June 2008

Operating Room


Outpatient Connection

Remote monitoring improves heart patients’ health, may reduce hospital readmissions

A remote monitoring program can improve the condition of heart failure patients who are mobile and may reduce hospital readmissions. According to the study, conducted by the Center for Connected Health, a division of Partners HealthCare, included 150 heart failure patients admitted to Massachusetts General Hospital in Boston, MA.

"The goal of our Connected Cardiac Care program for this group of patients is to reduce hospital readmissions, provide timely intervention and help them understand their condition using home telemonitoring," said Ambar Kulshreshtha, M.D., M.P.H., lead author of the study and a research fellow at Harvard Medical School and Massachusetts General Hospital.

Patients in the remote monitoring group experienced lower average hospital readmission rates (31 readmissions per 100 people) compared to patients in usual care (38 readmissions per 100 people) and non-participants (45 readmissions per 100 people). Patients in the remote monitoring group also had fewer heart-failure related readmissions and emergency room visits than usual care and non-participating patients.

Patients received telemonitoring equipment to monitor vital signs such as heart rate, pulse and blood pressure. They also weighed themselves daily and answered a set of questions about symptoms every day. That information was transmitted through the telemonitoring device to a nurse, who would call weekly or more often if a patient’s vital signs were outside normal parameters. Researchers also monitored patients’ re-hospitalization rates and emergency care use. "Patients could see the fluctuation in their vitals and realize they hadn’t taken their medications or weren’t eating right or exercising," Kulshreshtha said. "A weekly call from the nurse reinforces lifestyle management of the patient’s heart failure."

Ninety-five percent of participating patients in the intervention group said the program improved their heart failure control and helped them stay out of the hospital. All participating patients said the equipment was easy to use. Ninety-five percent believed they were able to manage their heart failure better. All participants said their health improved and they received adequate interactions with a homecare nurse.

This program has the potential to have "a dramatic impact on improving the lives of heart failure patients and reducing hospital admissions," Kulshreshtha said. An estimated 5.3 million Americans have heart failure. Hospital discharges for heart failure rose from 400,000 in 1979 to 1.08 million in 2005, an increase of 171 percent. The estimated direct and indirect cost of heart failure in the United States for 2008 is $34.8 billion, according to the American Heart Association’s Heart Disease and Stroke Statistics – 2008 Update. Connected Cardiac Care creates an interaction between patients, nurses and doctors that allows for timely medication changes based on a complete clinical picture and helps heart failure patients feel empowered." This study was funded by Partners HealthCare.

Mobile workstations gain traction

Portable units boost accuracy, efficiency and care

by Julie E. Williamson

Lionville iPoint Computer Workstation with Med Drawers

These days, most would agree that time is of the essence. Often, there aren’t enough hours in the day to accomplish every task, and even if there were, we’d likely find ourselves scrambling to cram even more into that already narrow time slot.

Perhaps no other industry is more keenly aware of time limitations and the need to do more with less than healthcare. Each minute — or even second — that passes can mean the difference between good outcomes and bad, and even life or death. And while providing quality patient care remains the primary focus, as it should, it would be a bit naïve to believe that time doesn’t factor into the bottom line. Although the "time is money" mantra is one that may not leave a good impression with the media or general public, it’s nonetheless become a part of doing healthcare business, particularly in light of caregiver shortages, increasing patient acuities and ever-shrinking reimbursement rates.

One way facilities are aiming to streamline efficiencies and improve outcomes is by adopting products and practices that allow for better data capture and care at the patient’s bedside. As more and more healthcare organizations can attest, mobile workstations – fast becoming the gold standard for point of care computing and charting —can go a long way toward reaching those goals.

"Mobile carts allow a nurse or clinician to have real-time access to patient information in a convenient and mobile platform, while also providing a work surface and optional storage drawers that enable them to make fewer trips back and forth to the nursing station," explained Phil Smakula, national sales manager for IT Solutions, Lionville Systems Inc., Coatesville, PA.

In terms of investment, mobile workstations also provide more bang for the buck. Because computers can be moved where needed, facilities don’t have to purchase a computer for every room and a workstation for every user. They can invest in fewer devices, yet still benefit from flexibility and mobility, according to Keith Washington, vice president and general manager, Flo Healthcare, Norcross, GA. "In this sense, mobile workstations are the productivity-enhancing devices for the lowest cost of ownership."

