By Ken Terry
May 25, 2017
Lack of evidence
Beyond OIRD, early detection of patient deterioration—from sepsis, maternal conditions or postoperative complications, for example--could save many lives. But again, not many hospitals have applied CEM to identify declining patient conditions outside the ICU, says Priyanka Shah, project manager in ECRI’s health devices group. “Interest is growing, but it’s not yet there,” she explains. “There’s still a lack of peer-reviewed clinical evidence that suggests that the use of continuous electronic monitoring would provide better clinical outcomes as compared to spot checks.”
Even if the evidence were abundant, Shah adds, it would be difficult to know which devices to use to monitor patients for unexpected events. For example, an ECG monitor might be the wrong device to use with a patient who is heavily sedated.
In addition, Ritter says, nurses would have to be retrained for CEM. “When you put continuous monitoring into a low-acute area, it’s a big change in practice. There are workflow issues, and you have to make sure that people not previously accustomed to alarms respond to them and do what they can to minimize false alarms.”
A&N platforms manage alarms by placing them in the context of other patient data and comparing them with large databases of similar alerts. Hospitals can use the latter capability to set their own alarm thresholds to minimize alert fatigue, Shah notes. But if the threshold is set too high, she cautions, nurses might miss important clinical events.
Cost is also a barrier, especially for smaller community hospitals. A traditional vital signs monitor without analytics can serve 10 patients at a time, Shah says, and might cost $5,000. But with analytics and filtering added, each bed would need its own monitor, which would substantially raise the cost of monitoring. In addition, the hospital would have to pay for the software and “consumables” such as the disposable tubing used in capnometry.
Device and mobile connectivity
A&N platforms are usually vendor neutral; that is, they can connect to any patient monitoring device from a major device vendor, Runyon says. They can also link to the leading electronic health record (EHR) systems, he notes. But Shah points out that this is less important than the ability of monitoring systems to communicate with nurse call systems.
Because of licensing requirements, Runyon notes, there must be a hardwired connection between patient rooms and nurse call stations on hospital floors. However, Shah says, she has seen some nurses using mobile devices to receive monitoring data on medical-surgical floors. A&N platforms can be used to send data either directly to clinicians or to nurse call systems, which can relay it to nurses.
Nearly everything that clinicians do in hospital EHRs, including the placement of orders and communication among nurses, can now be done wirelessly, Runyon notes. The hardwired criterion of nurse call systems, he notes, is a function of their evolution, but he expects that to change.