PURPOSE: Historically, ST segment elevation acute myocardial, STEMI,infarct patients presenting to hospitals without Heart Surgical programs have substantially higher mortality, are less likely to receive guideline recommended medications within 24 hours, and are less likely to undergo acute re perfusion therapy.1Circ Cardiovasc Qual Outcomes.2009 Nov;2(6):574-82. Epub 2009 Nov 3. First of its kind TeleICU and Interventional Cardiology collaboration was established to extend the capacity of solo interventionalist and to achieve compliance with all national guidelines.
METHODS: Level 3 community hospital in Georgia recruited a solo Board Certified Interventional Cardiologist and established new TeleICU service. Prior to this program patients were required 70 miles to nearest hospital with interventional capabilities including cross state referrals. Protocol established streamline TeleICU intensivist, Cardiologist and Emergency Physician care roles. Secured high resolution cameras connected to continual proactive computer monitoring were established in the Emergency Department and ICUs. TeleIntensivist collaborated with on site physicians to diagnosis and prepare patients for catherization. Post catherization TeleIntensivist proactively intervened on arrhythmia, pressor titration, balloon pump, medications and other critical care interventions.
RESULTS: One year review of all patients, revealed 222 patients presented for PCI elective or urgent and 48 STEMI with average door to balloon time, D2B, 66 minutes. Full guidelines were met on all patients,no MACE events notated and zero moralities.
CONCLUSIONS: TeleICU collaboration with Certified Interventional Cardiologist allowed 270 patient to receive care in their hometown. This cutting edge collaboration allowed for full compliance with national cardiology measures. Estimating 48 patients would have required emergent transferred at minimal cost of $5,000/transfer cost saving to State of Georgia was $240,000.
CLINICAL IMPLICATIONS: Collaboratives with skilled clinicians on both sides of Collaborative with skilled clinicians on both sides of TeleMedicine provided University level care in hometown environment. The D2B time was 66 minutes with zero mortality and 100% guileline compliance. THis cutting edge collaboration assisted in saving lives while delivering cost saving to the patient, family, and State level.
DISCLOSURE: The following authors have nothing to disclose: Elizabeth Cowboy, Timothy Catchings
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