Convenience and efficiencies aside, perhaps the biggest perk afforded by mobile workstations is that they allow the clinician to spend more time with the patient.

Nurses select nursing as a profession because they are passionate about providing care for patients, stressed Brad Blackwell, senior product manager for Mountain View, CA-based Omnicell Inc.

"Their highest satisfaction comes from direct time and care at the bedside, and patients feel the highest level of comfort and care when the nurse is with them. Finding efficient and effective workflows that can be performed at the bedside is crucial to improving a nurse’s ability to provide the highest quality patient care," Blackwell noted, adding that a well-designed mobile workstation meets a large number of those objectives.

Brains — and brawn

As the name implies, mobile workstations primarily center around computing. Depending upon the model – and a facility’s unique needs and budget — these workstations can support all software platforms and accommodate virtually any size and type of existing computer hardware (including barcode technology), or if preferred, can be outfitted with an integrated computer system and built-in network.

In terms of connectivity and integration capabilities, some mobile workstation "smart carts" are really living up to their name.

"The ability to add optional equipment [such as] vital signs [equipment] and data collection devices has become a regular expectation," Smakula noted. Lionville designs and engineers its carts for such integration.

With this added power and IT capabilities comes the need for better and longer-lasting power supplies. More and more, manufacturers are incorporating improved batteries and power supplies into their mobile workstations, allowing for longer run times and rapid recharging. Remote battery management software is also available to extend the life of a cart’s power system, pointed out Steve Reinecke, global director of healthcare, Ergotron Inc., Eagan, MN.

Patricia Moore, vice president of marketing and sales, CompuCaddy, Louisville, KY, explained the push for advanced power this way: "At the end of the day, if a [workstation] isn’t functional because its power supply fails it really doesn’t matter how many other features the cart has. A good, reliable power system is a must-have. CompuCaddy’s DC power design allows maximum computer runtime (between 8 and 24 hours depending on technology configuration, application, battery age, and usage pattern). The company’s X2 Power Option – for use with CompuCaddy’s X2 Series carts – implements a direct DC to DC connection, thereby omitting the need to invert the energy from the battery. This allows more efficient use of power when transitioning power from the battery to the computer.

Ergotron’s Styleview Cart

When comparing workstations and power capabilities, Omnicell’s Blackwell said customers should look for those that "provide wireless connectivity and come equipped with a battery that can last 12 hours" and recharge quickly. Beyond that, he said a nurse should also be able to easily change the battery without the use of tools.

Battery monitors, an option on many of today’s workstations, display real-time battery power status and remaining runtime, meaning clinicians won’t be left stranded. Omnicell’s BatteryPro, for example, even allows clinicians to configure alerts to sound when the charge dwindles to a preset percentage. Users can also set BatteryPro so that data will be saved if the system shuts down. "This is a big deal for someone who has just spent two hours documenting," Blackwell explained.

Facilities concerned about the environment will be pleased to learn that vendors are also stepping up with battery replacement and recycling programs to keep batteries out of the landfill. "Obviously, customers will have to replace their batteries at some point," said Jeff Chochinov, senior product manager for Rubbermaid Medical Solutions (RMS), Huntersville, NC. "We offer a battery swap-out program that allows customers to offload the recycling part to us."

Form meets function

These days, workstations manufacturers are providing power in other ways as well, most notably in terms of their products’ durability and improved construction.

Not surprisingly, customers are generally seeking smaller, more lightweight – yet sturdy – workstations that are easy to maneuver and flexible enough to accommodate a broad range of needs and upgrades.

"Several years ago, the average cart weighed 180 pounds and had an overall base of 21 by 21 inches," said Washington. Today, Flo Healthcare’s most popular workstation, the Flo 1750, weighs just over 100 pounds with a 17 by 17 inch base, he said, explaining that during this transformation, Flo’s displays have become bigger, its computers faster and with more memory, and its battery system more powerful. We have also added peripheral devices, such as printers, scanners, enabling devices, and storage.

Customers are also looking for workstations that are easy on the eyes, as well as a slew of ergonomic design elements. And the models on the market today deliver.

"Carts today have a sleek, pretty design that really appeals to today’s nursing staff," said Reinecke. "Advancements in ergonomic functionality, such as height adjustability and negative tilt keyboard trays, are now being incorporated into workstations."

