"Many patients require monitoring but don’t require the one-to-one or one-to-two nurse-patient ratios of an ICU," said Gibson. "Consider the stroke patient that exhibits some arrhythmias. In the past, this patient would likely be transferred to an ICU/CCU bed because that’s where the monitors are. By bringing a monitor down to the stroke floor, this patient may be able to stay on the stroke floor, preserve the care map and not tie up an ICU/CCU bed. Accordingly, another patient that the hospital would have had to divert to some other institution, might now be admitted becuase the stroke patient didn’t tie up the ICU bed."

According to Gibson, flexible monitoring was a concept originated a decade ago with Massachusetts General Hospital. "They were experiencing an ever increasing demand for monitored beds and could not justify expansion in ICU beds. The idea was to be able to bring the monitor to the patient rather than move the patient to a monitored bed," said Gibson.

"Where we see the biggest challenge in the acute care setting is in the unmonitored areas of the hospital," he continued. "If you pulled 100 beds out of the hospital, whether it’s a 100-bed hospital or a 1,000-bed hospital, 80 percent of them are unmonitored. They may have some spot-check devices, but not continuous monitoring. On these floors, you have approximately 80 percent of the patients, but only about ten percent of the resources."

"Flexible monitoring is a way to be able to bring a monitoring safety net to a medical- surgical floor that never had continuous monitors before," he said.

Welch Allyn Propaq LT

Welch Allyn recently introduced its Propaq LT. A lightweight monitor weighing less than two pounds, the Propaq LT was designed to travel with the patient, serving as an ambulatory, transport and bedside monitor in one.

Gibson said the new portable monitor was designed to help alleviate two major barriers to implementing flexible monitoring: Cost and the complexity of operation typically associated with critical care monitors.

At just under $4,000, compared to an average starting cost of $7,000 for the typical portable crtical care monitor, the Propaq LT provides a manageable option for bringing continuous monitoring to more floors of the hospital. Since the portable monitor can easily transfer from room to room as patients convalesce, a 35-bed stroke floor could conceivably get by with around six to eight monitors that float between beds to cover the entire floor, said Gibson. In addition, the new monitor is designed to be intuitively easy to use even for per-diems, temps or floater nurses, with pre-configured settings that can be customized to the individual facility according to the nuances of the floor and the competency level of the nurses. For example, minimizing waveform data for med-surg floor nurses, or setting the monitor to dim quickly on pediatric floors to keep parents from fixating on the screen.

Telemetry, wireless solutions take the lead
Centralized monitoring, in which several beds can be monitored from a central location, also facilitates a flexible monitoring environment. And one way to achieve centralized monitoring is though telemetry in a wireless environment. Traditional telemetry involves a blind telemetry transmitter worn around a patient’s neck that transmits data to a monitor in the central nursing station. Today, companies are moving towards solutions that bring more information to the bedside, that integrate with clinical systems, and offer standardization across entire facilities. The idea is to bring critical information to the caregiver when and where it’s needed.

LifeSnyc, GMP Wireless Medicine

Draeger Medical (Teleford, PA), provides true "plug-and-play" or as they coin the phrase, "Pick and Go" capabilities through its Infinity Docking Station which works with all Draeger monitors. When a monitor is placed on the Docking Station it automatically assumes the settings appropriate for that specific care area. The system supports a flexible monitoring environment in that one monitor can be brought to any patient, any place, any time, maintaining continuous monitoring even during transport. When unplugged from the Docking Station, the monitor automatically becomes wireless, and when placed back on the docking station, it automatically downloads the most current patient data.

Through a partnership with Cisco Systems, Draeger recently introduced its Infinity OneNet technology that allows all patient monitoring, both wired and wireless, and hospital applications to operate over one secure network.

Bringing technical support and clinical education to new levels, Draeger has partnered with the Intensive Care On-Line Network (ICON) and its staff of clinical specialists and IT technicians. Using web-enabled cameras and monitors, ICON’s staff provides real-time, interactive clinical education and technical support. Clinicians at the hospital and ICON staff can see each other, share charts, waveforms, DICOM images, and other patient data over a remote network.

Phillips Medical Systems (Andover, MA) recently introduced its new IntelliVue Telemetry System that improves upon its previous telemetry solution by using the industry standard 1.4 GHz Wireless Medical Telemetry Services (WMTS) band, a protected, licensed spectrum reserved for medical devices. The 1.4 GHz common wireless infrastructure can cover the entire facility, so that patients can be monitored anywhere in the hospital, from any information center. The system even allows for exporting of waveforms to an information system. A smart-hopping feature seeks out strongest available signals for seamless data integration as patients roam the hospital. The system enables scalable, flexible monitoring across Philips low-acuity IntelliVue MP20 and MP30, and mid-range IntelliVue MP40 and MP50 monitors.

The IntelliVue Telemetry system also includes a device location feature. David Russell, vice president global marketing, patient monitoring for Philips Medical Systems, estimates that facilities lose and replace 10 to 15 percent of patient-worn devices each year.

The Philips telemetry devices use AA batteries instead of 9-volt. In a 20-bed telemetry unit at 80-percent occupancy where batteries are changed every 36 hours, using AA batteries instead of 9V batteries could save the unit up to 50 percent in battery expenses, said Russell.

