A patient is struck down by an acute myocardial infarction in the middle of the night at his home. The paramedic at his bedside quickly transmits an electrocardiogram (ECG) to the regional hospital. After verification, the emergency physician sends the ECG directly to the interventional cardiologist at a specialized center. Quick, we have to unblock the patient’s artery. The specialist triggers an alert — similar to an Amber Alert — on the duty team’s smartphones.
A fiction ? One might think so in a health network that still uses pagers and fax machines to communicate. But no. The McGill University Health Center (MUHC) recently adopted a new cloud-based platform, Stenoa, to speed up the treatment of heart attacks. The Suroît Hospital is taking part in the pilot project. The regional hospital center redirects patients requiring angioplasty to the Royal Victoria Hospital, which is part of the MUHC.
“For the first time, hospitals are able to talk to each other intelligently,” said in an interview with the Duty, Jeremy Levett, president of Stenoa and resident in cardiac surgery at the MUHC. “Before, each hospital had to pick up the phone to be able to talk to each other and coordinate critical care. »
In the past, the telephone operator at Suroît had to contact the operator at the MUHC so that the latter could reach the interventional cardiologist on call by text message and pager. “We had to call her back to sometimes have elevator music at 2 a.m.,” says the Dr Jean-Philippe Pelletier, acting head of interventional cardiology at the MUHC. “She then put us in touch with the referring doctor [ex. : du Suroît]. No one gets bored of this! »
Every minute counts when someone has a heart attack. “The occluded artery must be unblocked as quickly as possible, recalls the Dr Peltier. The risk of morbidity or mortality increases exponentially with the duration of the occlusion. According to current clinical guidelines, the time between the first medical contact (arrival of medical technicians or emergency triage) and the intervention “should ideally be less than 90 minutes” in urban areas, he specifies. .
Since the implementation of Stenoa, hospital teams communicate directly with each other, without intermediaries, using tablets and smart phones. Bed managers also have access to the application. The on-call hemodynamics team can be called in for reinforcement at the same time, thanks to an alert on the employees’ cell phones. “Instead of having to contact the nurses, then the technologists, and waiting for everyone to call us back to tell them ‘come on, we have a heart attack'”, specifies the Dr Peltier.
The cloud platform also ensures secure data transmission. “We have the patient’s name and address,” says Dr.r Bernard Richard Jr, deputy head of the emergency department of the CISSS de la Montérégie-Ouest. “We are able to see in our system at home if it is known for a health problem. Which was not the case before.
In Montérégie-Ouest, paramedics were already sending the ECG to emergency physicians, even before Stenoa’s arrival. But as the transmission was carried out by unsecured waves, no “nominal” information was indicated, explains the Dr Richard. Only age, sex and city appeared. This resulted in irrelevant transfers to specialized centres.
“We could send an 85-year-old patient with super-advanced cognitive disorders and cancer to palliative care for hemodynamics at Royal Victoria,” cites Dr.r Richard. If we had known the background, he would never have gone there. »
An application certified by the Ministry of Health
The MUHC has so far managed some 500 heart attack cases with the help of Stenoa. Jeremy Levett maintains that the experiment is conclusive. “We’re going to present our data at a major international cardiology conference in San Francisco in October,” he said, declining to say more.
Stenoa has obtained certification from the Ministry of Health and Social Services. Its president now aims to implement it throughout Quebec, in order to coordinate critical care in a “more fluid” way, to “optimize the delays” of intervention and to save lives.
But a lot of work remains to be done to get there. Many ambulances transporting patients to the MUHC are not connected to Stenoa. The Cooperative of Ambulance Technicians of Montérégie (CETAM), which participated in the pilot project, installed the platform, but only in vehicles going to the Suroît hospital.
The Dr Dave Ross, regional medical director of pre-hospital emergency services in Montérégie, considers the platform promising. He says he works with Stenoa so that paramedics have access to data that can testify to the impact of their work: the time between their intervention and the unblocking of the artery. “Currently, the paramedics are rushing, they bring the patient to the MUHC emergency room, but they don’t have any feedback as such, he observes. When we give positive feedback quickly, it increases the performance of stakeholders. »