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Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, TaiwanChung Shan Medical University, School of Medicine, Taichung, TaiwanKaohsiung Medical University, School of Medicine, Kaohsiung, Taiwan
Department of Cardiology, Changhua Christian Hospital, Changhua, TaiwanPhD Program in Tissue Engineering and Regenerative Medicine, National Chung-Hsing University and National Health Research Institutes, Taichung, TaiwanInstitute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan Miaoli, Taiwan
Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, TaiwanChung Shan Medical University, School of Medicine, Taichung, TaiwanKaohsiung Medical University, School of Medicine, Kaohsiung, Taiwan
Although the benefits of prehospital ECG have been clearly demonstrated, only a few studies have focused on the challenges of data transmission/interpretation.
Instant messaging apps (i.e., LINE@, WhatsApp@) have not been adequately leveraged to improve the transmission/interpretation of prehospital ECGs.
During the study period (January 1, 2018 to December 31, 2019), our local government and regional hospitals sought to establish a solution that would prevent delays and errors in prehospital ECG transmission/interpretation. First, we established a 24-h chat group using an instant messaging app (LINE@). The members (n = 182) of this chat group included local emergency department (ED) physicians, cardiologists, and EMS personnel. Second, the prehospital ECG (as a deidentified PDF file) could be uploaded immediately to the chat group by EMS personnel using 12-lead ECG machines with Internet of Things functionality. Finally, in this chat group, the styles of feedback were not limited, and free text and uniform text/stickers (only mentioning “ST elevation” or “no ST elevation”) were all allowable (Fig. 1).
Fig. 1The prehospital ECG could be performed at the scene or in the ambulance. Data could be uploaded directly to the LINE@ chat group with an IoT device (SIM card with a 3G/4G signal). The feedback on prehospital ECG could be achieved by online physicians sending uniform text or stickers. The prehospital ECG could be opened as a PDF file (which could be zoomed in or out) on a smartphone. Uniform text indicates that online physicians had to type words, such as “ST elevation” or “no ST elevation”, in their feedback.
During this period, 165 patients’ prehospital ECGs (patients with severe chest pain) were uploaded to this LINE@ chat group, and all of them were reviewed and assessed by ED physicians or cardiologists. Among the 165 patients, 26 (15.8%) were diagnosed with STEMI and received emergency PCI in the ED (study group). To analyze the effects of prehospital ECGs on delays and outcomes, we matched two another comparison groups and adjusting variables with study group (group A: EMS without prehospital ECG, n = 52; group B: non-EMS patients, n = 52, each of them were diagnosed as STEMI and received PCI in ED). Of all, we found that prehospital ECGs did not significantly increase the time from the scene to the hospital; however, they significantly decreased “Triage time” “DTB time” “Door-to-first-ED ECG time” “Door-to-completed dual antiplatelet therapy (DAPT) time” and “The durations of ED and ICU stays”.
The “time to first response” was much shorter when using LINE@ than when using email. In addition, sending LINE@ uniform stickers cost less time than sending free or uniform text. We also noticed that physicians were more likely to respond and to respond quickly when feedback could be provided by sending uniform stickers.
In conclusion, instant messaging apps effectively shortened the time to first feedback on prehospital ECGs from online physicians. More importantly, physicians were more likely to respond and to respond quickly when feedback could be achieved by sending uniform stickers.
Conflict of interest
None declared.
Funding
None.
Acknowledgements
We would like to thank Changhua County Government and all members in this chat group for contributed greatly to establishing the response system.
Reference
Al-Zaiti S.S.
Shusterman V.
Carey M.G.
et al.
Novel technical solutions for wireless ECG transmission & analysis in the age of the internet cloud.
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