Barwon Health – University Hospital Geelong (Barwon Health) in Victoria has implemented the Rauland Australia automated Messaging solution integrated with the Responder 5 Clinical Workflow and Nurse Call System to improve efficiency and reduce the time required to alert and assemble the Code STEMI team.

Barwon Health is one of the largest and most comprehensive regional health services in Australia.  Barwon Health serves a geographically dispersed population through two major sites with a total of 1016 beds and a total of 21 sites overall, stretching from Geelong down the coast to Anglesea, Torquay and Lorne. Health services available through Barwon Health cover the full spectrum from emergency and acute to mental health, primary care, community services, aged care and subacute/rehabilitation.

The fully automated Messaging solution from Rauland Australia enables time-critical Code STEMI alerts to be sent to each on-call team member on their mobile phone. Each team member receives a text message with the event details, together with an automated voice call asking them to either confirm or escalate.

The system will attempt to call the appropriately skilled staff members three times, before escalating the call to a Manager for manual intervention.  Likewise, if an alert is rejected by a team member the system will automatically contact the next available person of equivalent skillset, or escalate to a Manager in the event the role cannot be filled. The system is designed to ensure all Code STEMI alerts are consistently received and responded to by the on-call team; enabling the team to be assembled in the shortest possible timeframe.

The new messaging system has replaced a manual paging process whereby team members received a Code STEMI alert on their pager. Overall confidence in the paging process had reduced overtime due to delivery instability and the inability to confirm an alert had been received.

Nathan Harrop, Nurse Unit Manager, Cardiac Cath Labs, Barwon Health says the new Messaging System has eliminated the uncertainty of alerts being received by team members and significantly reduced risk.

“Quite a few of our team members live outside of Geelong’s city, either on the Bellarine Peninsula or Surf Coast. We had a number of instances where alerts weren’t received on their pagers; this meant other team members had to effectively ‘ring around’ and see if the alert had been received,” said Nathan.

“It can be very stressful for team members if a page hasn’t been received; they may be delayed and then they are arriving flustered and anxious, which is not ideal.”

In addition, the Paging System required alerts to be sent to all team members regardless of their on-call status. This placed an additional burden on the paging system, causing further delivery delays and instability.

“The new Messaging System has reduced risk by removing any uncertainty about a Code STEMI being received and responded to. We’re now able to confidently confirm the attending team within on average 2 minutes and 11 seconds ^1.; previously we had to allow at least 10 minutes before the team could be confirmed,” said Nathan.

This means that we’re now spending the majority of the 90 minutes of ‘door-to-balloon time’ ^2. on the critical procedural work. This is a great outcome and fully supports our commitment to quality and excellence in everything we do.”

Nathan also observes that receiving the Code STEMI alert on his mobile phone is a much less stressful way to receive the message.

“Both myself and several of my colleagues have observed that the sound of the pager causes a real physical response of stress – probably because the pager has typically been used for emergency calls. However, receiving a call and message on my phone is fairly normal and so right from the time I receive the alert I find I’m in a calmer frame of mind.”

The team at Barwon Health worked closely with the Rauland Australia team to ensure their workflows were accurately replicated within the automated messaging system.

“The Rauland team were very receptive to working with us. They took the time to fully understand our workflows and were able to align the system configuration with our processes, which was great,” said Nathan.

“I really believe automated call and messaging systems are the way of the future. We’re working with Rauland Australia to see how we can further enhance the system – we’re very committed to looking at ways we can improve our service and ensure our patients are transferred to the Cath Lab as quickly as possible. Because every minute matters when someone is having a heart attack. ^2.

1.  Based on the average ‘time to confirmation for the 37 Code STEMI events occurring at Barwon Health between 1^st March 2020 and 3^rd May 2020.
2. For patients presenting with STEMI and undergoing primary PCI, the time taken from their arrival to the hospital until the insertion of a device to unblock the vessel (usually a balloon catheter or other device to extract clot) is known as the door-to-balloon time (DBT). This is a key performance measure that assesses the ability of hospital systems and processes to treat acute STEMI in a timely and efficient manner. It is generally accepted that the benchmark door-to-balloon time that hospitals should aim for is <90 minutes, in 80% or greater of cases. Door-to-balloon times are reduced in ST-elevation myocardial infarction by emergency physician activation of the cardiac catheterisation laboratory and immediate patient transfer. Alexander B Willson, David Mountain, Joanne M Jeffers, Cheryl G Blanton, Brendan M McQuillan, Joseph Hung, Michael H Muhlmann and Michael C Nguyen: MJA • Volume 193 Number 4 • 16 August 2010.