75 © Springer Nature Switzerland AG 2021 A. B. Bhatt (ed.), Healthcare Information Technology for Cardiovascular Medicine, Health Informatics, https://doi.org/10.1007/978-3-030-81030-6_6 Chapter 6 Telemedicine as a Cardiovascular Center Growth Strategy: Patient Experience, Provider Satisfaction and Improved Access Jaclyn A. Pagliaro and Ami B. Bhatt Cardiology presents itself as the ideal specialty for developing a reproducible structure for health information technology. It is immensely data driven and most guidelines have algorithms to provide comprehensive patient care. Telemedicine enables clinicians throughout the world to continually manage large populations at a distance, rather than with episodic in-person care alone [1]. Technologies such as Bluetooth enabled devices for heart rate, blood pressure, weight, oxygen saturation and activity monitoring create real-time individual cardiac fingerprints, which provide insight for the care team. The widespread dissemination of telemedicine also enables frequent assessment and high-touch interventions. The field of cardiac monitoring and treatment devices is one of the most advanced in the medical subspecialties. This affords clinicians with an existing framework for the mechanisms and workflow for remote data collection and analysis, as exemplified in hypertension, electrophysiology, heart failure, cardiac rehabilitation and most recently in cardio-obstetrics (Table 6.1). 6.1 Patient Experience The National Quality Forum has three recommended domains for telehealth measures: access, experience and effectiveness. Telecardiology is effective in all three areas, and has specifically been found to reduce the rate of hospitalizations and readmissions, improve morbidity and mortality rates, cardiovascular outcomes, access and quality of life, and increase cost-effectiveness and self-management of cardiovascular disease [7]. J. A. Pagliaro (*) · A. B. Bhatt Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA e-mail: jaclyn.pagliaro@mgh.harvard.edu; abhatt@mgh.harvard.edu
76 A recent use of telemedicine that is particularly useful to cardiovascular center operations is virtual pre-admission testing and evaluation. These virtual evaluations have been found to reduce overall patient time in the inpatient setting pre-operatively and improves patient satisfaction without increasing the operative case cancellation rate [8]. Streamlining periprocedural care without the use of physical hospital space and personnel allows for timely assessment and patient preparation. Patients and families are especially appreciative of both the convenience and inclusivity of the process, allowing for fewer missed days of work periprocedurally, as well as increased caregiver involvement leading to decreased anxiety. Table 6.1 Successful telemedicine implementation studies by subspecialty Hypertension [2] In a pilot study, patients were supplied with Bluetooth blood pressure monitors that transmitted data in real-time to their electronic medical record. They were asked to measure their blood pressure at home for one week; twice daily in the morning and evening in duplicate, prior to caffeine or taking antihypertensive medications. Then weekly BPs would be averaged and antihypertensive medication titrations were made utilizing an algorithm. In this program, control was reached in 81% of patients and in 91% of patients who were engaged in the program, in an average of 7 weeks. Electrophysiology [3] In a comparison study of long-distance telemedicine ICD visits and conventional in-person device clinic visits, the telemedicine group was found to have lower comorbidity burden based on the Charlson score as well as a lower proportion baseline prevalence of afib. During the median follow-up of 4.4 years, telemedicine care was found to be noninferior of all outcomes. Heart failure [4] When comparing a remote medication monitoring system to traditional management in heart failure patients, the use of telemedicine was associated with an 80% reduction in all-cause hospitalization and of those who were hospitalized, had a reduced length of stay when compared to the usual care arm. Objective device data also indicated 95–99% adherence rates for the telemedicine group. Cardiac rehabilitation [5] Cardiac rehabilitation programs have the potential to reduce morbidity and mortality in cardiac patients, while also increasing quality of life. One study found that the utilization of cardiac telerehabilitation to overcome the barriers and limitations of traditional programs. By increasing the accessibility to cardiac rehab it may increase patient volumes and adherence, decrease transportation barriers, and allow for personalized coaching and support for longer intervals of time. Remote monitoring can also also be used to track patient vitals during normal daily activities, which allows for closer clinical management. Cardio obstetrics [6] Obstetric ultrasonographers performed fetal echocardiograms at the patient’s local clinic however, the results were given to the mother in real-time by a fetal cardiologist at a children’s hospital 243 miles away. The study found that neither diagnostic quality nor patient satisfaction was hindered by the use of telemedicine. The program empowered the local clinicians, offered strong economic advantages to the patients and offered a timely, face-to-face, specialty consultation without travel. J. A. Pagliaro and A. B. Bhatt
