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         Clinical intelligence for supply chain leadership

INSIDE THE CURRENT ISSUE

May 2007

Operating Room

Outpatient Connection

HealthGrades study shows hospital errors rise 3 percent

Patient safety incidents at the nation’s hospitals rose three percent over the years 2003 to 2005, but the nation’s top-performing hospitals had a 40 percent lower rate of medical errors when compared with the poorest-performing hospitals, according to the largest annual study of patient-safety issued by HealthGrades, an independent healthcare ratings company.

The HealthGrades study of 40.56 million Medicare hospitalization records over the years 2003 to 2005 found: Patient-safety incidents continue to rise in American hospitals, with 1.16 million preventable patient-safety incidents occurring over the three years studied among Medicare patients in the nation’s hospitals, an incidence rate of 2.86 percent; 247,662 deaths were potentially preventable over the three years, and Medicare patients who had one or more patient-safety incidents had a one-in-four chance of dying; The excess cost to hospitals was $8.6 billion over three years, with some of the most common incidents proving to be the most costly; Ten of the 16 patient-safety incidents tracked worsened from 2003 to 2005, by an average of almost 12 percent, while seven incidents improved, on average, by six percent. Patient-safety incidents with the greatest increase in incident rates were post operative sepsis (34.28 percent), post-operative respiratory failure (18.70 percent) and selected infections due to medical care (12.23 percent); and Patient-safety incidents with the highest incidence rates were decubitus ulcer, failure to rescue and post-operative respiratory failure.

Of the nearly 5,000 hospitals studied, the HealthGrades study identified 242 hospitals, those in the top five percent of all hospitals, to serve as a benchmark against which other hospitals can be evaluated, naming them Distinguished Hospitals for Patient Safety. On average, these hospitals had a 40 percent lower rate of patient-safety incidents when compared with the poorest-performing hospitals. If all hospitals performed at the level of the Distinguished Hospitals for Patient Safety, the study found: Approximately 206,286 patient-safety
incidents and 34,393 Medicare deaths could have been avoided; and $1.74 billion could have been saved. For more information see www. healthgrades.com

Monitors flex their muscles, hospitals reap rewards

by Julie E. Williamson

Patient monitors are garnering a great deal of attention these days. And for good reason. Not only are they among the most vital and relied upon pieces of medical equipment, serving as an invaluable watchful eye over critical physiological parameters, they serve the important function of alerting caregivers to potentially life-threatening complications and failures.

Of course, there’s far more to the monitoring buzz than just the audible alarms these devices emit and the data they deliver. These days, all eyes are on so-called flexible monitoring technologies, which offer increased portability, durability, reliability and, well, flexibility.

The Masimo Radical-7 bedside monitor is capable of continuously and noninvasively measuring carboxyhemoglobin (SpCOTM) and methemoglobin (SpMetTM), in addition to oxyhemoglobin (SpO2), perfusion index (PI),
pleth variability index (PVI) and pulse rate.

Even the term itself can be somewhat flexible. Some monitor manufacturers prefer the term general floor monitoring, while others prefer telemetry monitoring or some other label. Whatever the case, the modern definition is generally the same.

"It’s having the ability to supply the hospital with the monitoring solutions it needs to provide vital signs monitoring wherever and whenever the patient needs it, and ideally, in the lowest cost setting," explained Stephanie Musho, market manager, acute care monitoring, Welch Allyn Inc., Skaneateles Falls, NY.

Put simply, it’s about bringing the monitor to the patient, as opposed to bringing the patient to a monitored bed. From there, the functions and capabilities are less black and white, with the levels of flexibility dependant upon the hospital’s own unique needs and infrastructure set-up.

"Some monitors are considered flexible because they are smaller and more portable, which allows them to move around more easily. Other monitors are capable of connecting and synchronizing with the hospital network," tying into the IT infrastructure and clinical information systems to allow data to be easily passed from the bedside to the clinician, Mike Arani, patient monitoring market analyst for Palo Alto, CA-based Frost & Sullivan, told Healthcare Purchasing News. "These two [capabilities] don’t always come together, but that appears to be the way technology is going in the industry."

