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Telemedicine To Expedite Patient’s Transfer: The Introduction of the Videophone Lowell Satler, MD Washington Hospital Center.

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Presentation on theme: "Telemedicine To Expedite Patient’s Transfer: The Introduction of the Videophone Lowell Satler, MD Washington Hospital Center."— Presentation transcript:

1 Telemedicine To Expedite Patient’s Transfer: The Introduction of the Videophone
Lowell Satler, MD Washington Hospital Center

2 Lowell F. Satler, MD DISCLOSURES Grants/Contracted Research
Medtronic CardioVascular, Inc., Edwards Lifesciences LLC, Abbott Vascular Speakers Bureau -Daiichi-Sankyo, Inc. -Eli Lilly and Company

3 Options for Transport of Patients With STEMI and Initial Reperfusion Treatment
Hospital fibrinolysis: Door-to-Needle within 30 min. Not PCI capable Call 9-1-1 Call fast EMS on-scene Encourage 12-lead ECGs with transmission Consider prehospital fibrinolytic if capable and EMS-to-needle within 30 min. Onset of symptoms of STEMI 9-1-1 EMS Dispatch EMS Triage Plan Inter-Hospital Transfer PCI capable GOALS 5 min. 8 min. EMS Transport Options for Transportation of STEMI Patients and Initial Reperfusion Treatment: Goals Reperfusion in patients with STEMI can be accomplished by the pharmacologic (fibrinolysis) or catheter-based (primary PCI) approaches. The overarching goal is to keep total ischemic time within 120 minutes (ideally within 60 minutes) from symptom onset to initiation of reperfusion treatment. The medical system goal is to facilitate rapid recognition and treatment of patients with STEMI such that door-to-needle (or medical-contact-to-needle) for initiation of fibrinolytic therapy can be achieved within 30 minutes or door-to-balloon (or medical-contact-to-balloon) for PCI can be achieved within 90 minutes. These goals should not be understood as “ideal” times, but rather the longest times that should be considered acceptable for a given system. Systems that are able to achieve even more rapid times for treatment of patients with STEMI should be encouraged. Note “medical contact” is defined as the “time of EMS arrival on scene” after the patient calls EMS/9-1-1 or the “time of arrival at the emergency department door” (whether PCI-capable or non-PCI-capable hospital) when the patient self-transports. Patient EMS Prehospital fibrinolysis EMS-to-needle within 30 min. EMS transport EMS-to-balloon within 90 min. Patient self-transport Hospital door-to-balloon within 90 min. Dispatch 1 min. Golden Hour = first 60 min. Total ischemic time: within 120 min.

4 Currently Available System: STEMI Management Solution
How does it work? EMS Transmits Data via Broadband Hospital Receives Data via internet Care Teams Share Data and Act on Data

5 Current System Problems
Expensive hardware requirements-15k to 25K per ambulance for ECG-Defibrillator-Transponder Requires Server(s) Still Requires Broadband Transmission and Network

6 Prehospital ECG using VideoPhone
Confidential Prehospital ECG using VideoPhone Videophone

7 VideoPhone STEMI Solution: Acquiring and Sending the ECG
Videophone is used to acquire the ECG Live video is transmitted to the selected hospital or Cardiologist’s VP

8 VP STEMI Alert System STEP 1 STEP 2
ECG acquired by EMS iPhone live camera and transmitted to receiving hospital’s ED ECG sent from ED or ambulance to Cardiologist’s smartphone Internet appliance in ED Internet appliance or Videophone

9 Videophone STEMI alert: System Details
ECG’s sent from EMS to any hospital; hospital can redistribute to appropriate physician Hospital PC with internet application Physician VP and PC Hospital 1 Physician VP and PC Hospital 2 Physician VP and PC Hospital 3 Ambulances with Videophone Physician VP and PC Hospital 4 Physician VP and PC Hospital 5

10 D2B Time= 90 – (evaluation time)
ED with STEMI Fax ECG Receive ECG 5-10 minutes? D2B Time= 90 – (evaluation time)

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12 AT&T Healthcare Community Online
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16 Easy to use Secure

17 ED Cath Lab CCU MEDSTAR (one call) VP C VP C C VP In house VP outside

18 VP Ambulance Referring ED C MEDSTAR (one call) Helicopter VP C

19 VideoPhone Demonstration

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26 3G WiFi Hospital WiFI WiFI 3G 3G WiFi WiFi

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28 Pt Placement Supervisor Telecommunications Director
Patient Placement CCU Fellow Pt Placement Supervisor Telecommunications Director Page Operator Interventionalist Code HEART page STEMI Program CVTs Answering Service CCU Charge RN ED Com Physician Admitting Director House Supervisor STEMI Program Nurse

29

30 Videophone for STEMI Initial testing demonstrates proof of concept
Technical details for user friendliness and function are in the final design stages Pilot rollout expected shortly Low cost and ease of use will likely replace alternative technologies Applications to other medical and surgical specialties is broad

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