77 Chronic disease management with virtual visits, asynchronous questionnaires and peripheral devices is also evolving. It is no longer limited to heart failure and hypertension management but also routine outpatient care and subspecialty care including cardio-obstetrics and congenital heart disease. The challenge of an effective virtual care paradigm is building an infrastructure and developing a toolbox from which heterogeneous patient populations and provider preferences can both be met to optimize a care delivery plan (Table 6.2). 6.2 Improved Access Between WiFi and cellular data networks, patients with cardiovascular disease have access to rapidly contact their clinicians thus removing proximity from the equation of care. Telemedicine has been shown to successfully reduce barriers to traditional modalities of care such as access to transportation, travel distance and time, lack of childcare and loss of work productivity while providing comprehensive medical care with the same or greater effectiveness [7]. The use of digital health, monitoring vitals with wearables, asynchronous screening tools, virtual visits for medical management and behavioral health are revolutionizing the delivery of care in the face of social barriers to health (Table 6.3). Social determinants including financial barriers and access to nutritious meal plans further create challenges in implementing cardiovascular health recommendations. Engaging with patients via video and in their homes allows care teams to better understand the individual circumstances, which may influence compliance with medical and lifestyle advice. This allows personalization to create a successful healthy lifestyle partnership. The involvement of family members in discussion, Table 6.2 Telemedicine utilization for pre-admission, inpatients and post-discharge follow up Chronic care & pre-admission monitoring The remote clinical management of outpatients allows for remote patient monitoring using wearable devices. The data collected remotely can then be used to support the decision-making process of physicians. In-hospital telecardiology Most applications of in-hospital telecardiology refer to real-time collaborations between small hospitals and tertiary care centers. Examples include rural hospitals consulting larger institutions for the diagnosis or exclusion of congenital heart disease in newborns, or for acute stroke management. However, since the emergence of COVID-19 in-hospital telemedicine has been increasingly used between clinicians for teleconsultations to provide comprehensive care while reducing exposure and decreasing PPE utilization. Post-hospital follow up Close post-discharge follow up improves outcomes and reduces readmissions and urgent care utilization in patients with heart failure, arrhythmias and implantable devices. Source: Kruse et al. [7] 6 Telemedicine as a Cardiovascular Center Growth Strategy: Patient Experience…
78 Table 6.3 Evaluating access, experience and efficacy of telemedicine implementation At-risk populations International patients Procedural patients Urgent and emergent care Access – Increase access to subspecialty care – Promote continuous rather than episodic chronic disease management – Identify increasing risk earlier and intervene – Bring tertiary care to novel populations – Create a unique growth and branding opportunity – Increase education and sharing of best practices across institutions – Increase throughput of pre- and post-operative evaluation – Decrease readmission and ED utilization with high-touch periprocedural care – Prioritize interventional timing with virtual monitoring (RPM, asynchronous, video) – Allow rapid assessment and triage to the correct level and location of care (ie, cardiac clinic, community ED, tertiary ED) – Aid smaller institutions and practices with urgent expert evaluation – Increase expertise of pre-hospital care delivery in the field with virtual consultation Experience – Decrease time and cost associated with travel to visits – Allow family participation – Increase sense of respect for patient and dismantle the physician-patient hierarchy – Allow for consultation and worldrenowned expertise – Create access in areas where healthcare is lacking – Promote continuity of care among international patients, local clinicians and remote clinical teams – Decrease time spent periprocedurally in the hospital – Decrease discomfort of travel – Increase rapidity of access to medical expertise when health-related anxiety is peaking – Increase sense of connection with the practice in times of need – Encourage appreciation for team based care (more easily accepted and understood in times of need) – Allow participation of family members during emergent care, at times of significant illness, or end-of-life situations J. A. Pagliaro and A. B. Bhatt
