times, every minute saved can have a significant impact on a patient’s outcome.
Q: How does CareConvergence improve on what happens in the ED today?
Habash: Today we have to wait for a patient to arrive before triage begins. We have little idea whether it’s a patient with a minor issue or a life-threatening injury. From that point, an array of requests goes out for further diagnostics or to bring in a clinical consult. Hospitals are big places and teams are widespread, making it difficult to rapidly coordinate response to a patient event.
For example, if an acute heart attack (STEMI) patient arrives in the ED, the typical protocol is to activate the Cath Lab in order to treat the patient. That requires nurses, technicians, and cardiologists rapidly mobilizing. This typically starts with a nurse contacting the switchboard to activate the “Code.” The switchboard operator then sends out an overhead page, looks up which cardiologist is on call for the Cath Lab that day, sends out a page to the cardiologist, and awaits a response. The nurse then waits to see if everyone arrives. It’s a spoke and wheel situation, where the clinical point person is coordinating between several parties.
CareConverge automates all of that, notifying the team over multiple communication paths — including mobile devices — all at once. The messages are predefined, including all necessary patient info, and confirm each person responds and when. If someone does not respond, the solution automatically escalates to the next available staff member. CareConverge also enables real-time communication across clinical teams as they manage the patient, such as video assessment for tele-consults, lab results, imaging results, photos, or any other communication that occurs across a care team.
While emergencies dramatically show the benefits of CareConverge, day-to-day functions of running a hospital can be managed on the platform too. Simple things like transferring patients onto a floor, calling for consults, and coordinating with different departments for discharge are made vastly more efficient. Patient follow-ups after discharge can also be done through CareConverge, which greatly reduces readmission rates. We have a study going on right now with Brigham & Women’s Hospital in Boston looking at that specific problem, and the early feedback is excellent.
Q: Will using CareConverge help hospitals manage costs and patient outcomes?
Habash: Time is money, and hospitals are required to meet various CMS Core Measures which are directly tied to reimbursements, penalties, and public ratings. Readmission rates are one such Core Measure; besides the monetary benefits, lower readmission rates mean improved patient outcomes and higher satisfaction. Similarly, ED Throughput is another Core Measure, so expediting patient flow through the ED is directly tied to a hospital’s bottom line. Of course, it’s invaluable for the staff and patients as well. It’s a win-win for everyone.
Ranya Habash will discuss the Mayo Clinic Study in detail during HIMSS. You can see her talk at the Verizon booth at 3 p.m. on Tuesday, Feb. 21.
