Hospitals speed-up time-to-table for heart attacks

MONTREAL – The McGill University Health Centre, along with the Royal Victoria Hospital, have deployed a real-time care coordination platform called Stenoa (https://stenoa.com) that quickly pulls together the team members needed in the cardiac catheterization laboratory when a patient presents with a heart attack.

“The diagnosis can be confirmed and the entire team can be alerted almost instantly,” said Dr. Jeremy Levett, the founder and chief executive officer of Stenoa and a cardiac surgery resident at the MUHC. “Before, the process of confirming the diagnosis of an acute myocardial infarction and activating the team could take anywhere between 10-25 minutes.”

And in critical-care situations like an acute myocardial infarction, every second counts.

“Some patients do pass away on the table,” said Dr. Marco Spaziano, Stenoa’s chief medical officer and an interventional cardiologist at the MUHC. “There are cases each year where we say, ‘If only the patient had been here five minutes earlier, we may have been able to save them.’ This is a life-or-death issue for many patients.”

Using the Stenoa platform, a paramedic on the way to the hospital or an Emergency Department physician can activate the system within the ambulance or from a shared device in the Emergency Department. That consults the interventional cardiologist on call and gets the whole team in motion, ready for the arrival of the patient.

That also contrasts with the outdated and manual process in many hospitals in Quebec and across Canada. Traditionally, they have gone through a back-and-forth process using locating personnel and text messages whereby information was shared non-securely, and activations were subject to human error and lots of manual intervention.

For its part, Stenoa sends out its “omnichannel” alerts sequentially, ensuring that all team members receive the message. These channels include critical alert push-notification technology, SMS, phone calls, and pagers for those who still wish to use them.

Cath lab teams typically consist of an interventional cardiologist, nurses and X-ray technologists. Additionally, there are downstream professionals who must be alerted, as well, including nurse resource managers, bed flow managers, and the coronary care unit who arrange the care for patients after the procedure is completed, as well as cardiology residents and fellows.

Dr. Spaziano stressed that, “We optimize for a 90-minute window to get the heart attack patient from the Emergency Department to the cath lab table with the artery unblocked.”

In a blog, he writes, “For patients in whom the culprit artery is opened within 90 minutes, the risk of death is as low as 4 percent. However, in those for whom it takes over 90 minutes to unblock the culprit artery, the risk of death increases to over 12 percent. And in those with a delay of over 150 minutes, the risk of death is as high as 20 percent. That’s one in five patients.”

Stenoa has been deployed at the MUHC and Royal Victoria Hospital for about a year-and-a-half and has been used with more than 500 heart attack patients. It’s been so successful in speeding up the process of getting coronary patients into the cath lab that plans are in the works to roll it out to other Quebec hospitals.

Dr. Levett founded Stenoa as a medical student. He and his colleagues, including Dr. Spaziano, realized that an electronic, real-time system could dramatically reduce the time needed to assemble highly skilled teams.

“It was built to meet the needs that we see every day in the hospital,” said Dr. Levett.

They started development in 2021 and it was first used at MUHC in September of 2021. It runs in the cloud, using AWS, and has unique features built into the platform.

First, it has ECG integration capabilities, so when a patient’s ECG is read by the Stenoa system, it automatically extracts patient demographics and relevant time components. This data can be transmitted to the cath lab, enabling the staff there to have the information ready at hand.

Moreover, the company has obtained from both Apple and Google (for Android systems) access to the emergency alerting system on smartphones.

Its omnichannel alert capabilities help to ensure that team members will still get the message, even if a telecommunications carrier goes down – like the Rogers network did, a year ago.

“We have access to emergency technologies,” said Dr. Levett. “It’s built to a mission-critical standard, with 99.5 percent guaranteed uptime.”

“To date, we’re proud to have maintained a 100 percent uptime,” he added.

Tomer Moran, chief technology officer at Stenoa, noted that Stenoa’s integration with ECG systems enables them to parse ECGs, meaning that it provides real-time statistics that can be used by hospitals to improve their internal processes.

Traditionally, hospitals keep track of the time from ED to cath lab table using paper or spreadsheets, and often only compile this data yearly. Quality improvements are slow to happen, if at all. By contrast, high-quality data is available immediately with Stenoa’s web app through its data platform, and trends and problems can be analyzed instantly.

“It allows you to spot the bottlenecks in real-time,” said Dr. Levett.

In this way, logjams and delays can be quickly corrected. For example, Stenoa can be used to inform staff in the ED when the cath lab is ready, so the patient can be immediately wheeled in for a procedure to unblock an artery.

Even earlier in the process, paramedics can use Stenoa to check on which hospital to bring the patient to. “You want to bring the right patient to the right hospital at the right time,” said Dr. Spaziano.
That avoids pit-stops for the patient and prevents time-delays.

Stenoa is currently being used to connect physicians and staff at the MUHC’s hospitals. In the future, it could be used to connect multiple hospitals, across regions, so patients can be directed to the centre that can provide the fastest care.

“It can detect which site to go to, so that we don’t overload certain sites,” said Dr. Spaziano. “Some teams are already stretched to their limit.”

And while it’s being used now for cardiac emergencies, Stenoa can be adapted for any type of emergency care – such as strokes, traumas or other emergency surgical procedures.

According to a news release from the McGill University Health Centre, medical staff have been highly positive about the use of Stenoa. “This is the best thing that has happened to the Cath Lab in the last 17 years I’ve been a nurse here,” said Johanne Haley, a nurse in interventional cardiology and critical care at the MUHC.

Dr. Levett said the team at Stenoa also takes pride in its focus on design, striving for a seamless, elegant, user experience. It takes minutes to onboard – simply through accepting an email invite – and less than five minutes to learn how to use, he said.