79 “kitchen tours” to discuss food availability and choices, and medication storage, organization and review are a few successful social assessments which strongly influence heart health and are more difficult to address during in-person clinic visits. 6.3 Provider Satisfaction Physicians have to navigate a rapidly expanding medical knowledge base, increased administrative burden associated with the introduction of electronic medical records and patient portals and new regulatory requirements for patient care and maintenance of certification. In addition they face an unprecedented level of evaluation including quality metrics and improving patient satisfaction [9]. Studies have shown that decreased physician satisfaction leads to burnout, which is costly, disruptive to clinic workflows and leads to rapid turnover. This collectively negatively impacts patient access to care. As a result of the COVID-19 pandemic, clinicians are under an even more burdensome workload than normal as well as pressure due to increased total health expenditures [10]. Telemedicine may promote physician wellness and engagement thus decreasing burnout and associated deficits. In the Cardiovascular Center, a modern growth strategy optimizes the use of in- person and virtual care to improve patient safety, outcomes and satisfaction while increasing the efficiency and quality of clinical care, reducing cost and utilization. The cardiovascular center approach to care can be divided into disease management and acute care, each focus benefitting from a unique blend of virtual, in-person and hybrid services (Fig. 6.1). Table 6.3 (continued) Effectiveness – Identify barriers to care by evaluating home environment – Increase touch points through remote monitoring to treat chronic diseases that disproportionately impact these populations – Increase patient education and literacy leading to better selfadvocacy and compliance – Increase access to subspecialty expertise – Increase the diversity of the patient population receiving care – Earlier identification of disease progression to allow for improved international triage – Ensure optimal patient preparation – Engage in close post-procedural follow up – Decrease hospital readmissions – Streamline location of services – Offer prehospital clinical support – Expansion of triage capability 6 Telemedicine as a Cardiovascular Center Growth Strategy: Patient Experience…
80 6.4 Digital Health Implementation Successful adoption of telemedicine and digital health as a growth strategy eventually requires integration at the system level of a practice, in inpatient hospital care, at skilled nursing facilities, and for at-home and clinic care. In some areas there may be remote practices and urgent care centers which require unique digital health implementation as well. Sustainable technology will require choosing a platform or application. Future iterations of virtual care may then include image interpretation, risk prediction, clinical decision support, and eventually artificial intelligence driven care. Digital health can also optimize care management by improving upon transitions of care. Payment models will have to align with provider and patient experience, clinical outcomes, and cost reduction. Telemedicine and digital health will therefore need to deliver value on these measurable endpoints. When assessing the role of digital health from chronic disease management, there are three tiers of cardiovascular patient needs which can be addressed. A majority of low-risk patients have minimal interventional needs and active surveillance can be performed in the community/at home. For the rising risk patients, more intensive at-home monitoring enables early intervention decreasing hospital resource utilization. This allows the intense care, high risk patients to benefit from timely clinic visits, diagnostic testing and procedures, and with advanced monitoring workflows, even some of these high risk patients can have an improved trajectory of safe and high quality care with continuous rather than episodic assessment (Fig. 6.2). The IMMACULATE randomized clinical trial [11] of remote postdischarge treatment of patients with acute myocardial infarction by allied health practitioners vs standard care revealed that among low-risk patients with revascularization after myocardial infarction, remote intensive management was feasible and safe with no differences in achieved medication doses or indices of left ventricular remodeling. Additional studies in higher risk populations are underway and the massive shift to Algoritham Based Disease Specific Programs Outcome-based Improvement Remote Patient Monitoring Disease Management Acute Care Quality Improvement Reduced utilization Decreased Iength of stay Team-based Decision Making Education Virtual In Person Hybrid Increased access to multidisciplinary subspecialty care Clinical Research Increased community access Fig. 6.1 Using fully virtual, traditional visits and hybrid models to manage chronic disease and provide acute care J. A. Pagliaro and A. B. Bhatt
81 virtual care in 2020 will likely provide additional data on the efficacy of remote monitoring and the ideal populations who will benefit from this strategy. 6.5 Guidelines and Workflows to Support Virtual Clinical Care During the COVID pandemic, virtualizing clinical care resulted in stable quality despite moving large populations from in-person to virtual visits. The systems were built with the intention to deliver safe care and importantly, allowed in-person visits as needed. With the rapidly changing landscape of cardiovascular care and the incorporation of virtual care delivery, we need to develop agile systems, which can aid clinicians in seamlessly offering and delivering blended care. Every practice will require local guidelines regarding tele-triage of patients, identification of patient populations or diagnoses which benefit most from remote monitoring and workflows to enroll patients and acquire data. Tele-triage can include risk stratification for effective early intervention and use of digital therapeutics to enable targeted outreach to at-risk