While some facilities have yet to adopt flexible monitoring technology on a broader scale, sources agreed that the technology will become increasingly attractive as facilities strive to boost clinical decision support, increase patient satisfaction, reduce costs, and tap the far-reaching benefits associated with continuous patient monitoring.


GE CIC Pro Central Station

 

Buying into benefits

Although budgetary concerns continue to weigh heavily on most healthcare organizations, hospital executives may quickly find that flexible monitoring solutions are a wise – and necessary — investment.

For starters, flexible monitoring technology can enable caregivers to continuously monitor patients in lower-acuity areas, thereby reducing transfers between departments, freeing up limited ICU beds to those who truly need them, and reducing length of stay. Having the ability to effectively monitor more patients in areas such as the emergency department can also help reduce patient diversions to other hospitals due to overcrowding. Another key advantage of flexible monitoring is its ability to allow nurses to work more efficiently, without having to worry about leaving a patient or monitor unattended.

A study conducted by Christiana Care Health System in Wilmington, DE, supported the notion that flexible monitoring leads to improved outcomes and healthcare worker satisfaction. In the 2003 study, Flexible Monitoring for Better Patient Outcomes, author Maureen A. Seckel, APN, imagined a scenario where a patient had returned to an orthopedic unit following a total knee replacement and soon developed a new onset of an arrhythmia, which, per hospital policy, required the patient be moved to a telemetry unit. Although the telemetry nurses were skilled in cardiac monitoring and arrhythmia detection, they had little experience with post-op orthopedic cases, she noted. To bridge those gaps and ensure all the patient’s needs were being met, the health system implemented the Flexible Monitoring by Welch Allyn Protocol, allowing staff to rapidly deploy wireless multi-parameter monitoring systems anywhere and at any time they were needed.


Welch Allyn Acuity Wireless Monitoring Solution

Adopting the solution led to numerous benefits for CCHS, including continuous rhythm visualization, accurate interpretation and trending by monitor technicians; increased staff satisfaction related to enhancement in technological capability; increased physician satisfaction related to the ability to display ECG waveforms, trends and full disclosure of any patient at any view station; a decrease in the number of patient transfers; less than ten second response times to lethal arrhythmias by nursing staff, direct waveform visualization of ECG at the bedside; and an increase in revenue capture of telemetry charges. What’s more, the study revealed that data for patients being monitored with the Flexible Monitoring Platform had a 6.5% increase in surviving a code versus traditional forms of cardiac monitoring, including critical care.

Of course, given today’s higher-acuity healthcare environments, any technology that aids clinical decision-support and response times will also drive up the value quotient for hospitals.

David Freeman, chief marketing officer for GE Healthcare’s Monitoring Solutions business, explained that "hospitals today are essentially becoming big ICUs" because of higher patient acuities. In fact, he said a customer advisory board member pointed out that the patients he discharges today are sicker than the ones he admitted to the ICU ten years ago. That sobering reality, Freeman said, is necessitating the development and implementation of more advanced, reliable and integrated monitoring solutions that enable clinicians to make the best care decisions, and in as quick a manner as possible.

At the heart of flexible monitoring solutions is their ability to allow seamless data transfer and continuity between different devices and departments, and allowing – through hospitals’ network infrastructures – to provide caregivers with at-a-glance, real-time access to critical patient data from a central station or other secure location.


Somanetics Next-Generation INVOS Cerebral Oximeter

Dorothy Marshall, communications manager for Spacelabs Healthcare, Andover, MA, explained the value of high-level flexible monitoring this way: "Imagine giving a physician the ability to view live patient waveforms at his home PC or from another hospital in the network. [Imagine what this] would mean in terms of efficiency and care," she said. "Think of the advantages for nurses to chart at the bedside and have access to labs at the patient monitor. Spacelabs’ patient monitoring and connectivity solutions can use the hospital’s existing network to move data whenever and wherever needed – throughout the enterprise and beyond."

The focus, Marshall continued, is transforming patient monitoring from boxes to enterprise-wide networked solutions. The Intesys Clinical Suite collects and stores real-time and retrospective patient information, which it seamlessly integrates into hospital information systems. Real-time and retrospective information is easily accessed from any networked PC or Spacelabs patient monitor in the hospital, clinic, office or even home.

