Monitoring surgical patients has come a long way since 1846 when Oliver Wendell Holmes coined the term anesthesia. Way back then, monitoring the patient basically boiled down to observing whether the patient was still breathing. Patient monitoring today can answer that question and a zillion more, with monitors proving to be a valuable tool to the surgical team in helping to ensure quality care for patients.

What’s flexible about them?
Roy Wallen, director, critical care, Edwards Lifesciences, Irvine, CA, explained what makes a monitor flexible: "Flexible monitors are devices that can provide a variety of patient parameters in a variety of care locations." Walter Huehn, director, anesthesia care segment, patient monitoring, global marketing, Philips Medical Systems, Andover, MA, explained what makes these new monitors so flexible: "Generally speaking, flexible monitors are portable, can be adapted to a variety of clinical situations, and can support wireless communication. For the anesthesiologist, flexible monitoring means having a range of patient monitors, from which he or she can choose the most suitable, for the specific needs of the patient in a given situation and clinical setting. This includes choice of different display sizes; state-of-the-art, modular measurements relevant to anesthesia; configurability to suit user- and department-specific needs; and seamless data continuity throughout the perioperative process."

Features and capabilities
Today’s monitors can do so much more than monitor the patient’s numbers. Power and versatility are words often associated with flexible monitors. Many monitors offer multiple ways of configuring screens with a touch of the finger, provide data to support decision-making, make available access to outside sources of information, and even move with the patient through different levels of care without interruption in data or struggles with wires.

With so many options available, what features and capabilities should a user look for in a flexible monitor? Wallen believes that "The most important feature is the ability to measure the essential parameters for patient care in as many locations as possible." Dorothy Marshall, marketing communications manager, Spacelabs Medical, concurred: "With so much activity occurring between emergency, pre-op, O.R., and recovery, it’s even more critical to have one monitoring system that can move with the patient."

Marshall described the flexibility of Spacelabs’ Ultraview SL patient monitors as being due to modules, "which allow use for all levels of acuity throughout the hospital. The modules are interchangeable, so they can be used with other Spacelabs monitors, including portable monitors. Specialty modules can be added to expand the acuity level of the monitor further. Upgrading can be as simple as adding or replacing a module, something a clinician can do easily,"said Marshall.

Huehn outlined current capabilities of Philips’ monitors and explained why these features are important to the surgical team: "The most important features in flexible monitors are mobility and portability, ease of use, and seamless patient-data transfer," he stated, adding: "For mobility, a monitor should be compact in size and rugged in design, with a long battery life. The monitor should be easy to use with all kinds of patients, from neonatal to adult, and usable in different clinical locations, not just in the O.R.

"A consistent user interface for all patient monitors throughout the hospital is of huge benefit, as clinicians can spend more time caring for their patients rather than struggling with the monitor," said Huehn. "A common user interface also reduces training time for personnel, thus lowering training costs."

All of Philips’ IntelliVue patient monitors share the same user-interface concept; once you learn to use one monitor, you can use all the others as well, explained Huehn. The customer has the choice of various user-interface devices, from touch-screen, the easiest and most intuitive, to SpeedPoint or Navigation Point trim knob devices. PC-standard PS-2 devices such as a mouse or keyboard can also be used. "The unique concept of profiles allows IntelliVue monitors to adapt to different monitoring requirements by patient condition, surgery performed, phase of anesthesia, clinical environment, or individual user pref-erences,"said Huen.

Philips IntelliVue

"Seamless patient-data transfer when moving a patient is important in maintaining continuous monitoring and data continuity," Huehn continued. "Philips’ Multi-Measurement Server combines the most important and most frequently used physiologic measurements in a compact, battery-operated package. It connects to any IntelliVue monitor, operates on its own during transport, and uploads data saved during transport to any IntelliVue monitor as soon as it’s connected, without having to disconnect and reconnect sensors and cables from the patient and without having to perform any manual upload procedures. This concept is unique in the industry."

"Philips’ patient monitors interface to scores of anesthesia machines, and third-party stand-alone monitors, such as pulse oximeters, infusion pumps, etc. Validated mechanical mounting hardware is available to create the optimal anesthesia workspace, combining IntelliVue patient monitors and the CompuRecord Anesthesia Information Management System with virtually all brands and models of anesthesia machines,"said Huen.

Philips’ monitors also provide data export capabilities (HL-7) and an ADT interface to Hospital Information Systems. Portal technology provides access to external applications and information on the monitor display without interfering with the critical physiologic data, such as waveforms and alarms. Applications that can be accessed directly on the monitor include still images from a Picture Archiving and Communication System, laboratory results, hospital intranet, and decision-support applications such as On-Line Electronic Help for Anesthesiologists.

Huehn said, "Philips flexible monitors can adapt to different clinical environments by just switching profiles, say from O.R. to ICU, which takes care of all measurement, display, and monitoring configurations. The monitor displays provide the utmost flexibility in screen configurations. A large variety of predefined named screens is also available. Philips puts emphasis on presenting data in meaningful ways that support clinical decision-making, rather than just listing the huge amount of data on the display."

