Whitney Palmer

Saving Time, Saving Lives

Published in the Summer 2011 Summa Magazine

Software Created at Summa Helps Staff Speed Aid to Heart Attack Victims

By Whitney L.J. Howell

Last year, paramedics rushed a man in his late 40s with a blockage to his left coronary artery to Summa Akron City Hospital’s Emergency Department. He was a victim of a massive heart attack – the one frequently dubbed “the widow maker.”

“He was really as sick as you can get,” said Brenda Kovacik, R.N., cardiac care unit manager. “He was on a ventilator. We were using a balloon pump. Most people don’t survive that type of cardiac event.”

This patient did. Within a few days of his arrival, Kovacik said, he was sitting up in bed, talking and generally looked wonderful. His survival and speed of recovery are due, thanks in large part, to a new software system designed at Summa to help cardiac staff move patients through the door-to-balloon (D2B) process as quickly as possible.

Each year, according to the American Heart Association (AHA), nearly 400,000 people suffer an ST segment elevation myocardial infarction (STEMI), putting them at high risk of death. Both the AHA and the American College of Cardiology recommend healthcare providers treat these patients with a balloon angioplasty or a stent within 90 minutes of receiving the patient into the emergency department (ED). Extra minutes beyond that mean more cardiac tissue death, so truncating this time frame is highly advantageous.

Here is where the development of Summa’s STEMI computer software has made a measurable difference.

Changing the System

On average, Summa receives and treats 300 to 400 STEMI patients each year. In 2006, healthcare providers kept track of D2B performance with pencil and paper, relying on individual computational skills to keep accurate records. Kovacik noticed that, while Summa already had a fast D2B time for STEMI patients – 83 minutes – there was room for improvement. From the emergency medical technicians (EMTs) to the EKG technicians to the cardiac catheterization lab (cath lab) staff, Kovacik knew it was possible for Summa to streamline the process even more by shearing away any action that didn’t provide additional value to the patient.

“First, we had to recognize that each person along the path had an opportunity for improvement, as well as error and delay,” Kovacik said. “We broke down the process and gathered feedback from staff about what would help them increase their speed dramatically.”

At the same time, the AHA launched an initiative focused on using evidence-based research to cut D2B times nationwide, which bolstered Kovacik’s plan to help make the time savings a reality at Summa. She enlisted her husband, Mark Kovacik, a research associate in Summa’s Walter A. Hoyt Jr. Musculoskeletal Research Lab, to conceive and design a computer software system to assist in reducing the D2B time in Summa’s Akron City Hospital emergency department.

The result: a user-friendly computer interface that keeps track of the duration of each D2B step and allows nurses and doctors to pull reports about unit performance.

After implementing the system, changes happened quickly, Brenda Kovacik said. In the first year, D2B times dropped by 15 minutes. By 2010, they had fallen to an average of 48 minutes. Now, during the weekdays when all staff are on duty, the D2B time is often less than 20 minutes. The health system decided to push the envelope further and extend the time reduction efforts to the paramedics. It worked. EMT to balloon time – known as E2B – is now 56 minutes.

The time improvements are important from a monetary perspective because the Center for Medicare and Medicaid Services considers acute myocardial infarction incidents one of the core measures to determine reimbursement rates. However, that wasn’t the reason Summa decided to refine its D2B process.

“It’s more than just working to save a person’s life. If we don’t get them the proper treatment within 90 minutes, they could have continued problems after the cardiac event,” Brenda Kovacik said. “The faster we move and get the artery open, the better long-term outcomes the patient will have.”

How It Works

To be effective, a new software system must be readily accessible to users and easy to understand. According to Mark Kovacik, the STEMI software is written to accommodate all levels of computer skills and does not require any special training.

The system, which currently operates on a mainframe computer, allows staff to select the date of service. It then uses color-coded fields to record the times for all points along a patient’s journey through the hospital, such as when a patient enters the ED, when the EKG is complete and at what time the patient enters the cath lab. The patient encounters are transcribed retrospectively based on data manually recorded on the patient’s chart. Entering the data into the software system during the treatment process would cause undue delay.