Casting a wider net

Not surprisingly, multi-parameter patient monitoring is capturing much of the spotlight these days as facilities increasingly adopt a "do more with less" philosophy that allows them to monitor more physiological parameters with fewer pieces of equipment.

A report from Frost & Sullivan indicated that the emergence of telemetry solutions, implementation of clinical information systems and development of wireless transport monitors will "motivate healthcare facilities to prematurely upgrade their patient monitors and purchase higher-end units." The firm revealed that revenues in the U.S. multi-parameter patient monitoring market totaled $861.6 million in 2004 and is projected to reach $1.01 billion in 2011; much of that growth potential, Frost reported, will come from alternate care facilities, such as ambulatory and outpatient surgery centers that perform high-profit surgical procedures.

The goal, vendors agreed, is to create monitoring solutions that can be "flexed up or down" to meet the exact needs of a patient at any given time, as opposed to saddling clinicians with an array of separate, non-integrated solutions or tying patients down to monitors they don’t need.

Modularity plays a key role. Spacelabs’ product line has been designed to allow clinicians to easily adapt to different acuity levels and its Data Shuttle feature allows for continuous monitoring that creates a seamless record during transport. Its Ultraview SL monitors have interchangeable modules – including specialty ones — that can integrate easily with other Spacelabs monitors.


Hospira GemStar Infusion Systems

Advanced configurability is also at the heart of Philips Medical Systems’ patient monitoring portfolio. Its IntelliVue product line, for example, allows clinicians to monitor a wide range of parameters – from simple, noninvasive measurements all the way up to advanced measurements needed in high-acuity areas. This allows facilities to quickly begin monitoring a patient who has just arrived in the ED, for example, and then quickly increase that monitoring capability via add-on modules. If the ED wants to maintain its own inventory, the facility can use the monitor during transport and then seamlessly transfer the data from the ED system to the ICU system. According to Martha Dolan, director of patient monitoring for Philips Medical Systems, that’s an important capability because if a potential stroke or heart attack patient enters the facility, clinicians in other areas will have access to vital information, including when the event was detected and the therapy that was administered. "Being able to have that kind of continuity [with patient information] is critical."

GE Healthcare’s forward-looking approach to high-level patient monitoring revolves around the concept of Clinical Information Logistics, where information-intensive environments need to make split second decisions. While the clinical information logistics concept may conjure images of technology used by FEDEX or even air traffic control centers, Freeman said the application of this concept in hospitals is a perfect fit.

"I can’t think of a more information-intensive, dynamic environment than hospitals, and monitoring needs to fit into that domain." Through its Carescape portfolio, GE Healthcare is providing its healthcare customers with solutions that can pull all the monitoring data together to facilitate better and faster care decisions and response. CARESCAPE represents a portfolio of integrated products encompassing advancements in bedside and specialty monitoring, as well as wireless and networking solutions. The portfolio includes CARESCAPE CIC Pro, a clinical information center that can monitor up to 16 patients; CARESCAPE iPanel, a care port that unites the clinical environment, displaying records, diagnostic images, lab results and other care-centric data through an integrated touchscreen (clinicians can also view data from the iPanel via the CIC Pro, facilitating consultations with other clinicians); CARESCAPE Enterprise Access, which gives hospitals of all sizes a flexible, scaleable and open architecture wireless network that delivers in-building coverage across the entire range of wireless devices; and CARESCAPE Mobile Viewers, which allow clinicians to review and respond to patient monitoring information from almost anywhere within or outside the hospital.


Philips IntelliVue MP5 transport monitor

Recognizing that hospitals are integrating more wireless technologies, vendors are offering monitoring solutions to accommodate those needs. Welch Allyn’s FlexNet monitoring network seamlessly links wireless devices with traditional hardwired connections to provide a robust, reliable and scalable solution for comprehensive patient monitoring. FlexNet links multiple devices such as wireless portable monitors and ambulatory telemetry monitors to Acuity Central Monitoring Stations.

When a Draeger Medical monitor is placed on the Draeger Infinity Docking Station, it automatically assumes the appropriate settings for that care area. What makes the system truly unique, however, is its ability to seamlessly shift from a wired to wireless network, simply by removing the monitor from the docking station.

