I have covered the topic of electronic monitoring of patients from two difference perspectives. First, I discussed the so-called e-ICUs (electronic ICUs) more than four years ago whereby small hospitals in larger health systems could support critical care beds with monitoring by nurses and physicians at remote hospitals in the same system (see: Telemedicine Transforms Intensive Care Units in Smaller Hospitals with Remote Monitoring). In another note about a year ago, I discussed e-monitoring of post-discharge patients (see: Keeping Tabs on Patients Post-Discharge Via Telemonitoring). Now comes news about hospitals wirelessly monitoring patients (see: Hospitals Find New Ways to Monitor Patients 24/7). Below is an excerpt from the article:
Hospitals are trying new early-warning systems to monitor patients for subtle but dangerous signs of a worsening condition. After surgery or during hospitalization for illness, patients are at risk for complications that can quickly turn fatal, such as a depressed breathing rate that can lead to cardiac arrest caused by over-sedation or an adverse reaction to narcotic pain medications. Patients can show signs of deterioration...as many as six to eight hours ahead of a cardiac or respiratory arrest, studies show. But the signs aren’t always picked up or acted upon by staff. Patients on general medical and surgical floors are usually not monitored 24/7 unlike patients in intensive care units, who are hooked up to multiple machines and monitors.
Among the strategies hospitals are adopting is a wireless monitor that slips under a mattress and alerts nurses to changes in breathing and heart rate. Another approach rates a patient’s risk of serious deterioration in real time based on lab results, vital signs and nurses’ assessments gathered from electronic medical records....Children's Hospital of Pittsburgh of UPMC has integrated PeraHealth's Pediatric Rothman Index with their medical emergency response team to deliver alerts to doctors and nurses when a patient is in critical condition, anywhere in the hospital, at anytime. ...[A recent publications indicated] that wireless monitors slipped under the mattress at Dignity Health’s California Hospital Medical Center in Los Angeles were linked to shorter hospital stays and a lower rate of “code blue” events....compared with units without the technology.
The monitors, developed by EarlySense also send alerts to nurses if patients get out of bed and when it is time to turn them to avoid skin breakdown....The cost of EarlySense varies depending on hospital size, and how many features it includes. It can range from $80,000 to $200,000 for a 30-bed unit. Pressure is mounting for hospitals to better identify patterns or changes before they get out of control. There is a national coalition of patient safety groups that is promoting continuous electronic monitoring of patients on narcotic pain medicines.
It seems to me that one of the critical aspects of broader e-monitoring of patients is which healthcare professionals will be responsible for such monitoring and what actions are taken when significant problems are noted. These questions are most relevant for ambulatory care patients. For elderly post-op patients for whom such monitoring is most relevant, such monitoring would be the responsibility of the clinic responsble for post-operative care. Part of the benefit of such monitoring will be the inevitable lower number of readmissions on an urgent basis. Such readmissions have become a measure of the quality of care so that it's in the hospital's best interests to bear the burden of the cost of monitoring (see: Addressing the Hospital Readmission Problem; Hospital at Full Census; Surgery Patients Discharged Too Early?; Talking to Patients Helps Reduce Hospital Readmissions).
Relevant to wireless inpatient monitoring, the EarlySense web site makes the following statement: The two most important predictors for patient adverse events are Respiratory Rate and Heart Rate, and experts have begun to emphasize the importance of continuous monitoring of vital signs as a means of detecting patient deterioration (see: Early Detection). I am sure that these monitoring systems incorporate algorithms to generate alerts when readings suggest a critical problem. Thus, medical personnel stationed in the patient units can be electronically notified without constant surveillance of the wireless data.