patients and optimize medical treatment. Virtual care models can aid in the adoption of guideline directed medical therapy by prompting visit frequency, medical uptitration and offering frequent at-home vital sign monitoring to allow rapid and safe medication titration and increased patient engagement compared to episodic clinic visits. Integration of clinical care guidelines and prompts can decrease loss to follow up by intentionally prompting clinician and patient to increase engagement when active management is ongoing, and otherwise allow episodic check-ins for routine stable care. HighRisk Patients Rising-Risk Patients Low-Risk Patients 5% of patients; usually with complex disease(s), comorbidities Innovative monitoring and real-time treatment Hospital care for interventional treatment Divest from HospitalBased Care for Patient Centric Care 15-35% of patients; may have conditions not under control 60-80% of patients; any minor conditions are easily manaaged Fig. 6.2 Patient risk stratification for chronic disease management 6 Telemedicine as a Cardiovascular Center Growth Strategy: Patient Experience…
82 Dashboards which report remote data in a meaningful way for patients and clinicians will accelerate patient engagement and promote asynchronous chronic disease surveillance. Patients are expressing a desire to remain connected to their caregivers and for the healthcare system to harmonize fragmented care. They will need information regarding their blended virtual to in-person chronic disease management journey and should be offered technical and digital health literacy support. The user experience should be seamless to promote patient adoption, facilitating access to care while minimizing the footprint of the technology. Blended care assessment will also require standardization of data collection of accepted clinical endpoints to build virtual clinical decision tools. Once virtual visits and remote monitoring are implemented and studied, AI-driven guidance can be layered onto care in the form of triage assistance, image interpretation, risk prediction, decision tree guided testing recommendations and clinical decision support. Diagnoses including atrial fibrillation, heart failure reduced ejection fraction, chronic secondary prevention of atherosclerotic cardiovascular disease and pre and post-procedural evaluation are areas ripe for blended care paradigms with clear guidelines for evaluation and management. As always, clinical acumen must be superimposed on any virtual care workflow, remote monitoring mechanism or AI driven decision aid. When considering a digital health strategy for cardiovascular center growth, establishing goals and then the tools to accomplish those goals is essential. Access to high quality patient care, patient, clinician and community education and presence are all necessary in a growth strategy (Fig. 6.3). In the era of digital DIGITAL HEALTH STRATEGY Presence Social Media mHealth Direct Pt Care Education Tele Medicine Advertising Marketing Branding Digital health incorporated into the Heart Center’s infrastructure Applying modern digital technoogies-- the web, mobile, date analytics, the cloud, wearables, sensors, etc.-- to healthecare. DIGITAL HEALTH: Patient Provider Community Program Accounts Individual Accounts Blogs General Wellness Continuous Care Virtual Care MGH TeleHealth GOALS TOOLS Fig. 6.3 Digital health strategy J. A. Pagliaro and A. B. Bhatt
83 education and literacy, telemedicine and mobile health are also accompanied by social media as a platform for patient and clinician education, entrepreneurship, and industry interaction. The skill sets needed to navigate these varied facets of the cardiovascular center footprint require multidisciplinary coordination across clinical, administrative and technology teams with a clear shared vision to engender success. 6.6 Quality Measures in Virtual Care As telemedicine continues to be integrated into cardiovascular care models, a comprehensive understanding of outcomes and expectations, from the clinicians’ and patients’ perspective, is required to advance care provision. Blended care challenges the concept of quality of virtual care as not all individuals will use the same ratio of virtual and in-person care. This reminds us that virtual care cannot be considered as an isolated mechanism of care delivery and therefore quality measures need to account for the spectrum of care from asynchronous to synchronous at a distance to in-person care. Importantly, the implementation of sustainable, virtual and in-person blended care requires that quality measures, backed by data, must extend beyond patient adoption and experience. Practices must determine the high-priority goals for blended care implementation and create quality measures to assess achievement of those endpoints. Assessment of variables including access and compliance have already begun, however longevity and quality of life in cardiovascular patients requires assessment of mortality, disease progression and hospital admissions. Identifying quality metrics to specifically address patients with high resource utilization is a pressing clinical and financial healthcare challenge where telehealth may be leveraged to address social determinants of health and co-morbidity progression in addition to cardiac disease management. Once priority goals are identified, the methods of evaluating virtual visits, asynchronous care and digital health data streams must