Case Study – St. Mary Medical Center

EXECUTIVE SUMMARY

For the hospital, patient care provided by EMS is often a blind spot in the overall care continuum. The national average for the percentage of EMS ambulance arrivals that get admitted to the hospital is more than triple that of walk-in patients (39 percent vs 12.5 percent). As admitted patients account for a significant portion of hospital revenue, EMS patients are very important to hospital administrators, as well as, quality and process managers. This case study demonstrates how St. Mary Medical Center, located in Langhorne PA, implemented a technology solution that addressed these concerns in a positive way.

The addition of a CAREpoint workstation with D-Scribe provided St. Mary Medical Center with:

• An important means for continuous quality improvement on EMS-ED communications.
• A risk mitigation mechanism through improved medical-legal documentation.
• Ongoing value and strong ROI for CAREpoint with D-Scribe.
• Ability for future gains by implementing GD’s e-Bridge secure messaging and Mobile Telemedicine app as a force multiplier.

THE CHALLENGE

The hospital emergency department (ED) is typically a busy place. In addition to providing care for patients already registered, medical staff needs to be aware of inbound patients arriving by ambulance.  The latter is accomplished by emergency radio and phone calls from Emergency Medical Services (EMS) ambulances’ for pre-arrival notification and medical direction. These calls provide important information about the patient being transported. For lower level acuity issues, a concise notification message or call may be all that is needed.  With more serious issues and where online medical direction is required, a notification is not enough and a timely consultative conversation with a nurse or physician is required to direct appropriate care. The challenge is to balance the amount of content and time spent on the call with time diverted from patient care.  This rings true for both EMS and the ED.

A patient from a 911 call that is transported by EMS to the ED is often an emergency and time is of the essence. This is especially true in cases of a heart attack, stroke, or trauma. Performing emergency patient care in the field, selecting the appropriate hospital, and a timely ambulance transport is just the first phase in the continuum of patient care. Once arriving at the hospital, care is transferred to the ED.  For the continuation of care to be optimal, the ED needs to be best prepared and the call from the EMS crew helps minimize blind spots. Similarly, important process improvement, medical legal documentation, and continuous quality improvement (CQI) programs, must include patient care from the time of first contact with EMS. As such, ambulance calls need to be documented and recorded.  This should include both voice and data such as email, fax, forms, 12-Lead ECG reports, and vitals transmitted to the ED.

THE SOLUTION

To address the challenge, St Mary Medical Center implemented a solution demonstrating Responsive Innovation from GD, specifically the CAREpoint 2.0 Workstation with integrated D-Scribe logging recorder. This system utilizes advanced calling features that streamline handling of communications between EMS and hospital emergency departments over both 2-way radio and telephone. In addition to simplifying user operation for nurses and physicians with advanced alerting features, the CAREpoint’s recording and documenting of all call audio and data into its D-Scribe database facilitates effective CQI and medical-legal documentation.

“Until CAREpoint and D-Scribe, we had a very limited and inefficient process for call review.” said Christopher Reif, EMS Program Manager for St. Mary. “The (recording/documentation) process was split into phone and radio transmissions. Our hospital held the phone tapes and the regional dispatcher center held the radio recordings. Retrieval was cumbersome and lengthy and it was voice only; no important data like 12-lead STEMI reports. CAREpoint was a single integrated solution for our varied communication environment.” added Reif.

With the CAREpoint’s built-in D-Scribe log recorder, Reif or an authorized user could review call audio  immediately or whenever needed either at the CAREpoint in the ED or privately from their office PC using Remote D-Scribe software.  This gave St. Mary a highly desirable quality and risk mitigation mechanism.

Besides regular CQI reviews of call audio or the inquiries from the ED Director to review a particular call for medical aspects or concerns, D-Scribe was also utilized to provide timely legal documentation. “On a couple of occasions, we were approached by the Prosecutor’s Office for call audio or data to help them in cases of possible criminal activity. We were able to provide important discoverable information that helped them act quickly. Before CAREpoint this was not possible.” said Reif.

An additional technology St. Mary is considering to further improve communications, workflow and patient care for both EMS and hospitals is GD’s e-Bridge “app” which provides secure notification and Mobile Telemedicine capabilities. e-Bridge integrates with CAREpoint and enables EMS to share HIPAA-secure text notifications and calls with pictures, video, forms, and medical data directly with the hospital, which can add a new dimension to patient care and hospital preparation prior to the ambulance arrival. The emergency department can also use e-Bridge for live ETA tracking to better anticipate ambulance arrival, as well as relay pre-arrival information with responding specialty physicians, such as cardiologists and neurologists, right to their mobile devices.

“Until CAREpoint and D-Scribe we had a very limited and inefficient process for call review.”

Christopher Reif,
EMS Program Manager for St. Mary

RESULTS

Until arrival of the ambulance at the hospital, patient care provided by EMS is often a blind spot in the overall patient care continuum. The national average for the percentage of EMS ambulance arrivals that get admitted to the hospital is more than triple that of walk-in patients (39 percent vs 12.5 percent). As admitted patients account for a significant portion of hospital revenue, EMS patients are very important to hospital administrators, quality, risk, and process managers.

The addition of CAREpoint and D-Scribe provided St.  Mary Medical Center with an important mechanism for time-sensitive continuous quality improvement and medical-legal documentation of EMS-hospital communications relating to patient care. The value and strong ROI for CAREpoint with D-Scribe continues to be demonstrated through proactive CQI and risk mitigation. Additional future gains may be realized by implementing GD’s e-Bridge secure messaging and Mobile Telemedicine app as a force multiplier in EMS-ED communications. Both figuratively and literally minimizing blind spots.

ABOUT ST. MARY

St. Mary Medical Center is a 371-bed hospital providing care to generations of families in Bucks County, PA and nearby communities. Recipient of the America’s 100 Best Hospitals award for three consecutive years.

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