Reducing Door‐to‐balloon Time Using Ems Initiated App Based Communication

Background Reducing door-to-balloon (D2B) time for ST-Segment Elevation Myocardial Infarctions (STEMI) has been shown to be effective in improving outcomes. Delays still occur due to various factors such as time to lab activation and diagnostic clarification in equivocal cases. We propose that early communication through a mobile application between Emergency Medical Services (EMS) and in-hospital providers can reduce EMS-to-balloon time and D2B time. Methods We implemented the General Devices Company, Inc. e-BridgeTM mobile application for EMS providers. The app allowed real-time communication and data transmission between EMS providers and the cardiac catheterization lab and emergency department staff. A single-center, retrospective observational study was conducted on 795 STEMI activations undergoing emergent coronary angiography between January 2017 and July 2020. After exclusions, sample size was determined to be 428. The implementation of the app occurred on May 14th, 2019, and EMS transmissions were utilized in 132 patient cases during the study period. Results The implementation of the application resulted in a significant reduction in D2B time by 7.2 minutes (61.2 minutes vs. 68.36 minutes, p=0.005, CI -12.2 to -2.14) and ED board time by 4.41 minutes (29.38 minutes vs. 24.98 minutes, p=0.01, CI -7.8 to -1). There was a trend towards a reduction in First Medical Contact to balloon time, although it was not statistically significant. Further analysis revealed that the application did not significantly reduce D2B time or First Medical Contact to balloon time during the day shift but had a significant improvement in these metrics during the night shift. Conclusion The implementation of app-based communication between EMS providers and in-hospital providers using GPS tracking resulted in statistically significant reductions in First Medical Contact to balloon time and D2B time at our institution. This approach holds promise in improving the timely management of STEMI patients, particularly during the night shift.