Addressing the Challenges Hospitals Face in Improving Outcomes from SCA

Annette Fasnacht, Senior Director of Marketing for ZOLL Medical Corp., discusses how the next generation of defibrillators produced by ZOLL are even better at saving lives than their predecessors.
R Series with CPRFuture Healthcare What are some of the challenges that customers face regarding the use of technology in resuscitation?

Annette Fasnacht Outcomes for sudden cardiac arrest in hospitals have not improved in over 30 years, despite all the advances in cardiac care. That’s not acceptable, and we believe that technology can help. Some of the challenges that hospitals face include the quality of CPR, the cardiopulmonary resuscitation procedure. We found that even experienced users go too fast or too slow, too shallow or too deep, and there are far too many pauses in the process of providing cardiopulmonary resuscitation to maintain adequate perfusion.

Another problem for hospitals is trying to capture accurate information during the chaos and confusion of a cardiac emergency. This can rapidly become a crisis situation. There are lots of interventions going on, and trying to keep track of the information is very difficult.

Maintaining accurate timeliness is another issue. One of the things that we know is the sooner we get to a patient experiencing cardiac arrest, the better the outcome. However, there are multiple sources of time information—from a wall clock to a wrist watch to the defibrillator clock—all of which may give conflicting information and which may not be set accurately. When trying to determine accurate time to first shock, to measure the quality of the response in the hospital, this all becomes very difficult to coordinate.

Lastly, another big challenge is managing the defibrillator asset. Because we want to be able to respond quickly, defibrillators are one of the most widely dispersed pieces of equipment in a hospital. However, with the exception of a few departments, like the emergency room and the intensive care unit, a defibrillator may be rarely used. This situation creates huge training and maintenance issues.

FH What solutions has ZOLL developed to help hospitals address these challenges?
AF In 2002, we started to address the CPR quality issue by providing feedback to people who are performing CPR. Every defibrillator that we manufacture today provides users with feedback about whether or not the rate and depth of their compressions is in the target range, and the defibrillator additionally tracks how long people pause. That was the first huge leap forward: introducing a way for people to see how well they were performing CPR.

In 2005, we introduced a technology called See-Thru CPR®. This is a proprietary filter that removes the artifact that CPR causes in the electrocardiogram and allows the users to see if there is an underlying organized rhythm developing. In the past, what people had to do was frequently stop compressions in order to see what the rhythm looked like. With See-Thru CPR, you don’t have to pause unless you see something that looks like it might be organized. That’s a huge improvement, because it helps maintain perfusion pressure.

CodeNet® is our electronic code documentation system. Using a simple, hand-held PDA, all the interventions performed in a code can be easily and quickly documented. The data from the PDA and the defibrillators is combined in a single time-synchronized record that ties back to network time in the hospital. Therefore, nobody relies on anybody writing down the time on their wrist watch or the time on the wall clock. It is all being electronically captured and is therefore very accurate. Finally, this program generates accurate quality reports that hospitals can use to assess their response times. You can compare the performance of different divisions and know where you need to address quality issues.

Lastly, we’ve tackled the question of asset management and training. We have a wholly interactive online training program for the defibrillator. People in the hospital can train on the product any time they have access to the Internet or the hospital network, which represents a huge reduction in hospital costs and training time. We have also just introduced Wi-Fi communication on our defibrillator. That’s unique in the industry, and it will allow code data to be transmitted wirelessly to CodeNet and to the network.

In association with Wi-Fi, we have developed a suite of products designed specifically for the clinical engineer. Our Defibrillator Dashboard product, which is the suite, allows remote monitoring of every defibrillator in the hospital network. So, from any remote desktop that has access to the network, a clinical engineer can determine if a defibrillator is ready to use.

