Days of tethered and isolated "spot-check" monitoring are becoming a thing of the past. Not only are hospitals adopting state-of-the-art solutions that are mobile, flexible and able to be integrated into existing information systems, they are also looking to improve efficiencies and enhance care decision-making at the bedside and beyond.

Such technological pursuits are understandable given the range of challenges and requirements facing healthcare organizations today, explained one monitoring solutions provider.

"We are hearing from hospitals that the patients ending up in the Intensive Care Unit today are sicker, with higher levels of acuity, and there is a shortage of healthcare workers, especially nurses. And then there are the regulatory demands and quality requirements. All of these factors are making it more essential to have real clinical intelligence solutions in place," reasoned Derek Wagner, chief marketing officer for GE Healthcare, Monitoring Solutions and Diagnostic Cardiology in Milwaukee, WI.

"On a monitor, that means not just having the real-time clinical information available, but also being able to pull lab studies, patient demographics and prior X-rays, foar example, from the hospital’s Picture Archiving and Communication System (PACS)," he said. "It’s about pulling all these different flows of data together at the right place and at the right time, for the caregiver." Beyond that, it’s about being able to put information back into the system at the bedside, which helps create a complete medical record and close the loop in terms of patient care, Wagner added.

Certainly, marrying all these capabilities is no easy undertaking. But manufacturers of patient monitoring solutions are making these goals a reality – and in doing so, are significantly changing the face of patient care, sources told Healthcare Purchasing News.

"Today, patient monitors are the single most important component of a medical facility’s equipment arsenal and an integral part of healthcare information systems," confirmed Michael O’Reilly, M.D., executive vice president of medical affairs, Masimo Corp., Irvine, CA. "Being aware of what is currently available in patient monitoring technologies and understanding how these advances promote improved patient care and reduce the costs of care is critical for facilities to maximize their technology investment in the long-run."

Masimo Patient SafetyNet Remote Monitoring and Clinician Notification System allows noninvasive, continuous remote monitoring of up to 80 patients on four separate floors.

The GE Healthcare CARESCAPE Monitor B850, for example, is a high-acuity monitor that can be used in different departments, and given the customized format, it can be easily configured. The CARESCAPE Monitor B850 allows caregivers to input information into the patient record and when combined with CARESCAPE Mobile Viewers, caregivers can access the data not just at the bedside, but other parts of the facility and even outside the hospital. GE Healthcare’s strategy, called Clinical Information Logistics, helps make such high-level monitoring possible by pulling into one monitor the clinical information from the patient, as well as information from the hospital’s other information systems. "The idea is if you combine all this information in one point – clinical, labs, PACS, the electronic medical record and so on – you’re going to provide better clinical support and faster decision-making for the patient’s care," said Wagner.

Monitoring more patients while simultaneously providing a centralized station to view multiple patients is also key, Bartlett explained, adding that such a capability increases vigilance within the hospital without placing additional strain on caregivers who are already dealing with increased patient-clinician ratios.

The portability and flexibility trend is helping reshape patient care in a number of ways. Not only does it allow for convenient, space-saving patient monitoring in previously unmonitored areas, it also ensures that patients can be comprehensively monitored during transport, which is one of the most vulnerable times for patients, according to Patricia McGaffigan, director, critical care, Philips Healthcare, Andover, MA.

"Our latest patient monitors are designed to be more flexible and portable, and are able to maintain continuity of patient monitoring and patient data," she said. The IntelliVue MP2 is a lightweight, flexible, wireless transport monitor designed for transport of patients and for comprehensive monitoring of lower-acuity patients. It can be connected to the IntelliVue XDS large display to add a higher resolution bedside display. It’s also a measurement module, offering continuity of patient data and seamless transport across all levels of patient monitoring. Philips’ SureSigns patient monitors also offer a range of options for flexible care, including a portable bedside monitor, compact patient monitor and vital signs monitor.

More healthcare organizations are now tapping the benefits of a wireless infrastructure, Pishal confirmed. That gravitation can, in great part, be credited to the more widespread adoption of healthcare information systems and electronic medical record requirements.

