At first glance, one of the most obvious areas of change in patient monitors is size, due to the move from cathode ray tubes (CRTs) to liquid crystal display (LCD) screens. Kile Jackson, regional service manager, Modern Medical Systems Co., Kirkland, WA, noted: "Just in the past 5 to 8 years, we have seen monitoring move from large-frame CRTs with heavy metal cabinets to modular, light-weight, LCD-screened polymer cases."

Other changes in recent history, according to Michael Hubbard, RN, BA, market manager, Smiths Medical PM, Inc., Waukesha, WI, include "emergence of electronic medical records, increasing demand for wireless solutions, and increased competition from Asia." These changes have fueled a demand for compactness, portability, and communication between devices, he continued.

Standardization is another big difference in patient monitoring then and now, said Steven Kennimer, RN, regional category specialist, monitoring, Welch Allyn, Skaneateles Falls, NY: "Hospitals are more frequently standardizing equipment to one monitoring vendor across patient-care areas. Usually this is a top-down standardization, which means it’s very ICU-centric." Another advantage of standardization of patient monitors in a facility, pointed out Kennimer, is that it "makes it easier for biomed professionals to care for equipment."

Kile Jackson, RSM, Modern Medical Systems, with a Philips MP70 Bedside Monitor

The nursing shortage has been a point of concern in the healthcare industry for quite some time. Kennimer explained how the shortage of nurses related to a need for advances in patient monitors: "Nursing schools are trying to push more students through programs to fill the gaps left by retiring nurses or those who have moved into other career paths. This means nursing managers typically want equipment to be very easy to use and intuitive."

Kennimer also noted that there is a need for patient monitors to be "flexible, mobile, and smaller, for certain, but remote monitoring, particularly from home, is certainly gaining momentum." Offering further insight as to what has led to these changes in patient monitors, Kennimer said: "This has been fueled by the migration of care into lower acuity settings and the need for caregivers to do more with less, given staff shortages and advancements in technology."

Donna Ford-Serbu, vice president, product marketing, patient monitoring, Covidien Respiratory and Monitoring Solutions, Boulder, CO, offered other reasons that are fueling changes in patient monitors. "One is an aging demographic, with sicker patients being taken care of in lower acuity settings. This translates to a need for better technologies to monitor poorly perfused patients with easy-to-use tools. Another reason is that there are fewer and less-skilled clinicians in the lower acuity setting. This led to a need for remote monitoring systems that can consolidate multiple patient monitors’ outputs for observation by a central station within the hospital. This helps mitigate the risk of alarms going unheard at the bedside due to short staffing levels," said Ford-Serbu. "Hospitals need to achieve positive outcomes and mitigate risk."

Patient monitors’ purpose is to enable the needs of patients, nurses, anesthesiologists, and surgeons to be better and more efficiently met. Monitors now go beyond just signaling that a dangerous situation has developed; they can warn against developing problems, facilitating earlier intervention, possibly warding off a situation before it becomes critical. Being aware of what is currently available in patient monitors and understanding how these advances promote improved patient care is important knowledge for those looking over these new products. The experts had good advice on capabilities and features purchasers should look for in patient monitors.

"Monitoring that is smaller, lighter, wireless, portable, and networkable is the product that will get nursing and administration excited," said Jackson. Modern Medical Systems repairs patient monitors. Jackson works in-house at a hospital that chose Philips Healthcare (Andover, MA) monitors. Jackson described Philips’ monitors as lightweight and offering a choice from a larger number of module options. "We have moved house-wide to the Philips line of monitoring. This allows us to have patient info available in every department the patient may visit. Philips interfaced easily with the hospital information system and, with electronic charting, incidence of patient-
history problems is now a non-issue."

Kennimer, Welch Allyn, suggested looking for parameters that meet department-specific needs; reliability and accuracy; trending; long battery life; ease of use; durability and ruggedness; versatility; and service and training support supplied by the vendor.

Welch Allyn’s Propaq CS offers parameters needed by most hospital departments; it is rugged, being able to withstand a 4- to 5-foot drop; and it has a battery life of up to 5 hours. The Propaq LT also offers parameters needed by most departments, particularly the medical-surgical and emergency departments; it’s small, about the size of a paperback book, making it easy to transport, easy to store, and easy to deploy when census is high; it can withstand a 6-foot drop; has a battery life of up to 24 hours; is versatile, because it can act as a continuous bedside monitor, transport monitor, or a spot-check device; has camcorder-style navigation with up to three display views for patient data; has a wireless connection to the acuity central monitoring station; a USB port allowing for 8.5"x 11" printouts of tabular trends and waveforms, as well as configuration using the Propaq LT PC-based configuration tool; and, it can store up to twenty 21-second ECG snapshots and 24 hours of numeric and graphical trends.

