• Studies in Innovation: Sensing Trouble

    Sidebar: Karen Wagner Apr 27, 2016

    Healthcare organizations around the country are working on new ways of delivering better-quality care more cost efficiently. At the crux of many of these innovative efforts is technology, as the following case study illustrates.

    Continuous monitoring of inpatients can be a challenging task for busy clinicians. A prevalence of false alarms emanating from monitoring systems has resulted in alarm fatigue, causing staff to often ignore alarms. Yet early detection and prevention are cornerstones of value-based care.

    In 2011, Newton-Wellesley Hospital, Newton, Mass., part of Partners Healthcare, implemented a continuous monitoring system on its medical-surgical units. The sensor lies underneath the patient’s mattress and continuously monitors heart rate and respiratory rate. When rates fall out of the normal range, the sensor transmits an alarm to a pager worn by the patient’s nurse or to a central monitoring system located at the nursing station, says Perry An, MD, COO of the medicine division for Newton-Wellesley and director of implementation for the continuous monitoring system.

    “It allows us to monitor the heart and respiratory rates in a continuous fashion, without placing the patient in the ICU,” An says. In comparison, the standard of care for checking vital signs on medical-surgical units is every four to eight hours.

    An says the sensors, which are used on all 150 beds in the medical-surgical units, have alerted medical staff to dangerously abnormal heart and respiratory rates, enabling nurses and physicians to intervene and save lives.

    The sensor also helps nurses work more efficiently.  Use of the sensors oftentimes means that patients do not require telemetry monitoring. For example, a patient with gastrointestinal bleeding can have his or her heart rate monitored continuously without cardiac telemetry monitoring. By optimizing management of clinical alarms and sensor alerts, Newton-Wellesley reduced the number of telemetry alarms by 80 percent in one year. Having the continuous monitoring system in place played an important role in reducing alarm fatigue, An says.

    “It’s allowing our nursing staff to focus on the work they need to focus on as opposed to false alarms,” he says.

    How does a Continuous Monitoring Device Work?
    A continuous monitoring system used in the medical-surgical units at Newton-Wellesley Hospital.

    David Bates, MD, chief innovation officer at Brigham and Women’s Hospital, Boston, also part of the Partners system, and his colleagues published a study in The American Journal of Medicine on a randomized controlled trial of the continuous monitoring system at a hospital in Los Angeles.

    “We showed that when you do monitor, it decreases the likelihood the patients will need to go the ICU subsequently, and it also decreases their risk of a code blue [cardiopulmonary arrest] very substantially,” he says.

    Results from the study, which compared a 33-bed medical-surgical unit to a sister control unit for an 18-month period spanning pre- and post-implementation, showed a decrease in overall length of stay of 0.37 days (9 percent). In addition, the average stay in the ICU for patients transferred from the medical-surgical unit was about two days fewer in the intervention unit after the device was implemented—a 45 percent reduction in length of stay. The rate of code blue events decreased by 86 percent.

    Bates says that a cost-effectiveness analysis showed that the technology paid for itself within a year.

    An says continuous monitoring technology and the data it produces will accelerate the use of telemedicine, enabling more care to take place outside the hospital setting.

    “We’re trying to care for more populations of patients in the ambulatory setting, so they can be in the comfort of their own home, as opposed to being in hospitals that are chaotic, expensive, and where there is a risk of picking up hospital-acquired infections,” An says. “In order to prevent those things, lower costs, and increase quality, we need to be able to care for patients at home or in the ambulatory setting, and the only way to do that is with better remote monitoring. I do think it’s the way of the future.”

    Karen Wagner is a freelance healthcare writer based in Forest Lake, Ill., and a member of HFMA’s First Illinois Chapter.

    Interviewed for this article: Perry An, MD, COO, medicine division, Newton-Wellesley Hospital, Newton, Mass.

    David Bates, MD, chief innovation officer, Brigham and Women’s Hospital, Boston.