Improvements and new developments surrounding wireless technology and bandwidth is also helping to overcome some of the wireless-related challenges of the past – particularly concerns that other devices might interfere with a hospital’s wireless network.

Vendors are also working hard to help hospitals integrate all their different wireless devices that are trying to connect to hospital information system. Vendors are also working hard to help hospitals integrate all their different wireless devices that are trying to connect to the hospital information system. "A common theme across the U.S. and the world is how to tie all these together on one platform and work seamlessly," said Wagner. One of GE Healthcare’s solutions has been partnering with Sprint on integrated wireless infrastructure products, including CARESCAPE Enterprise Access.

"Today’s real-time noninvasive technologies offer safer, faster measurement alternatives that virtually eliminate the delays and infection risks associated with invasive measurement procedures," said O’Reilly.

"These evolutions have had a measurable impact on patient safety," he said. "For example, the rise and success of rapid response or medical emergency teams has been aided by the low-cost remote monitors now present on many general care and post-surgical floors."

Another example, he pointed out, is the growth of noninvasive brain function monitoring during surgery and the improved patient outcomes associated with delivering the precise level of anesthetic to a patient during surgery. Covidien’s BIS technology brain function monitors provide a bilateral view of brain activity, and provide the clinician with richer reporting and analysis to assess a patient’s condition under anesthesia.

Interoperability, connectivity and compatibility are also at the heart of today’s advanced monitoring solutions, allowing facilities to make the most of their capital dollars, while also maximizing efficiencies.

"We recognize that customers can’t simply keep stacking monitors in already cramped spaces. That’s why we’ve partnered with all major multi-parameter [monitor] manufacturers to ensure our technology is available in their latest offerings, and designed sensors to be as widely compatible with older generations of equipment as possible," said Bartlett.

Upgradeability is also becoming a greater priority for hospitals and vendors. Customers need to know whether the monitor they are purchasing has the capability to be upgraded when new functionalities or sensors are released, Bartlett added.

Standardization and compatibility with other manufacturers’ equipment is also becoming more of a priority. Welch Allyn’s FlexiPort blood pressure cuffs, for example, are the first cuffs designed to work with devices in any patient care area. The cuffs connect to virtually any manual or electronic blood pressure device (not just Welch Allyn’s), so patients can be freely moved from room to room, floor to floor and department to department without forcing clinicians to find new cuffs for each different device. When a facility standardizes with FlexiPort cuffs, they attach FlexiPort fittings to every device tube they have in-house. The fittings can snap directly into the FlexiPort connection to eliminate traditional tubes and connectors from their cuffs. Standardization with FlexiPort blood pressure cuffs can reduce the typical hospital’s cuff part numbers by up to 60 percent, Welch Allyn reports, which means a significant reduction in inventory. Further, allowing the cuffs to stay with the patient throughout their stay cuts the risk of infection, noted Quatier.

Today’s monitors are pushing beyond their past capabilities and offering a number of "smart" features that can increase accuracy and reliability, improve caregiver communication and minimize false alarms, and, above all, allow caregivers to detect potential problems or warning signs earlier.

"If deterioration is occurring, we can now use equipment to detect that at its earliest point," said Quatier. Welch Allyn’s Clinician Notifier offers patient assigning, alarms (including those to back-up staff), views of live, real-time patient waveforms from Welch Allyn monitors, and more. This technology interfaces with the Welch Allyn Acuity Central Station via the Welch Allyn Connectivity Server. The system can be configured to distribute only specific types of alarms and customize alarm hold-offs between each level of escalation. Alarms are automatically escalated when the team is unable to respond and alarms can be suspected at the Acuity Central Station and at the bedside via a handheld device.

Philips Patient Monitoring Gateway extends the functionality of Philips’ patient monitoring systems by delivering automated, complementary event notification directly to clinical staff. Bedside and telemetry alarm messages can be routed to the appropriate caregiver (via pagers, wireless phones, voice communication badges, computers, and marquees), providing staff with alerts related to critical and non-critical alarms and events.