be defined. National efforts by cardiovascular societies will be essential in standardizing an approach to evaluating effective telemedicine strategies. Drivers of optimization for synchronous and asynchronous care include the quality of data, contextualizing data, trends of data, and building intelligence to create relevant data interpretation. Optimal inputs to evaluate blended care include experiential, clinical and utilization metrics. Validated instruments like patient reported outcomes (PROs) which report the status of a Telemedicine is now the fastest growing modality of healthcare delivery. It is our responsibility in the healthcare industry to ensure timely, effective, equitable and patient-centered care. This responsibility lies with the digital technology companies, their investors, hospital systems, payors, clinical teams and the patients. 6 Telemedicine as a Cardiovascular Center Growth Strategy: Patient Experience…
84 patient’s health condition without any interpretation by the patient’s clinician [12] could be the first metric to transition to digitized models and be administered broadly to patients receiving virtual care. In heart failure, PROs are incredibly predictive of quality of life and outcomes and even if a patient is not involved in digital care, the PRO could be delivered digitally. Advances in digital technology can improve clinical workflows and drive patient empowerment [13]. Clinical workflows can now include assessment with remote patient monitoring to now allow daily vital signs and medication adherence to improve clinical insights into the success of treatment plans (Fig. 6.4). Patient empowerment will increase as clinicians and patients can use these parameters to collaborate to improve engagement strategies and devise comprehensive cardiovascular care plans. Digital devices which generate automated alerts for patients will further involve them in their care and make them responsible for their own data. Collaborations between cardiovascular centers and industry will certainly accelerate the adoption of new technologies. The inclusion of patient advocacy groups will increase dissemination and adoption. Hospital patient family advisory committees should be rapidly introduced to cardiovascular center goals and strategies around digital health for active feedback, while associations with national advocacy organizations such as the American Heart Association, Marfan Foundation, Adult Congenital Heart Association and others should also incorporate their leadership and membership in the digital transformation of cardiovascular care delivery. Subspecialty care programs can serve as opportunities to closely examine the use cases, patient and provider engagement and downstream quality, outcome and financial metrics in telemedicine based blended care. Follow-up for symptoms Review of data Routine follow-up Pre-operative planning Post-operative follow-up 4 % 3 % 15 % 30 % 48 % Fig. 6.4 Use cases for video visits in the MGH ACHD multidisciplinary program prior to COVID-19 J. A. Pagliaro and A. B. Bhatt
85 Long term, the establishment of cardiovascular care delivery registries at large centers will enable quality assessment of digital tools, rapid iterations of care delivery models and opportunities for research and publication. Such registries will also aid in creating dashboards to ensure equitable access and care provision in the community. In the near-term to support clinicians and patients, vetted assessments of existing digital health platforms and products, perhaps with consideration of integration for a select few, will lessen the burden on the Cardiovascular center physician from feeling isolated in the transition to blended care. Lastly, the strategic mission of any cardiovascular center will now benefit from identifying the role of (and barriers to) telemedicine and digital health integration in emerging models of patient care and clinical research. 6.7 Conclusion Telemedicine will undoubtedly be integrated in the future of cardiovascular healthcare delivery. The utilization of telecardiology can lessen physician burnout, disassemble the physician-patient hierarchy and allow patients to more rapidly meet their cardiovascular goals. Remote monitoring can also enhance chronic cardiac disease management and decrease the rate of hospital admissions thus reducing the overall cost of healthcare. Telemedicine increases the accessibility of care, efficiency of management and decreased utilization of resources, overcoming barriers to address social determinants of health. The major goal for a cardiovascular center is to create an agile infrastructure to incorporate virtual care into the existing in-person workflows. In some areas, such as electrophysiology, the transition may be smooth and require minimal change based on the previous utilization of remote monitoring. Similarly, heart failure programs have already begun to optimize asynchronous and synchronous care, preventing readmissions, addressing disease progression early in its course, and significantly improving patient quality of life and satisfaction. In areas significantly dependent on the physical exam, such as valve programs, there will be a blend of remote and in-person care, a clear advantage to pre- and post-procedural virtual access, and the need to build out digital stethoscopes and remote detection of atrial fibrillation, for example. For rare diseases including adult congenital heart disease, telemedicine has increased access to specialized care and improved patient engagement. For all of these circumstances, the diagnostic accuracy of telehealth applications, the ability to obtain actionable information to inform decision making and systems to communicate among teams and with patients in a timely manner will impact the cardiovascular center’s success with virtual care delivery. The reward is extensive, with increased patient and clinician satisfaction and a proactive, equitable, personalized system of cardiovascular care delivery. 6 Telemedicine as a Cardiovascular Center Growth Strategy: Patient Experience…