Once all the times are in the system, the software automatically calculates the intervals, identifies spots where timing is sluggish and emails feedback to the patient’s healthcare providers within 48 hours. Giving feedback to staff in a timely manner is far more effective than waiting weeks to discuss performance, according to Mark Kovacik.

“Everyone recognizes that the data doesn’t lie,” he said. “And we’re not using these findings to point fingers. Instead, we’re problem solving, sometimes on a case-by-case basis. Maybe there’s a legitimate reason why some actions take longer and we can use that knowledge to make changes.”

Performance Improvements & System Benefits

Brenda Kovacik noted that some D2B timing issues were easy to identify once the STEMI software was implemented. For example, recorded data suggested having an ED-only EKG would be helpful.

“By having someone always in the emergency department to conduct EKGs, we managed to cut the time spent getting the test by 50 percent,”she said. “Without the data collected through the software system, we would not have known to make this improvement.”

Summa has seen further advances in EKG efficiency over the past year with many paramedics now performing the test on the way to the hospital, then faxing the results in to the ED. This step often allows the paramedics to make a quick stop-over in the ED before rushing the patient directly to the cath lab. It also helps EMS crews understand how big a role they play in ensuring patients receive proper care as soon as possible, Brenda Kovacik observed.

“The electronic and automated format also allows staff to run performance reports in a quicker, easier way,” said Don Noe, a research information analyst at the Musculoskeletal Research Lab who completed the now patent-pending software programming. Performance reports that once took two to three hours to create can now be compiled in three to four minutes.

“The software also removes the potential for human error,” he added. “Before we had the software, times were entered manually and staff was doing the interval calculations themselves,” Noe said. “Necessity really is the mother of invention. Now we let the computer do the math.”

According to Kenneth Berkovitz, M.D., chair of the department of cardiovascular disease and system medical director, Summa Cardiovascular Institute, creating and using the software has improved patient outcomes by uniting the staff in a common goal of enhancing both individual and group performance in cardiac care.

“This software is a really incredible tool that allows us to easily see and identify where in the D2B process we have issues with slowdown and where we have opportunities to improve,” Berkovitz said. “It’s visually powerful to see all of the data or look at a case-by-case basis to see where we’ve shaved time. We now have some of the fastest D2B times in the country and this is the tool that helped get us there.”

Some other ideas for the software’s use have surfaced, postulating an agreement between Summa and the AHA that would establish Summa Health System as the national repository for STEMI data.

Next Steps

Mark Kovacik began developing the STEMI software in 2006. It entered beta testing – testing by a limited external audience – in 2009 and officially went online in the cardiac care unit in 2010. Its resounding success prompted Summa to look toward expanding its uses.

“After a rigorous evaluation of the software, the hospital is now testing the waters to see if the system can be applied to all time-sensitive services,” he said. “The biggest immediate potential is with stroke.”

Some other ideas for the software’s use have surfaced, postulating an agreement between Summa and the AHA that would establish Summa Health System as the national repository for STEMI data. Discussion includes the possibility of hospitals across the country purchasing or licensing copies of the STEMI software, then sending their information to Summa to be housed in a main data repository.

In the meantime, Summa will continue to work toward providing the highest quality care in the fastest time possible. Future success will depend on every team player.

“Everyone needs to see how their part in the process makes a difference,” Brenda Kovacik said. “This software shows them their work is important.”

To read the story in the original publication: http://www.thesummafoundation.org/media/11058/18979.pdf pg.2

September 14, 2011 - Posted by wjpalmer | Healthcare | balloon angioplasy, Brenda Kovacik, computer interface lets nurses and doctors speed cardiac care, computer software to improve time for heart attack victim to get stent, critical time to get stent, D2B, Don Noe, Kenneth Berkovitz, M.D., Mark Kovacik, ST segment elevation myocardial infarction, STEMI, stent, Summa Akron City Hospital, Summa Health System, Walter A. Hoyt Jr. Musculoskeletal Research Lab, widow maker heart attack