Patient Monitoring Moves Beyond Vital Signs

Patient monitoring technology is evolving to deliver far more than digital vital signs. Today’s physiological monitoring systems provide immediacy, accuracy and ease of access with an added dimension of both intelligence—to predict, monitor and analyze patient events over time—and flexibility to monitor patients from other areas in the unit and even the patient’s home. 

For patients, these advances mean better care through speedier delivery of information to clinicians. And because these new devices can relay information in real time and automatically notify clinicians when patient data falls outside a preset range, they can provide caregivers with a more accurate picture of a patient’s condition and alert clinicians to potential trouble even before it happens.
 

Better care for smallest patients

The University of Colorado Hospital (UCH) in Aurora, Colo., recently upgraded its neonatal intensive care unit at the Anschutz Medical Campus, adding a series of GE Carescape Monitor B850s from GE Healthcare. The new system enables nurses to more closely watch patients because they are no longer limited to monitoring zones of six to 12 patients as in the past, says Ed Heath, director of patient services at UCH.

UCH’s 50-bed NICU consists of 30 single pods and 10 twin pods. Each pod has one or two wall-mounted physiologic monitors connected to a central server that relays clinical information to four central care stations within the NICU. A nurse can configure each monitor for each patient to display all of the babies in his or her care. “Instead of alerts potentially going unanswered or reviewed, the provider can remotely assess the reason for the alarm and decide if the alarm needs immediate response or remain with his or her current patient,” says Heath.

“Our former monitoring system limited staffing assignments geographically, based on monitoring capability within the nurse’s location,” says Christy Math, clinical nurse manager at UCH. “Now we can assign nurses anywhere as they are able to view patients on any monitor in the unit.” 

“On the first day of implementation, we noticed right away that patients being transferred from our old monitoring systems had higher oxygen saturation on the new systems, and we were able to monitor their oxygen delivery very carefully to keep oxygen saturation in a very tight range to avoid long-term damage; for example, to a patient’s retinas,” says Math.

The new monitors allow nurses at UCH to create custom-designed “profiles,” with set parameters for heart rate and respiratory activity based on gestational age that adjust alarms automatically to ensure that the patient is in a safe range, says Kari Waterman, clinical nurse specialist. The monitors also feature a 72-hour trending capability to determine whether and how to assess care if needed, Waterman adds.

The Carescape system provides continuous monitoring to patients while in the NICU. Since the monitors went live in mid-November, UCH nurses’ workload has decreased enough that the NICU could have reduced staffing, according to Math. Instead, the unit has elected to keep nurse-to-patient ratios in the 1-to-1 to 1-to-3 range, Math says.
 

Monitoring goes mobile

A variety of patient monitoring applications have made the transition to mobile devices. Smartphones in particular are getting smarter—and allowing greater flexibility and knowledge sharing among clinicians. That flexibility is the reason Memorial Hermann Healthcare System, an 11-hospital system based in Houston, uses Airstrip Technologies’ AirStrip OB to enable obstetricians to remotely view waveforms of uterine pressure contractions and fetal heart rate in real time using a variety of smartphones, says M. Michael Shabot, MD, Memorial Hermann’s chief medical officer. Physicians within the Memorial Hermann system deliver more than 26,000 babies each year.

Here’s how smartphone access works. Data from individual Airstrip OB-equipped bedside devices is transmitted to a central server, where clinicians can quickly access it to assess the progression of labor, including vital statistics, nursing notes, and possible maternal or fetal distress, says Shabot. 

The Airstrip OB application has been deployed at Memorial Hermann for a little more than a year, says Pepper Pittman, ISD manager for women’s services, and about 80 doctors use Airstrip OB on iPhones, BlackBerrys and mobile tablets. Plans are in the works to deploy the app to 10 to 15 more clinicians, Pittman says.

“The Airstrip OB application [gives] clinicians another vehicle to monitor patients,” says Pittman. Clinicians using Airstrip OB can monitor fetal tracings in their home, make notations from their phone and send these messages to other clinicians, he says. Good data, fast and flexible at the physician’s fingertips means better patient care decisions.
 

Beyond the hospital

The patient monitoring capabilities that enable clinicians in hospitals to manage patients anywhere in a facility are now following patients at  home after discharge, lowering costs by enabling patients with chronic condition to self-monitor. This could require less frequent hospitalization—increasing quality of life and reducing costs for the patient and clearly cutting costs for healthcare systems as a whole. 

“Hospitals have a financial need to make certain that a heart failure patient doesn’t get readmitted after discharge within a 30-day period,” says Karen M. Garfield, RN, BSN, director of clinical development at Suncrest Home Health, in Madison, Tenn. Suncrest uses Philips Telehealth Solutions, a package of devices including a telestation, blood pressure, pulse oximetry, scale and rhythm strip (ECG) system to assist patients in their homes across Tennessee and Florida. On a daily basis, the patients take vital signs and send the information to the telestation through wireless technologies. The telestation prompts a series of questions and the vital signs and survey data are uploaded to a web portal, which a clinician can securely access to view a digital dashboard of the patient’s clinical data. A physician can then contact the patient if data are outside of their safety range.

“Ultimately, we’re going to see decreased hospitalizations and long term, [nurses] might be able to reduce a visit here or there because they’re able to get great information on a daily basis,” says Garfield.

Benefis Spectrum Medical, an affiliate of the Great Falls, Mont.-based Benefis Health System, serves patients across a six-county area of north-central Montana covering 24,000 square miles. In September, Benefis Spectrum purchased 26 Intel Health Guides for use by patients in its home care program. Patients with conditions such as congestive heart failure, chronic obstructive pulmonary disease, asthma, hypertension and diabetes use the Health Guide to selft monitor in their own homes, says Teresa O’Connell, RN, BSN, manager of clinical services.

“First-generation monitoring systems didn’t have much interaction between the patient and clinician,” says O’Connell. “[They] just presented data.” Intel Health Guide’s web-based system connects patients and their healthcare teams via broadband, cellular, wireless and residential phone service. Patient data are securely sent to Benefis Spectrum clinicians, who review the data and share the information with physicians as necessary.

The Intel Health Guide’s trending capabilities let clinicians review their patients’ progress, with a goal to anticipate or prevent hospitalizations. For example, when one patient’s oxygen saturation strayed from acceptable parameters, Benefis Spectrum saw the change and notified the primary care physician, O’Connell says. Both Benefis Spectrum and the physician called the patient to check on her condition. “She hadn’t gotten up to take her medications or do her nebulizer because she felt poorly. But by having someone watching over her and communicating, we were able to keep her on track with her medications and prevent a hospitalization,” O’Connell says.

Monitoring systems continue to evolve as the underlying technology develops—think WiMax, faster processors and evolving device integration standards—and will gather more data for useful patient information. With no end in sight to sick patients, regulatory demands or budget pressures, the information these systems provide will be even more vital.