Speeding Time-Critical Care at University Hospitals
University Hospitals Cleveland Medical Center
Mobilizing specialized care teams before patient arrival is key to improving treatment and outcomes. It requires accurate interpretation by EMS in the field and a secure way to transmit vital patient data and alert members of the care team, wherever they may be. Leading medical centers—like University Hospitals (UH) in northeastern Ohio—started years ago to create ST segment elevation myocardial infarction (STEMI) systems of care for patients with cardiac arrest caused by sudden, complete blockage of coronary arteries. Now, UH is using lessons learned from STEMI patient care to improve treatment of other time-critical patients, such as stroke and trauma. The UH system includes its flagship academic medical center in Cleveland and a network of 18 regional hospitals. UH also serves as medical authority for EMS agencies in 165 towns and cities across northeastern Ohio. Here’s their story.
Challenge
Before 2005, many Cleveland-area EMS and hospitals lacked the tools and processes to provide the recommended standard of care for STEMI patients. Few EMS crews were equipped and trained to transmit ECGs to a hospital to quickly identify patients with STEMI. It wasn’t standard practice to take patients directly to a hospital capable of performing emergency angioplasty. Once a patient reached the appropriate hospital, precious minutes were spent getting through the emergency department and to the interventional cardiac catheterization lab for definitive treatment. In 2005, the average door-to-balloon time at UH was about 96 minutes, longer than the AHA 2005 Guidelines of 90 minutes or less for STEMI patients to receive PCI treatment after hospital arrival.
University Hospitals set out to change that, building on a long tradition of innovation in emergency medical care. More than 20 years ago, UH’s Cleveland Medical Center began receiving prehospital ECGs from EMS for interpretation by a hospital-based cardiologist.
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