Advanced monitoring solutions keep caregivers, patients connected

A growing number of innovative patient monitoring and communication solutions have hit the market in recent years to help organizations do just that. Some of these technologies make it possible to proactively, yet silently track physiological trends and alert caregivers to potentially serious events while others rely on centralized telemetry monitoring, coupled with advanced communication solutions, to monitor and analyze patients’ vitals in real- or near-real-time, and initiate alerts to help caregivers address potential problems before they occur.

Implementing such solutions can pay big dividends. Not only can false (and loud) alarms be avoided, which makes better use of caregivers’ time and minimizes patient disruptions, the proactive, rather than reactive approach to monitoring can significantly reduce morbidity, mortality and length of stay by pinpointing problems early and initiating appropriate intervention sooner – all of which play a critical role in patient safety initiatives, sources told Healthcare Purchasing News.

Recognizing the value of piggybacking enhanced monitoring capabilities with existing medical devices, vendors are now offering healthcare customers a more robust and cost-effective solutions offering.

Covidien’s Respiratory and Monitoring Solutions business, for example, offers a broad portfolio of hospital respiratory products, such as mechanical ventilators, endotracheal tubes, tracheostomy tubes, and pulse oximetry monitoring. The vendor also recently introduced the Alarm Management System, a new software suite for the Nellcor OxiMax N-600x pulse oximeter.

"It identifies and alerts hospital staff to ongoing respiratory developments, such as worrisome patterns in patients’ oxygenation, thereby giving healthcare providers the ability to make early and more informed decision about the care of patients," said Chris Lowery, global vice president and general manager of Covidien’s patient monitoring division. The system enhances information provided by traditional pulse oximeters and supports efficient, comprehensive care of patients at risk for upper airway abnormalities, such as sleep apnea, asthma and COPD. Trending and alarm capabilities are other key advantages, Lowery pointed out.

"The majority of pulse oximeters only monitor heart rates and saturation in real-time. The Alarm Management System brings together two unique technologies, SatSeconds and OxiMax SPD, to continuously monitor for trends and alert clinicians to potentially worrisome oxygen desaturation patterns, while reducing nuisance alarms." The SatSeconds alarm management feature allows clinicians to define specific parameters for each patient, while the newly FDA-cleared OxiMax SPD alert uses a complex algorithm to provide notice of desaturation that is indicative of repetitive reductions in airflow in adults, Lowery further explained. Covidien also touts the system’s ease of use and value. Because the Alarm Management System works with hospital’s existing N-600x monitors and Nellcor sensors there’s no need to purchase new ones, and integration into existing, feature-rich equipment means there’s a shorter learning curve.

Telemetry is also taking off with gusto thanks to innovative, advanced solutions that marry centralized monitoring with comprehensive communication and data capturing technologies. The Philips VISICU eICU Program, for example, uses a blend of video, voice and data technologies to enable round the clock, remote monitoring of critical care patients. A blend of information, A/V, and broadband technologies aggregate data into one centralized monitoring system and generate Smart Alert Prompts to notify a dedicated team of critical care specialists of potential patient problems before they occur.

"The eICU Program is enabling new models for critical care delivery which leverage board-certified critical care physicians (intensivists) with advanced technologies to drive new standards of practice," Marty Doerfler, MD, Vice-President of Medical Affairs for Philips VISICU explained, adding that the close integration with clinical process and workflow is what differentiates programs like the eICU Program from conventional HIT to truly transform and improve patient care.

Some eICU customers have successfully used the Program to extend their services to remote hospitals within and beyond their traditional coverage areas. For Avera Health System in Sioux Falls, SD, the eICU Program is servicing 16 facilities across a 4-state area and has led to a 29% reduction in severity-adjusted mortality and a 46% reduction in severity-adjusted lengths of stay. The Program has also provided a safety net when severe weather strikes by allowing patients who are located a great distance from the nearest critical care facility to receive critical care at the local hospital, delaying or, in some cases, avoiding transfer to another facility for specialized care The results are compelling. Avera recently reported a 37.5 percent reduction in the number of patients requiring transfer, representing a cost savings of more than $1.2 million.

At Saint Luke’s Health System in Kansas City, MO, the eICU Program helped halve the organization’s ICU mortality rate, while also seeing a 18% drop in ICU length of stay. In Maine, where there’s an acute need for intensive care services because of its higher-than-average senior population, the eICU Program has helped expand healthcare access to rural residents. MaineHealth’s eICU Program, known as MaineHealth VitalNetwork, services 84 ICU beds at four MaineHealth hospitals and one non-affiliated hospital, and will soon be servicing four more regional hospitals with plans to continue expanding coverage across the state. Post-implementation data compiled by MaineHealth over a year’s time revealed a dramatically improved survival rate, which translated into an additional 60 lives saved in one year.

Among the most valuable technological advancements is the development of monitoring and communications solutions that streamline caregiver alerts, minimizing distractions that can impede the performance of nurses and impact the patient healing environment. Rather than sending blanket alarms to all nurses on a particular floor through a public address system, for example, today’s technologies can route individualized patient alerts to their assigned caregiver.

