Ischaemic heart disease

Phone app cuts door-to-balloon times for STEMI patients


An app that connects paramedics and hospital clinicians has substantially improved door-to-balloon times for STEMI patients in rural Victorian hospitals.

The Pulsara STEMI app allows paramedic first-responders to input critical information for suspected cardiac event patients, such as symptoms, ECG results and estimated time of arrival at hospital.

The information is viewed in real time on a phone or tablet by staff at linked emergency departments, who notify the relevant cardiac team clinicians that a time-critical patient is expected.

Results from a pilot program involving two hospitals in Ballarat and Bendigo and 25 Ambulance Victoria branches showed 81% of STEMI patients (33/41) had a door-to-balloon time within the recommended 90-minute timeframe when the app was used, compared to 73% (8/41) when it was not.

For suspected stroke patients, use of the app doubled the number achieving door-to-needle time: 26% of stroke patients were thrombolised within 60 minutes (9/35) when the app was used compared to 12% (3/25) when it was not.

It’s the first time the US-developed app has been used in Australia, according to study lead investigator Dr Kathleen Bagot (PhD), a Postdoctoral Research Fellow at the Florey Institute of Neuroscience and Mental Health, Victoria.

“It’s incredible what’s been able to be achieved,” she told the limbic.

“STEMI patients are getting into triage and off stretcher quicker and getting their first medical review quicker.”

She said one of the system’s greatest strengths is its ability to streamline communications between everyone involved in a time-critical case, with the app installed on dedicated workplace tablets and clinicians’ personal phones.

This eliminates the need to use fax machines, pagers and phones, meaning messages can’t go missing and giving hospital clinicians time to prepare for a patient who will require urgent attention.

The GPS-generated ETA means radiographers “can look at their patient load and say, ‘I’ve got time to run a scan on 2 patients then wait, so that time-critical patient does not get delayed’.”

“With just a swipe it will add when the CT is available, when assessments have been completed, and after treatment a case summary goes out to everyone involved,” she said.

The app’s use will now be expanded into other time-critical conditions such as sepsis, trauma, mental health and paediatric care, and a further trial is planned at another hospital in Victoria’s Gippsland region, Dr Bagot said.

And while a regional area was chosen for the pilot trial, Dr Bagot said she believed the app was suitable for metropolitan settings.

“It’s well used in the United States by over 300 hospitals, they’ve got more than 60,000 patient cases on the app, but we just wanted to see if it was going to translate into an Australian context and it certainly has.”

Hospitals and emergency service providers can purchase the technology from the US-based creator at a cost which compares to “a very small percentage of what you would have to pay for a CT scanner”, she said.

To date, the team’s work has received funding from the Heart Foundation, Stroke Foundation, Safer Care Victoria, the Florey Institute, Ambulance Victoria and the Victorian Stroke Telemedicine Program, whose founder Professor Chris Bladin is the project’s clinical lead.

The initial results for Pulsara were presented at the International Forum on Quality and Safety in Healthcare in Melbourne in September.

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