Hubbard, Smiths Medical, also mentioned the importance of customer and product support, versatility in functionality, and a wide choice of parameters as desirable features. He also suggested looking for ease of use; economical accessories, especially disposables; and low maintenance. "We offer a wide range of products that are suitable for various clinical environments, allowing the users to choose only those functions they need. We also provide rapid turn-around times for technical service needs."

Safety, efficaciousness, and efficiency were highlighted by Ford-Serbu, Covidien. She suggested investigating answers to these questions when shopping around. Regarding safety: "Is it accurate? Is it reliable? Is it backed by independent clinical data to support its claims? Does it provide the capability to capture a reading on a patient that has low perfusion or delicate skin?" Regarding efficaciousness: "Does it have the alarm-management strategy that fits your hospital’s needs, minimizing alarm fatigue or nuance alarms so that clinicians are responding to real events? Is it integrated?" Regarding efficiency: "[Is there] standardization throughout the hospital to ensure proper training and use, and to capitalize on the financial benefits of being standardized? Do the sensors used by the monitors interface with other monitors in the hospital, to allow for the widest use without having to employ a different sensor?"

"Covidien Nellcor monitors provide clinicians, caregivers, and other decision makers with the tools that enable them to achieve positive outcomes in an environment in which patients’ health conditions are increasingly acute and perfusion increasingly poor, requirements for patient care are greater, and medical professionals are asked to do more," said Ford-Serbu. "Covidien patient-monitoring solutions help improve medical efficacy because they allow clinicians to intervene earlier. Our patient-monitoring solutions provide patient data in ways that help clinicians to make informed decisions earlier by providing readings that are easy to analyze and communicate; identifying potentially harmful patterns of desaturation in adult patients, in addition to providing SpO2 values; monitoring patients remotely; and reducing alarms that are less clinically significant. Covidien patient-monitoring solutions help improve healthcare efficiency because they are reliable, contribute to productivity, and are cost-effective. Nurses can do more with less because they have access to a monitor, preferably with central-station capability, that will proactively notify them of a potential physiological condition indicative of a respiratory event."

Smiths Medical’s Advisor multiparameter monitor measures ECG, heart rate, non-invasive blood pressure, and oxygen saturation

A look toward the future

Whereas companies often are reluctant to admit to the particulars of what they have up their sleeve as far as new or improved products on the horizon are concerned, some will offer predictions in general. Hubbard, Smiths Medical, believes we can look forward to increased use of "electronic medical and health records, increased demand for wireless solutions, and communication between medical devices."

Jackson, Modern Medical, thinks "smaller, lighter, multidepartment use of wireless monitoring is coming. As the cost of purchase comes down, I could see where a monitor is placed on the patient at admission and travels with them for the duration of the stay."

Ford-Serbu, Covidien, expects to see more predictive and interpretive data analytics to support clinicians. Some other areas in which monitoring equipment is headed were outlined by Ford-Serbu: "Multiparameter systems with modular and more parameters in the higher acuity settings are being pushed into other areas of care within the hospital, such as the general-care floor and post-surgical areas." She also mentioned "connectivity of the monitor to central stations so that more patients can be monitored by fewer clinicians . . . also, data integration into other software applications such as the electronic medical records, or even decision-support software, so that the data captured by a monitor can be stored with the patient’s record."

"Our primary focus," continued Ford-Serbu "is to ensure appropriate oxygenation. We do that by monitoring the cardio-respiratory cycle and will look to introduce new technologies and parameters that allow for monitoring of patients, data capture, and integration into the critical applications the hospital uses to manage the patient’s care. As for new developments, our goals are twofold: (1) to extract additional, relevant clinical data out of the current oximetry signal in ways that can give clinicians additional insight into a patient’s evolving condition. Our recent launch of the Alarm Management System with OxiMax Saturation Pattern Detection is a good example. By using this tool, clinicians can be alerted to patterns of desaturation that are indicative of repetitive reductions in airflow, even if the alarms do not cross the threshold traditionally recognized on the monitor. In this way, clinicians can potentially get early warning of repetitive reductions in airflow that could signal a worsening patient condition; (2) to develop new, clinically relevant, non-invasive parameters."

In conclusion, Jackson, Modern Medical Systems, said: "Optionalized modules, wireless technology, network protocol, and the big advances in available software options has made patient monitoring a much safer environment."