One example is the Emergin alert management and notification system, which aggregates alerts and events from multiple devices and systems, and then delivers the notifications directly to assigned caregivers through their preferred communication devices. If primary caregivers are unavailable, alerts are escalated. "This employs a cost-effective and efficient process for enabling hospitals to maintain responsiveness to patient alarms, while minimizing unnecessary disruptions and distractions for nurses, patients and patient families," noted Mike Breslow, MD, Philips VISICU vice president for clinical R&D.

The challenge with any of these technologies is the proper management of bandwidth usage and scalability to support multiple bedside devices. The lifeblood to these advanced technology solutions is the patient monitoring telemetry systems that communicate vital patient information. The Philips Intellivue Telemetry System, for example, uses advanced IntelliVue Smart-Hopping technology, originally developed for voice communications, to support up to 1,024 devices (telemetry or wireless monitors). These systems manage flows of time-critical patient monitoring data to integrated solutions like the Emergin and Philips VISICU systems.

Wireless platforms are also gaining momentum, making it possible for patients and staff to stay connected, regardless of their location in the facility. RF Technologies’ array of safety and security solutions are fully integrated and use the same software suite for data capture and reporting on combined reports. The company’s most recent product offerings operate on platforms that conform to IEEE standards (including the popular 802.11 WiFi and 802.15.2 ZigBee platforms). RF Technologies’ most recent product release is its Help Alert, a WiFi emergency call solution for use by hospital staff in duress situations. A press of the Help Alert e-call pendant notifies security staff of an emergency and informs them of the location of the event (even if the person in need of assistance).

"Help Alert uses existing WiFi infrastructures and permits system components to communicate with the network immediately upon activation," explained Kathie Vick, marketing manager, RF Technologies, Brookfield, WI.

RF Technologies employs the same wireless door security technology used in its Code Alert wander management solution for its Safe Place Hospital Security Solution, an infant and child abduction technology. As soon as a nurse applies a bracelet onto an infant or child’s ankle, the system provides immediate security. Also included in the vendor’s patient safety product portfolio is the Sensatec Fall Management Solution, which uses a weight sensing chair or bed sensor pad to monitor at-risk patients. The system provides audible and visual notification of the current unit status, and an optional nurse call adaptor links to an existing call system. The portable unit automatically resets when the person’s weight is reapplied. To further enhance the system’s capabilities, Advanced 3-Way Care adds incontinence detection and turning schedule reminders to the Sensatec solution.

San Jose, CA-based Vocera Communications Inc., enables wearable, hands-free communication over a wireless network. Vocera can be integrated with third-party alarm and alert systems, with integration allowing messages and calls to be delivered directly to the appropriate contact. Calls from the patient’s bedside notification system go directly to the primary care provider’s wearable Vocera badge and are delivered as text messages, which the caregiver can then read or play back as text-to-speech messages. Requests can also be set to escalate, as defined by the hospital. What’s more, Vocera’s instant voice communication capabilities allow caregivers to request assistance or consult with other departments and members of the care team, without ever leaving the patient’s side.

"It provides [caregivers] with an opportunity to stay with the patient, as opposed to running around the facility to find the necessary resources," explained Victoria Holl, director of marketing for Vocera Communications.

The Vocera System Software is the centralized command center for the Vocera Communications System, and allows users to call by name, by function or by group – all with a simple, touchless, verbal command (currently, there are more than 50 command capabilities). User independent speech recognition and biometric voiceprint verification provide quality and security safeguards.

Communication and response delays associated with a traditional paging system led Metro Detroit’s Beaumont Hospital to Vocera. With the previous paging system, an alarm was detected, validated and sent out to nurses, regardless of whether the alarm was related to one of their patients. Upon measuring response times of pager alarms, Beaumont discovered it was taking approximately 9½ minutes to close the loop of communication (from the time the page/alarm was sent to when a call back was received that acknowledged the alarm). The facility also discovered that these communication loops were only being closed 26% of the time.

"Paging is outdated and it provides only one-way communication," said Monique Brand, manager of Beaumont Hospital’s telemetry department. She pointed out that a number of factors can lead to communication gaps with pagers – from a dead battery or full memory to the simple fact that the caregiver may not have been wearing the pager at the time of the notification. "Even if the page was received, they would then have to find a phone to make a [return] call."

Beaumont chose to improve the communication process by seeking a system that would allow direct – and instant – communication with a caregiver via a telemetry device. The facility trialed Vocera and discovered that its communication loop was being closed in 100% of cases, with the alarm response time dropping to just 39 seconds. Another key benefit of the system, according to Brand, is that when the telemetry team detects a patient condition, it is able to effectively communicate adequate information about that condition directly to the caregiver.

"There are so many different levels [and degrees of severity] of certain conditions, and with a text pager you are [limited in the amount of information] that can be sent," said Brand, adding that because of this limitation the person receiving the page won’t always know the severity of the condition or the urgency of situation. With Vocera, Beaumont’s telemetry specialists can now instantly arm the caregiver assigned to that patient with the proper information, which improves response and delivery of care.

While the technology has led to significant communication and response improvements for Beaumont, Brand stressed that – like other technologies – implementation success is largely dependent upon standardization and widespread buy-in, and proper staff training. In the case of Vocera, a strong wireless infrastructure is also required, she said.

While significant improvements and ongoing success are indeed possible, as Beaumont Hospital has shown, Brand pointed out that complete process changes won’t happen overnight.

"It’s taken us years to replace our pagers."