"When a patient needs to be moved, clinicians can pick the monitor up from the Docking Station and wirelessly capture all the data on the central nursing station," said Steve Menet, director, Enterprise Patient Monitoring and Information Technology, Draeger Medical, Telford, PA.

Having the ability to link with other specialty devices is another benefit vendors are passing on to hospitals. Philips’ "open systems-minded" solutions allow users to access information from more than 100 third-party specialty devices — including measurements, ventilators, gas analyzers, and anesthesia machines – on the IntelliVue patient monitor through its VueLink interface. For added flexibility, the IntelliVue Information Center transparently coordinates wired and wireless data.

Welch Allyn’s Connex Data Management System works with all its vital signs devices to pull pertinent data directly into electronic medical records – a function that can dramatically reduce the time spent on documentation and minimize delays associated with getting data from vital signs monitors to the EMR.


Draeger Infinity TeleSmart
Patient-Worn Telemetry Monitor

Even specialty, single-parameter monitors are being designed with greater flexibility and connectivity. Troy, MI-based Somanetics, for example, has incorporated next-generation enhancements into its INVOS System – a solution that noninvasively and continuously monitors changes in the regional oxygen saturation of the blood in the brain. The INVOS Cerebral/Somatic Oximeter has doubled its data channels from two to four, enabling clinicians to use it for cerebral oximetry, skeletal muscle tissue oximetry or both simultaneously. Dominic Spadafore, vice president of sales and marketing for Somanetics, pointed out that the solution comes in a portable package "with information able to be easily extracted via USB connectivity." The system’s digital port connectivity allows clinicians to integrate the data with the other vital sign information being collected, while also providing the flexibility of allowing clinicians to review the data on a larger display.

Hospira Inc., Lake Forest, IL, manufactures a host of flexible patient monitoring devices, from brain function monitoring systems to vascular and cardiac monitoring solutions, as well as a portfolio of intuitive and flexible infusion devices. The company’s advanced wireless security platform for infusion devices provides the first three-in-one wireless multi-band module for an infusion system – giving hospitals the choice of operating Hospira’s infusion devices in "b" or "g" modes, as well as less frequently used "a" wireless mode, to help ensure clear, consistent data transmission. The new technology also incorporates leading-edge authentication standards and encryption protocols to assist hospitals in securely transferring data and complying with patient confidentiality standards. According to Symeria Hudson, vice president, Marketed Products, Global Devices, the new offering "will help hospitals improve the efficiency of their IT infrastructure today, while reducing the need for future upgrades."

"Furthermore, both pulse oximeters and capnography monitors can be included in the network," said Sean Stewart, patient monitoring marketing manager, Nellcor/Puritan Bennett. "These critical parameters provide earlier warning to
adverse respiratory events than other forms of monitoring that may be used on the general care floor, such as cardiac telemetry or apnea monitoring." In the past, Nellcor’s remote monitoring systems could be networked to pulse oximeters only. Further adding to its monitoring capabilities, Nellcor has integrated analysis software to allow for efficient in-hospital sleep screening.

Hospira’s medication delivery platform features the lightweight, configurable GemStar infusion system, which is suitable for use throughout the continuum of care; the Plum A+ infusion system, which electronically controls I.V. medication delivery for single-, double- or triple-line therapy, and incorporates required clinician confirmation of delivery parameters to enhance programming accuracy; and the Symbiq infusion system,  an advanced, yet easy to use device designed to improve patient safety through the use of Hospira’s MedNet Software. Symbiq offers both wired and wireless capabilities, and helps ensure that hospitals’ best defined clinical practices are being utilized in all programs. Hospira’s general-infusion devices deployed as stand-alone units are upgradeable to the Hospira MedNet Software. Adding wireless communication provides the additional power of remote programming as well as enhanced programmability using data from the facility’s own pharmacy protocols.


Welch Allyn Connex Data Management System

The pulse oximetry solutions offered by Nellcor, Pleasanton, CA, include standalone and portable monitors that can be connected to the patient at the bedside and networked to a central station display, where clinicians are alerted to alarm events and changes in patient status. Highly flexible and configurable, the solutions allow facilities to choose either a wireless or hardwired network. In addition to the central station display, users have the option of sending alarm data directly to pagers worn by caregivers on the unit.