Our defibrillators test themselves once a day automatically. For code readiness, we test 40 different points, including making sure that it is plugged in, the battery is charged, and the electrode is attached. If the defibrillator fails this readiness test, the information can be e-mailed to the clinical engineer telling him the defibrillator at a certain access point needs new electrodes, or is not plugged in, or is not charged. Sometimes it’s just a matter of the clinical engineer calling up the nursing floor and saying, “plug in your defibrillator.” In other cases, he knows he’s got to get that defibrillator and swap it out. That’s going to be incredibly valuable in terms of improving staff efficiency and increasing the confidence that the product is ready, not to mention reducing cost.

FH Does implementing ZOLL solutions require any proprietary infrastructure?

AF No, it doesn’t, and that’s really the beauty of the whole thing. It all runs on standard 802.11 infrastructure and the data files that we use are so small, they won’t impact the hospital bandwidth either.

FH Why did ZOLL choose to focus their technology solutions strictly in resuscitation rather than offering a more broad-based monitoring IT platform?

AF Working on a more broad-based platform would not be practical. Defibrillators are critical life support equipment. During a transport, for example, if you want that monitoring data, you can capture it in CodeNet. The data that is really important, though, is what happens when you need to use the product to resuscitate. You want to know if the defibrillator is ready, whether it can help you save lives, and if it will help you improve your response.
We wanted to make the product accessible to every hospital — from two beds to 1,000 beds. Hospital patients code everywhere in the hospital, but very few hospitals have organization-wide monitoring platforms. They are usually relegated to only a few telemetry and intensive care units. So it’s about accessibility, as well.

FH How does ZOLL view the IT portion of their solution and how it relates to the total resuscitation solution?

AF Firstly, IT helps to guide performance to improve resuscitation with the CPR tools. Secondly, it is tremendously beneficial for information. Improving outcomes from sudden death requires that ability to measure our performance and to review it with those who respond. If we don’t know how long it’s taking us to get there or how frequently we stop CPR and lose perfusion pressure, how do we know what to improve? We have this wonderful database of information that is unique to each code and can be aggregated to give you a hospital-wide picture.

Using IT to train and keep track of results aids in JCAHO compliance and is a very cost-effective way to improve information retention rates. The automated readiness test data can also be compiled into a very comprehensive report that demonstrates to JCAHO that defibrillator readiness is being maintained in order to maximize patient safety. It’s done automatically by the defibrillator and it’s captured as a database. This solution is also cost effective, and improves staff efficiency, asset management and maintenance.

FH Are ZOLL data products compatible with other manufacturers’ defibrillators?

AF The products are not really compatible, with the exception of the CodeNet writer. Any hospital can use the CodeNet writer to code data electronically on the PDA. If you don’t have the ZOLL defibrillator product, however, you aren’t able to take advantage of all of the capabilities, as you can’t marry it to the defibrillator record and get the single timeline vital to accurately measure response. Right now the data is captured by hand during the code — often on a set of scrubs or somebody’s arm or a napkin because codes aren’t something you plan for. The fact that you can have an electronic code record being collected is already a huge leap forward in understanding the process.

FH What is ZOLL’s vision for the future of resuscitation technology?

AF We’re supportive of more integration and more capability that uses technology to identify patients at risk to improve outcomes and response to reduce cost and increase staff efficiency, but only in the resuscitation space. We are experts in that area and we continue to look to move the needle in sudden cardiac death, the largest cause of death in the world. It far exceeds both cancer and HIV. The number of people in the United States who die during sudden cardiac arrest is equivalent to five jumbo jets crashing every single day.
We’re very passionate and focused on helping more patients survive this critical event. We’re even developing a consulting service to help hospitals benchmark their performance. We’ll then help them implement the tools that we’ve developed to help them save more lives. It’s an exciting vision.

Annette Fasnacht is the Senior Director of Hospital Marketing for ZOLL Medical Corporation. Ms. Fasnacht has more than 25 years of experience in medical device marketing and management with a background ranging from sales and sales management to marketing, clinical and international. Her experience ranges from work within start-up organizations to multinational corporations. She was most recently President of Optelec USA, where she was responsible for managing the U.S. subsidiary of the Netherlands-based Optelec, Tieman Group. Ms. Fasnacht joined ZOLL in December of 2005 in her current position.