One change CompuCaddy recently made was moving the handle from the side of the cart to the front. "This makes it easier and more comfortable to maneuver. We also offer sturdy, six-inch casters – the largest in the industry – to make it easier for clinicians to push the cart down the hallway," said Moore. A pull-out keyboard tray saves space and improves comfort, while a slide-through mouse pad tray accommodates both left- and right-handed clinicians.

Infection control is also catching on with mobile workstation manufacturers. CompuCaddy’s new Cynergy workstation, for example, features a new antimicrobial work surface, as well as an antimicrobial cord compartment that allows cords and wires to be tidily tucked away.

Mobile workstations are also offering unsurpassed flexibility and customization, allowing facilities to tailor the design and features to the unique needs of their end users – whether they’re used in admissions, the emergency department, operating room, at the bedside, and virtually everywhere in-between. Drawers and compartments that can house supplies come in a wide range of sizes and configurations, and can feature sturdy, tamper-resistant key- or combination-entry locks.

Understandably, carts that can blend computing and patient care delivery functions are gaining momentum. Workstations with medication storage and dispensing capabilities are a prime example. In April, RMS launched its Medication Expansion Pack for its M38 Mobile Computer Cart line, thereby creating a secure storage system that is essentially a hybrid of traditional computer and medication carts. Carts can be configured with two to six drawers. A patent-pending drawer system allows on-the-go customization for changing nurse-patient ratios (California legislation stipulates that patient to nurse ratios be limited at 5:1 or less).

"Our research shows there is a capacity and size gap between traditional computer and medication carts. One of the goals in creating this system was to eliminate that gap and provide a global platform that services any part of the hospital," Chochinov noted. Flexibility is key. Customers have the option of buying the M38 cart now, and then upgrading with the Expansion Pack in the future.

The Mobile Cart Solution by Omnicell comes with and without medication drawers (up to eight), and offers individual locking drawers, allowing for a nurse to be directed to the appropriate patient’s medication, explained Blackwell. Further, customers who purchase Omnicell’s Smart Mobile Cart Solution benefit from SafetyMed, a bedsite point-of-care software solution that’s integrated into the cart. "Customers using Omnicell’s Smart Mobile Cart Solution will often remove medications from existing Omnicell medication cabinets located on the nursing floor and then load them into patient-specific medication drawers on the mobile cart," he continued, adding that once at the patient’s bedside, a nurse can then scan the patient’s barcoded identification band, which will simultaneously unlock that patient’s medication drawer(s).

Omnicell’s SafetyMed solution,
extends medication safety solutions from automated medication dispensing systems to the patient’s bedside

What lies ahead?

While today’s mobile workstations are indeed sophisticated, vendors agreed that the industry has just begun to scratch the surface of advanced capabilities. In the future, look for workstations to allow for greater automation of repetitive tasks.

Having a workstation become a "partner" of the nurse is one possible future scenario, Blackwell said. He reasoned that a cart could automatically move to the first patient’s room where the nurse is going to need it.

"It would pleasantly and audibly let the nurse know it was time to perform an activity, such as medication administration. The software would then guide the nurse through the appropriate process and best practice, while allowing flexibility and human judgment whenever appropriate. The cart would then automatically move to the next room," envisioned Blackwell. Beyond that, mobile workstations of the future could also ensure that nurses complete all activities, know when new orders exist for patients, when lab specimens are to be obtained and when results are available.

Lionville’s Smakula predicts the market will see even more lightweight workstations (less than 100 pounds, including technology and power supply). Workstations that can integrate with the hospital’s software applications – including clinical and pharmacy data – are possibilities for the future, he explained, as is a battery or power system that can be recharged over a wireless or radio wave-type signal.

In the next ten years or so, Reinecke predicts that inputting of information by a caregiver will also start to disappear. "In the future, we will see more clinical information gathering integrated into the patient’s bed, medical equipment and room. These will monitor and record the information and activities that are taking place automatically."

Such high-level advancements aside, the adage of today – one size does not fit all – will be one that carries into the future. According to Washington, mobile workstations will probably always start with a common foundation, allowing every department and user in the hospital to configure a workstation to their own unique requirements.

"Although the hardware of future workstations will change very little, the software, systems and processes around data management will evolve," Washington explained. "For instance, we will see more Web-based applications, as well as increased visualization, where servers and data centers will handle applications more often than mobile devices, which will make devices more efficient and effective."