The cardiology department of Netherlands health-care provider Leiden University Medical Center (LUMC) has begun using a cloud-based Internet of Things (IoT) solution provided by Zebra Technologies to track the amount of time it takes for cardiac-arrest patients to receive a balloon angioplasty treatment. The solution is helping the hospital to improve what it calls its door-to-balloon (DTB) rate, in order to better ensure that patients are treated as quickly as possible, thereby improving their chances of survival and recovery.
The solution is powered by Zebra’s Zatar platform (hosted software that provides users with IoT data). The RFID company is now making the system, known as Time Tracking Solution for Acute Myocardial Infarction, commercially available to other hospitals. It is also offering the solution for other time-to-treatment use cases, such as for acute ischemic stroke victims, according to Thomas Kurian, Zebra’s senior director of new growth platforms.
Acute myocardial infarction (AMI), caused by a blockage in an artery to the heart, can reduce bloodflow enough to kill a patient. Therefore, providing fast treatment is critical. Hospitals try to keep track of their time performance on these kinds of time-sensitive procedures, but that is not always an easy process. To monitor such a procedure manually, an individual staff member writes down the time that the patient arrives, while employees in the lab input the times that the procedure began and ended. Such a manual system is laborious and prone to errors and incomplete data, the firm reports, since personnel can simply forget to enter times, or estimate the time incorrectly. What’s more, a manual system cannot provide real-time visibility into delays that might occur between the entrance and the lab.
LUMC is a part of the Dutch Federation of University Medical Centers. The hospital sought an automated method of measuring and documenting its DTB performance, and then using the collected data to improve its DTB times. With that goal in mind, the facility established a DTB Task Force that began seeking technology to provide automated time measurements.
The hospital’s representatives had seen Zebra’s Zatar technology demonstration at the 2014 Healthcare Information and Management Systems (HIMMS) conference, and had viewed the Zatar solutions the company had on display. The hospital then asked Zebra to develop a time-tracking system for its door-to-balloon needs. LUMC tested the technology for approximately six months before taking it live last month. (LUMC did not respond to requests for comment regarding this installation.)
When an ambulance carrying a patient with a perceived AMI condition arrives at the emergency department, a wristband with a built-in Bluetooth Low Energy (BLE) beacon is attached to that individual’s arm before he or she is removed from the vehicle. The unique ID number transmitted by the wristband’s battery-powered BLE tag does not link to the patient’s personal health information or identity, thereby protecting his or her privacy.
As the patient enters the facility, typically on a stretcher, a BLE radio built into a tablet mounted near the entrance receives the tag’s beacon. That tablet then uses a Wi-Fi or 4G Internet connection to send the wristband’s ID to the Zatar cloud-based service, where the Zatar application software links the time and location with the wristband and stores that information. As the patient is taken along one of several routes leading to multiple labs, other tablets installed along the route continue to pick up the wristband ID as it comes within range, thus updating that wristband’s status to indicate, in real time, how quickly it is moving from one location to the next.
Each time the wristband nears a tablet, the Zatar software prompts the tablet to display the accumulated time against a background color of green, orange or red, in order to indicate staff performance. For instance, if the patient is moving through the process to the lab quickly, the tablet screen will be green. However, if the time is approaching the maximum acceptable wait, the color will be orange, while very late would be indicated with a red screen. The hospital can set the criteria for the color changes on the tablet, based on its own performance goals.
The patient is then received into one of the labs, where one tablet and two Bluetooth button beacons have been installed. The interventional cardiologist presses one button beacon after the needle is inserted to record the needle time, and the other button beacon to document the procedure’s completion. The tablet captures the ID numbers of the button beacons and the wristband, thereby linking that patient with the final phases of the DTB process.
The data belongs to the hospital, Kurian says, and is available via Zatar’s Representational State Transfer (REST) application programming interface (REST is a commonly used architecture for running Web services on the Internet). Hospital personnel can view the DTB times by signing into the system and viewing average waits for specific days or times of day, or for particular individuals by anonymous ID number. However, one key benefit of the solution is its ability to display performance to the staff in real time as they are transporting or treating a patient, so that they know if they need to expedite the process in order to provide angioplasty within the desired time frame.
The technology does not integrate with any of the hospital’s existing software, Kurian explains, and is provided as software as a service (SaaS). “In that way,” he says, “it is entirely noninvasive to the process” of receiving and treating the patient. In addition, Kurian notes, installation consists simply of mounting the tablets within the hospital’s corridors and labs. Altogether, the facility has up to 20 tablets for all of its cath labs and routes.
Currently, the only time data that the tablets display is the amount of time that has passed since a patent arrived. However, during the next phase, the system will also show how much time is left for an acceptable treatment time, according to the hospital’s benchmarks. The facility is striving to decrease its median DTB rate to below 90 minutes after a patient arrives.
Initially, Leiden University Medical Center trialed the technology during a pilot involving a sampling of 100 patients who entered through the doors with an AMI situation. The hospital is now in a permanent deployment for all such patients—typically about 500 per year.
LUMC can gain from the system by reducing the amount of time that nurses spend recording DTB times, as well as by securing more reliable data. That information can also be used for the purpose of analytics, such as determining when treatment times are faster or slower, and thus what conditions might affect treatment speed.
According to Kurian, Zebra is currently in discussions with multiple hospitals throughout Europe and the United States about conducting pilots at their facilities. The solution could also be used to automatically record and document time-to-treatment for patients in an emergency situations, he says.