86 Case Study STAT: A Digital Tool for Saving Lives at the Bedside By Andrew L. Chu, MD, MPH, Joshua C. Ziperstein, MD, Blake A. Niccum, MD, Melvin G. Joice, MD, Eric M. Isselbacher, MD, MHCDS, Jared Conley, MD, PhD, MPH Background Hospitals have standardized protocols for inpatient clinicians to follow when confronting medical emergencies that carry a high risk of morbidity and mortality. Since these high acuity events (e.g. STEMI, stroke, airway emergency) occur with relatively lower frequency, clinician familiarity with workflows to expedite diagnostic and therapeutic interventions is often not fully optimized. These life-saving protocols can be difficult to access while caring for an acutely decompensating patient at the bedside, since they are often contained within e-mails or intranet websites. Although this has always been problematic during normal day-to-day operations, it was exacerbated by the COVID-19 pandemic. Problem In April 2020, Massachusetts General Hospital (MGH) had the highest number of COVID-19 confirmed admissions in Massachusetts. In order to accommodate this significant surge in patient volume, hospital leaders transformed existing clinical spaces into COVID-19 floors. These units were staffed by existing internal medicine (IM) staff as well as redeployed clinicians from other specialties (e.g. primary care, pediatrics, radiology). These redeployed clinicians had a wide range of depth and experience in mobilizing and working together with the MGH specialty teams that help manage these low-frequency, high acuity medical emergencies. The hospital, therefore, recognized the need for a tool that could empower all surge clinicians with rapid and reliable access to MGH-specific protocols to best manage these emergencies while at the bedside (Fig. 6.5). Fig. 6.5 MGH STAT Cardiac Arrest COVID-19 Pathway (2020 Launch Version) J. A. Pagliaro and A. B. Bhatt
87 Solution Physician innovators within the Healthcare Transformation Lab (HTL), a MGH innovation center, and the Department of Medicine worked together to develop a mobile application, named STAT, that they could build and launch quickly across the hospital. They conducted informal surveys on which protocols clinicians would prefer to have rapid access to (e.g. STEMI, PE, CVA, ACLS, PE, respiratory failure). Subsequently, the project leaders went through a design thinking process that involved rapid cycles of ideation, prototyping, and testing, with feedback elicited from all stakeholders, including department heads, to continuously improve the product during each cycle. The final version of STAT had 9 emergency protocols, the ability to page and call consultants directly (e.g. activate Cath lab, ECMO), and various code-running features. The Hospital Incident Command System (HICS) leadership labelled the STAT app a high-priority project, so it was launched broadly to become available to all surge clinicians. The tool has been downloaded by hundreds of clinicians, and 100% of surveyed physicians recommended STAT for clinical use. As of April 2021, a year later, the mobile app continues to enjoy regular use. Conclusion This case report showcases the effectiveness of STAT as a digital adjunct for managing bedside emergencies. Physician innovators identified a pressing need, and they worked with stakeholders to rapidly design, develop, and deploy a tool that could be scaled throughout the hospital. Although STAT was invaluable during the worst of the pandemic, it continues to be used regularly during normal day-to-day operations. This example illustrates how clinicians identified and rapidly addressed a large-scale problem by leveraging the power of digital health. 6 Telemedicine as a Cardiovascular Center Growth Strategy: Patient Experience…
88 Appendix: STAT User Experience Questionnaire Strongly Agree Strongly Disagree I think the MGH STAT app is easy to use. I would recommend the MGH STAT app to others, especialy interns, junior residents, and non medicine attendings. MGH STAT is a native iphone app that was released through the MGB app catalog in 4/2020. The goal of the app is to help doctors manage acute, life threateining emergencies at the bedside, In this survey. we hope to solicit feedback from MGH residents and attending who have downloaded the app. MGH STAT App Survey Strongly Disagree I think the MGH STAT app helps doctors manage acute life threacening emergencies (ACLS, airway crisis CVA, PE, STEM) at the bedside. Strongly Disagree I think the MGH STAT app helps improve patient care. I think apps like MGH STAT would be useful at other hospitals and healthcare settings. Strongly Disagree Strongly Disagree Strongly Agree Strongly Agree Strongly Agree Strongly Agre 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 J. A. Pagliaro and A. B. Bhatt
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