By Ken Terry
May 25, 2017
Continuous electronic monitoring (CEM) of vital signs has begun to spread from intensive care units (ICUs) to medical-surgical floors and other low-acuity areas of hospitals. Some hospitals are using standalone bedside monitors that communicate with nurse call stations and supplement manual patient checks by nurses.
There is also a growing interest in alarms and notification (A&N) platforms, which apply sophisticated analytics to CEM. A&N platforms use middleware to filter device alarms for relevance, analyze alerts in the context of other patient data, and send alerts to nurses’ mobile phones and tablets. According to a recent Gartner report, healthcare CIOs should “familiarize themselves with the A&N platform value proposition” and deploy these solutions “to reduce alert fatigue and improve patient safety, staff utilization and morale.”
An A&N platform can reduce the frequency and number of medical device alarms and provide centralized surveillance of patients, the report says. By reducing the need for manual checks of patients, moreover, A&N platforms can increase nurse efficiency and productivity. “A&N platforms are important to operational efficiency and critical to patient safety and care quality,” the report states.
These A&N platforms are part of a larger infrastructure known as real-time health system solutions (RTHS), which also include platforms for clinical communication and collaboration and interactive patient care. Barry Runyon, a research vice president at Gartner, predicts that by 2020, 30 percent of nurse call systems—which are mandated for the licensing of hospitals—will be replaced by a combination of RTHS systems.
CEM, he says, is migrating from ICUs to general wards “because it’s possible now. Until recently, you needed specially equipped patient rooms and beds to accommodate the medical and patients monitoring devices. Now some of this can be done with wireless medical devices and wearables.”
Another reason for the new interest in CEM is the threat of opioid-induced respiratory depression (OIRD), which can occur in patients who have received anesthesia during surgery or have been heavily sedated. According to one estimate, OIRD accounts for over half of medication-related deaths in hospitals. Opioid administration and monitoring is included in the ECRI Institute’s 2017 list of the top 10 patient-safety concerns for healthcare organizations. Both the Joint Commission, which accredits hospitals, and the Anesthesia Patient Safety Foundation have called for CEM to detect OIRD early on.
ECRI researchers recently examined the monitoring in low-acuity units of patients who had received narcotics, and “we have concluded that periodic vital signs checks and non-continuous monitoring are not adequate to detect OIRD,” says Tim Ritter, program manager in ECRI’s health devices group. The use of capnometers—devices that measure the carbon dioxide content in exhaled breath—would be a big step forward. Yet relatively few hospitals use any kind of CEM to supplement spot checks of patients at risk for OIRD, he says.