GE Healthcare (Waukesha, WI) offers monitors that span the entire care continuum that can all be connected together via the company’s Unity Network. The system offers a real-time patient monitoring network that can share data with any HL-7 based clinical system. GE’s new Aware Gateway is a single-server solution for inbound and outbound HL-7 data to and from the Unity Network. Aware includes a back collection feature that allows the system to store eight hours of data if the primary clinical system is unavailable. Using the new Aware iPanel, clinicians can, with a single click, pull the patient ID from the monitor and retrieve lab, imaging or any other clinical information and display it in a web-browser.

"The new Aware iPanel is a one-click information access solution," said Patti Brenton, marketing manager, GE Healthcare Technologies. "It’s patient-centric data at the bedside or in transport without the hassle of having to search for it manually."

GE Healthcare’s telemetry solutions also operate on the WMTS network. Speaking to the future of wireless applications, Brenton said GE is looking at wireless security and is "engineering solutions that use encryption, authentication, and quality of service to provide the most reliable and protected data stream."

GE has also built features into its monitoring system that make them easy for nurses to use. "Many of the most common features nurses and telemetry technicians need to do from our CIC Pro central station can be performed in three clicks or less," said Brenton.

Edwards Lifesciences FloTrac & Vigileo Monitor

Datascope Corp. (Montvale, NJ) provides seamless sharing of information between care units through its new Panorama Patient Monitoring Network. The Panorama Network supports a flexible monitoring environment by meeting step-down, emergency and critical care applications in one wireless system, matching the right monitor to each patient’s acuity level in a protected wireless network.

Monitoring systems from Spacelabs Medical (Issaquah, WA) use WinDNA technology to bring charting, labs, radiology, as well as HIS and Internet applications directly to the monitor. Working from a thin client server, the Spacelabs system doesn’t require additional computers or displays. The company’s Intesys Clinical Suite (ICS) provides time-saving tools to support workflow and improve clinical practice. For example, a Vital Signs Viewer feature allows physicians to view live waveforms from any networked PC, even from home.

Spacelabs also offers bar code scanning capabilities. When used in conjunction with WinDNA, it automates data entry into clinical applications, such as lab and pharmacy orders.

Modularity across the entire Spacelabs product line allows for easy adaptivity according to the patient’s acuity level and contributes to a flexible monitoring environment. A Data Shuttle feature creates a complete, seamless record during transport without having to re-cable the patient. A VCCR feature allows clinicians to View, Control, Review and Record patient information for any remote bed from the monitor of another patient without leaving the patient at hand. "Clinicians can stay with their most critical patients while accessing and reviewing information or alarms for other patients simultaneously, saving valuable time," said Dorothy Marshall, marketing communications manager, Spacelabs Medical.

Through a partnership with Emergin, Spacelabs also offers alarm paging that can be directed to any communication device, including pagers, cell phones, nurse call systems and PDAs. Optimizing alarm response is another requirement of the Universal Unit.

Adding new meaning to the word "wireless", the LifeSync Wireless ECG System from GMP Wireless Medicine (Fort Lauderdale, FL) converts hardwired bedside-, 12-lead-, and transport monitors to wireless technology, while un-tethering the patient from the monitor. The system consists of a monitor transceiver, patient transceiver and a LeadWear disposable cable replacement system. The monitor transceiver attaches on or near an existing ECG monitor via standard ECG lead wires and receives patient data wirelessly from the patient transceiver. The patient transceiver picks up patient data to send to the monitor transceiver via the disposable LeadWear system that is attached to existing electrodes.

"The system changes the way in which the monitor gets information, it doesn’t change the function of existing bedside monitors," explained Lana Urban, director of marketing, GMP Wireless Medicine.

By eliminating trunk cables and lead wires, LifeSync allows patients to ambulate up to 30 feet away from the monitor without risk of tripping or falling over wires, meaning the monitored patient no longer has to call for the nurse to use the restroom or move to a chair, for example.

The elimination of reusable lead wires on the patient also provides a significant infection control risk. A study published in the March 2004 issue of Cardiology News and led by Dr. Paul R. Brookmeyer, cultured 100 randomly selected ECG telemetry leads after they had been reprocessed and immediately before their planned attachment to new ICU patients. Brookmeyer’s team found that 77 percent of the ECG leads were contaminated with one or more antibiotic-resistant nosocomial pathogens. "With LifeSync, patients no longer have to be subjected to that potential source of infection," said Urban.

Another benefit of the LifeSync system can be measured in nursing time. When transporting patients, nurses don’t have to attach and re-attach lead wires from the patient; they simply move the patient data signal from one monitor to another. In addition, because patients are not tugging on wires as they move around, there’s less of a chance for leads to pop off and trigger a false alarm. Finally, nurses can save time cleaning leading lead wires. All totaled, in a "Benefits Analysis of Wireless ECG" performed by The Lewin Group, potential savings in nursing time was estimated at close to 3 hours per AMI and CABG patient stay.

Urban noted that the LifeSync system can help support three JCAHO guidelines, including: "Improve the effectiveness of clinical information systems" (by reducing false alarms); "Reduce the risk of healthcare acquired infections"; and "Reduce the risk of patient harm resulting from falls."

What it boils down to is: "How does a healthcare provider become more compliant with less money and fewer highly skilled clinicians caring for more and more sicker patients?" HPN