Royal Victoria Regional Health Centre is a 392-bed acute care hospital in Barrie, Ontario. It is an affiliated teaching site for the Department of Family and Community Medicine at the University of Toronto. It offers a wide range of inpatient and outpatient services, including a newly expanded cardiac catheterization program.
STEMI (ST-Elevation Myocardial Infarction) is the most serious type of heart attack. It is a sudden and complete blockage of a blood vessel that feeds the heart, and it is a race against the clock to reopen it. Seconds can make the difference between life and death, and international organizations have set strict standards for how long it takes to identify patients suffering from STEMI to the moment they go to the cardiac catheterization (“cath”) lab for life saving therapies.
Assembling the cath lab team can be challenging, especially after hours. It takes a coordinated response to ensure that every member of the team is alerted immediately and set in motion. This usually means a “Code STEMI” that is triggered via the switchboard, who then looks up who is on-call for the STEMI team, and each member is paged.
Making an accurate STEMI diagnosis can be challenging and providers may need to discuss a potential case with the interventional cardiologist. The most important piece of information that is used to diagnose STEMI is the electrocardiogram (ECG). However, unless the interventional cardiologist is in-house and nearby, there is no way to get the ECG to them quickly and without compromising patient confidentiality.
RVH had been providing diagnostic coronary angiography and coronary angioplasty services (stenting) during daytime hours for several years. The next step in their ramp up of services was to start accepting after-hours STEMI referrals from their emergency department, paramedic bypass from the field and transfers from other hospitals. RVH reached out to Hypercare to explore ways to improve their STEMI care coordination and delivery.
Hypercare worked closely with physician and program leaders in the Division of Cardiology to understand their workflow and explore their needs. Given that RVH is a regional STEMI centre, they needed a system that was familiar to their care partners in the region, but also somewhat disruptive to meet the challenges of modern STEMI care.
Together, RVH and Hypercare devised a new STEMI activation system. By becoming the scheduling platform for the interventional cardiology program and the STEMI team, locating had accurate real-time scheduling information. Administrators could manage their schedules directly without having redundant transcription steps and cumbersome processes to communicate last-minute changes.
After understanding the current and ideal workflow, Hypercare went to work creating two toll-free hotlines for referring hospitals in the region. When a STEMI call comes in to the locating department, the operator triggers the entire STEMI team with one click. This results in a STAT message that gets sent out to the STEMI team members on call that day, which bypasses any silent or do-no-disturb modes on their devices. Through the web portal, the locating operator can securely send pertinent patient clinical and demographic information to the entire team.
The STEMI activation has built in safeguards to ensure that every member of the team gets the message. If team members do not read the Code STEMI message, they will get a repeat notification that bypasses do not disturb alerting them of a code STEMI activation every five minutes for two attempts. As this is going on in the background, Hypercare sends an automated notification to the rest of the team informing them that there is difficulty in getting a hold of a specific team member. This in turn gives powerful information to the rest of the team to use manual escalation or move onto other contingency plans.
To help the diagnostic accuracy of Code STEMI activation, Hypercare set up a second hotline that is used for urgent consults with the interventional cardiologist. When the locating operator receives this call, they can send a detailed priority message to the interventional cardiologist on call. Once the interventional cardiologist discusses the case with the referring physician, they can decide whether to activate a Code STEMI.
The use of Hypercare for Code STEMI activation has been well received by front line staff at RVH. ""Activating a STEMI is much easier with Hypercare and saves valuable time because locating does not need to page individual team members and wait for them to call back," says Dr. Mark Kotowycz, who is an interventional cardiologist and medical director of the Cardiac Intervention Unit at RVH. “The faster we can get the team mobilized, the faster we can get the artery opened, and the better the long-term outcome for the patient.”
“To say Hypercare has simply made my life easier would be an understatement. This program has been one of the easiest to learn and navigate and the hours of time it has saved me from entering and altering schedules has been unbelievable. As our hospital rolled out a new Code STEMI scheduling system there were many concerns to ensure the correct people were paged, keeping the process simple for our locating staff and the ability to make last minute changes if necessary. The pre-set roles allow months of schedules to be inputted within minutes and shows when days are already scheduled to ensure the shift is not double booked." - Meghan Mannen, Administrative Assistant, Team Leader.
"Activating a STEMI is much easier with Hypercare and saves valuable time because locating does not need to page individual team members and wait for them to call back. The faster we can get the team mobilized, the faster we can get the artery opened, and the better the long-term outcome for the patient.”
- Dr. Mark Kotowycz
Interventional Cardiologist & Medical Director of the Cardiac Intervention Unit at RVH
Given the success of the Hypercare platform in Code STEMI activations so far, there are ambitions to expand the use of Hypercare in the region for ED physicians and direct STEMI activation from the field from paramedics. This would bypass the locating department completely, even with external organizations, and allow direct discussion and STEMI activation by physicians and paramedics in their referral network, and allow them to securely share ECGs to assist in making critical decisions.
"The Hypercare team has been unbelievable to work with, any text or email is answered within minutes to troubleshoot questions or concerns. I simply can’t say enough about how great this program is and the positive effects it has had on my work productivity."
- Meghan Mannen
Administrative Assistant, Team Lead