I have blogged about the development of virtual critical care units whereby smaller hospitals maintain critical care beds but rely upon remotely located intensivists to monitor their patients (see: Staffing An Intensive Care Unit From Miles Away Has Advantages; Telemedicine Transforms Intensive Care Units in Smaller Hospitals with Remote Monitoring). These units are developed in situations where skilled personnel are not available locally. The Cleveland Clinic has developed another variation on this theme with their centralized cardiac telemetry monitoring unit for non-critically ill patients (see: An Update on the Centralized Cardiac Telemetry Monitoring Unit). Below is an excerpt from the article with more details:
Hospitals have long struggled with “alarm fatigue,” when busy nurses become desensitized to the constant noise emanating from cardiac telemetry monitoring systems....Meanwhile professional organizations identified rampant overuse of telemetry in low-risk patients as a chief contributor to alarm fatigue. At Cleveland Clinic, a dedicated off-site central monitoring unit (CMU) provides 24/7 secondary cardiac telemetry monitoring for non-critically ill patients at the health system’s main campus and two of its regional hospitals. To avoid unnecessary monitoring of patients at low risk, the CMU team developed and rolled out standardized criteria for putting patients on telemetry in 2014....In August, results from the CMU’s first 13 months of using the standardized criteria were published by JAMA showing that there’s real hope of reducing rates of nonimportant alarms without an increase in cardiopulmonary arrest events. During that time, the CMU monitored 99,048 patient orders and detected serious problems and accurately notified on-site staff for 79 percent of 3,243 events, which included a rhythm and/or rate change within one hour or less of the event. As of September, accurate notification to hospital on-site staff was over 84 percent. Further, advance warning was provided directly to an emergency response team, and for those that went on to develop cardiopulmonary arrest, 93 percent were successfully resuscitated.
The Cleveland Clinic has adopted a two-pronged approach to cardiac monitoring for non-critically ill patients. First, it has created a central monitoring unit (CMU) for surveillance of such patents in both its main campus hospital and two of its regional hospitals. This centralized monitoring facility relieves the general nursing staff at these three hospitals of the responsibility of such monitoring. Secondly, and to fight alarm fatigue of the personnel working in its CMU, it has developed standardized criteria for placing patients on cardiac telemetry monitoring and thereby avoiding unnecessary services.
The creation of a central monitoring unit by Cleveland Clinic is an example of the increasing specialization of healthcare personnel with a cadre of personnel dedicated primarily to cardiac monitoring. The creation of such centralized cardiac monitoring units also enables capital investment in hardware and algorithms to assist in such monitoring. It also occurred to me that this CMU concept can be expanded to include monitoring of patients who are living at home but with telemetry connections to this CMU. Such a service, in time, would surely be reimbursable and anticipates the challenge of patients with a fragile cardiac status who are discharged from hospitals.