With Philips’ eICU Program, the eICU care team uses software prompts to track patient vital trends and intervene earlier – before complications occur. "Studies show that this type of care model can reduce ICU mortality by 25 percent, and save costs," added McGaffigan. The Philips ProtocolWatch Sepsis is also available on many of the manufacturer’s monitors. An "advanced CDS solution" that is based on the internationally-accepted Surviving Sepsis Campaign guidelines, ProtocolWatch Sepsis enables customers to step through the guidelines for sepsis screening, resuscitation and management in a more efficient and timely manner. Another advanced clinical decision support solution is the ST Map offering, which provides a visual display of the size and location of ischemic heart activity.

"By observing the size and changing patterns of ST Map over time, clinicians can determine whether a patient’s condition is improving or worsening," explained McGaffigan.

The Masimo Patient SafetyNet Remote Monitoring and Clinician Notification System combines the performance of Masimo SET pulse oximetry and the blood constituent monitoring capabilities of Masimo Rainbow SET Pulse CO-Oximetry with respiration rate monitoring and wireless clinician notification via pager to safely monitor up to 80 patients on four separate floors. Masimo’s SET pulse oximetry has been shown to reduce false alarms by 95 percent, while increasing the detection of "true" physiological events that demand caregiver attention.

Patient SafetyNet allows clinicians to noninvasively, continuously and remotely monitor multiple physiological parameters and have changes that signal early patient distress or deterioration automatically sent via pager to a qualified caregiver. "This is particularly important for post-surgical patients who are at increased risk of injury or death resulting from the respiratory depression effects of medication used for sedation and pain management," O’Reilly added.

Masimo’s newest patient monitor, the Masimo Rad-87 Pulse CO-Oximeter, is a bedside monitors that maximizes mobility with a built-in radio for wireless communication with the Masimo Patient SafetyNet. The Rad-87 features Masimo’s Rainbow SET Pulse CO-Oximetry technology to noninvasively and continuously measure nine vital physiological measurements.

Covidien’s latest pulse oximetry monitor includes an Alarm Management System, which reduces nuisance alarms that Bartlett said can lead to "alarm fatigue" among caregivers. It also delivers early warning that patients may be experiencing repetitive reductions in airflow, thereby alerting the clinician before the condition becomes a serious desaturation.

"In the past, the alarm would only sound once a patient had crossed a desaturation limit," he noted. "This new monitor allows a clinician to know sooner and act faster." Additionally, Covidien now distributes the LiDCO Rapid Advanced Hemodynamic Monitoring System, which helps clinicians optimize fluid management and provides a prompt indication of hemodynamic change.

Even bigger changes are on the horizon, sources assured. Body sensor networks – the miniaturization of monitoring devices so they are wearable and wireless – is one advancement that will likely be available in the coming years, according to Wagner.

"The idea is that you can monitor a number of different parameters with small wireless devices and that information can be transmitted wirelessly and captured by a small nearby receiver in or even outside the hospital," he explained. For that to occur, wireless radio spectrum without much interference from other devices will be required (last summer, in response to a GE petition, the FCC took the first step to allocate this spectrum issuing a notice of proposed rulemaking on medical body area networks, or MBANs, and Wagner said an FCC decision is expected by next year).Once the spectrum is allocated, the wireless, patient-worn technology will be developed. "A number of companies, including GE, are working in this area."

Hospitals can look for smaller, palm-sized devices that wirelessly connect clinicians to their patient’s real-time clinical data, predicted O’Reilly. "In the same vein, we see a future for intuitive technologies in patient monitors. Technologies that ‘sense’ when a clinician is in the room and automatically adjust the patient monitor to display the measurements and data they need to see have the potential to increase clinical efficiencies and improve patient care."

Algorithms will become smarter and more predictive, allowing for more patient-specific care. Further, linkages between monitoring and therapy will allow for more timely decisions and interventions, added McGaffigan.