Smarter solutions

Of course, no flexible monitor, regardless of how many parameters it tracks and how well it integrates with other systems, is of benefit unless the technology behind it and the information being recorded is accurate and reliable.

In the past, the lack of reliability of some of the most basic parameters posed a significant challenge for clinicians. Unreliable data leads to a high number of false alarms – a problem that takes up valuable caregiver time and may lead to desensitization.

"One of the things that will kill the effectiveness of a floor monitoring solution the fastest is the proliferation of false alarms," explained Jim Welch, vice president of systems engineering for Masimo Corp., Irvine, CA, adding that the reliability of pulse oximetry is the cornerstone of effective flexible monitoring. "If you don’t have a way to reliably test the oxygenation level of a patient on the floor, nothing else really matters," said Welch. Masimo addressed those reliability concerns with its Read-Through Motion and Low Perfusion pulse oximetry technology, which increases reliability and enhances caregivers’ ability to detect life-threatening events, and virtually eliminates false alarms.


GE Enterprise Access multi-use communication network

To further provide clinical decision support, Masimo is currently developing technology that combines its Rainbow SET Read-Through Motion and Low Perfusion pulse oximetry with Masimo’s Acoustic Respiratory Monitoring technology. The Masimo ARM technology uses a single adhesive sensor placed on the patient’s neck to provide non-invasive respiratory monitoring in a way that initial independent clinical studies have shown to be accurate, reliable and easy to use. These studies also concluded that this technology offers an accuracy that is "equivalent to capnography" – and even "more reliable for measuring respiration in spontaneously breathing patients." By combining these two technologies, Masimo intends to give hospitals a continuous and noninvasive way to monitor a patient’s oxygenation and ventilation during patient-controlled analgesia. Pending 510k approval, the technology is expected to be introduced at Alpha Sites in late 2007.

Welch Allyn will soon debut its Clinician Notifier solution, a software-driven accessory to the company’s acuity central station that puts the power of central monitoring in the palm of a clinician’s hand.

"In the past, nurses had used alarm notification systems that would only provide waveform snippets and text messages when a patient went into alarm. We really turned that idea on its head by providing a handheld that not only provides alarm information in a safe and reliable way, but also allows clinicians to access all of the real-time data directly from the handheld," Musho noted. She explained that earlier alarm notification systems were hamstrung by their inability to provide real-time data and their lack of bi-directional communication capabilities – both of which have been conquered by the Clinician Notifier. The solution, still pending FDA 510(k) clearance, is expected to be ready for release in Q2 2007.

In March, Draeger introduced the TeleSmart Patient-Worn Telemetry System, a WI-FI based solution with a color LCD display that allows clinicians to manage alarms directly from the patient-worn device.

More than ever, today’s monitoring solutions are pushing the limits even further, serving as an extra set of eyes to not only gather the right data, but also help caregivers improve outcomes by detecting potential problems earlier. "Our focus is on early health. By providing better information to care teams, they can intervene faster to improve patient health," said GE Healthcare’s Freeman.


Hospira Symbiq

Hospira’s Q2 Plus SO2/CCO monitor provides continuous measurement of cardiac output and blood oxyhemoglobin saturation levels, and features Hospira’s exclusive CCO algorithm to provide rapid response to changes in cardiac output. The exclusive 3-wavelength system for reflectance spectrophotometry provides accurate SO2 measurements independent of varying hemoglobin levels, eliminating the need for laboratory updates of hemoglobin and hematocrit.

Philips is taking a proactive approach with its new Protocol Watch solution, which helps detect potential events that clinicians may have missed. According to Dolan, Philips’ technology enables caregivers to more easily detect which patient is likely to have an adverse event – allowing them to bring in the rapid response team to try and reverse the event or even prevent it altogether.

"When hospitals have monitoring [solutions] that can help them address those early warning signs, as opposed to just responding to codes after the fact, the benefits are going to be dramatic," Dolan said.    

 


www.hpnonline.com

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         Clinical intelligence for supply chain leadership