"We have also built innovative clinical-decision—support tools into our monitors, which present a wealth of data in a clinically meaningful way to support fast and informed decisions," continued Huehn, "such as the Advanced Event Surveillance, which allows clinicians to define alarms for ‘events,’ based on multiple parameters with exquisite control; the Horizon Display, which focuses on deviations from a user-defined ‘horizon,’ or baseline value, to help clinicians recognize significant trends at a glance; ST Map, which provides an easily grasped visual overview of 12-lead ST segment deviations; Smart ‘Auto Alarm Limits’ for each measured numerical value, which can be set to ‘wide’ or ‘narrow’ limits with a single button push, depending on current patient status."

Spacelabs’ monitors also offer an impressive list of features and capabilities: "The monitors are not only powerful but versatile," Marshall told HPN. "The same monitor can be used for various levels of acuity, throughout the hospital care areas."

Spacelabs’ WinDNA technology delivers instant access to patient information, such as labs and radiology, as well as to Internet applications, directly at the Ultraview SL patient monitor. "This means that clinicians do not have to leave the patient to go to a PC or to another area of the hospital to gather information that is critical to making the best decisions. Information such as labs, patient record, and Physician’s Desk Reference is all accessed at the Spacelabs Ultraview SL as the patient is being monitored," said Marshall.

Spacelabs’ Ultraview SL Patient monitor mounted on an anesthesia machine.

"Spacelabs’ Flexport system interfaces integrate data and alarms from third-party devices (non-Spacelabs products), such as ventilators, directly into the Ultraview SL patient monitor. All data and alarms from the stand-alone devices are consolidated into the monitor for display on one screen. In addition, the data from the peripheral device are trended with the other parameters that are being monitored. Such connectivity with other devices and systems offers hospitals a way of building care systems at their own pace, while still enabling compatibility and information integration."

"Spacelabs’ Intesys Clinical Suite is an optional set of eight software applications that further save time, support workflow, and improve clinical practice for the entire hospital. One component, Vital Signs Viewer, enables physicians to view live patient waveforms from any networked PC at the hospital, home office, or even from home. Another application, Electronic Flowsheet, automates the collection of vital signs, eliminating time-consuming manual transcription. A third application, Print Manager, turns Spacelabs patient monitors into network printer-enabled devices. All patient data can be printed out directly from the patient monitors to any printer on the network, eliminating the management and cost of thermal strip paper."

Spacelabs’ Data Shuttle also maintains the electronic patient record, even during transport between care units, without having to re-cable the patient.

All these whistles and bells may sound complicated, but Marshall and Huehn assured HPN of their products’ user-friendliness, pointing out that the monitors are intuitive and that having learned to operate one of their monitors means the users will know how to operate all of those in the product line.

Patient safety
The buzz words in 21st century medicine are "patient safety." Flexible monitors play a role in patient safety in several ways, noted Marshall, not the least of which is the ability for healthcare workers to stay closely connected to the patient from admission through discharge, even when not in close proximity to the patient. "Spacelabs Ultraview SL patient monitor offers bar-code scanning for accurate, instant patient admissions. The VCRR function allows clinicians to view, control, review, and record patient data remotely for any other networked or telemetry bed without leaving the patient at hand. Alarm Watch delivers bed-to-bed and bed-to-central alarm notification. While tending to one patient, a clinician can be notified of a patient emergency at any designated monitor location, enabling clinicians always to be in touch with every patient."

Vigileo monitor and FloTrac sensor from
Edwards Lifesciences

Huehn highlighted additional ways that flexible patient monitors contribute to patient safety: "Of course Philips’ patient monitors, as well as other vendors’ monitors, are patient-safe in that they comply with regulatory standards for electrical patient safety. Philips monitors provide all measurements and comply with all standards mandated by focus on ease of use. If operation is easy, intuitive, and consistent, fewer errors in operation may be made, and the clinician is not distracted by dealing with the monitor."

Wallen has observed a movement in the area of patient safety: "There is an increasing trend to less-invasive measurements. The Edwards FloTrac system provides an easy-to-use method to provide a comprehensive view of a patient’s hemodynamic status. It can be added to any existing continuous blood pressure line by any healthcare professional. This system is unique in that it is the only system that can reliably provide continuous hemodynamic parameters without an external calibration. The ability to measure hemodynamic parameters in a less-invasive way eliminates exposure of the patient to other invasive techniques that may not be necessary."

Siemens’ INFINITY EXPLORER

The cost factor
Marshall believes that "Flexible patient-monitoring solutions can help clinicians and hospitals save time and expense, and improve patient care as well" an opinion shared by others in the field.

"These days, many hospitals are trying to optimize their workflows," observed Huehn. "For example, there are several clinical projects in progress trying to define the ‘O.R. of the Future.’ Perioperative workflow optimization approaches include using a separate induction room to prepare a patient for surgery and induce anesthesia before entering the O.R. for surgery. The Multi-Measurement Server, battery-operated monitors for patient transport, a docking station, and seamless data transfer optimally support these innovative workflows, which can improve the utilization of O.R.s and personnel, thus contributing to cost savings."

Whereas cost-saving is ever-important to healthcare facilities, Wallen and Huehn pointed out that cost shouldn’t be confused with value when making the purchase. "Hospitals should choose monitoring technologies . . . that offer the greatest value to its clinicians and patients," Wallen said. "Being able to treat patients accurately and quickly will provide a cost-savings to the hospital."

"Price is certainly one factor in selecting flexible monitors," added Huehn. "It is more important, however, to select the right product based on the required features and to what extent the monitor can support the anesthesiologist’s or nurse’s decision-making and workflow. Prices always need to be viewed in relation to the performance and advantages the product delivers."