Monitoring system saves hospital $180,000 a year

It’s 10 p.m. Do you know how your patient is?

Wouldn’t it be great if a hospital could have a patient monitoring system that would tell health care providers how patients were doing regardless of where they were in the hospital? St. Luke’s Hospital in Kansas City, MO, has designed a method to do just that. The result is an enterprisewide system that has saved the hospital $180,000 a year in monitoring technician salaries, has decreased the number of false alarms, and has given patients more time with their caregivers.

Under the old system, technicians in individual units used telemetry systems to monitor patients, explains David Zechman, vice president of cardiovascular services at the hospital. The technicians were subject to interruptions for other responsibilities, such as assisting patients, visitors, and other staff. "That made maintaining focus on monitors difficult," he says. "Sometimes it would take a while to detect abnormal rhythms that might not be threatening, but that can serve as a precursor to more serious events."

Monitoring at satellite facilities was even more challenging because lower staffing levels made it difficult to dedicate trained personnel to the monitoring function, he adds. And in some cases, patients who could have been adequately cared for at a facility close to their home were transferred to the heart institute at St. Luke’s, where a cardiac professional could monitor them more effectively, albeit more expensively.

"Another challenge with the conventional approach was that whenever a monitoring technician called in sick, he or she had to be replaced by a staff nurse who in turn was covered by a nurse from a temporary agency at a cost of about twice the rate of the technician," says Zechman.

Cardiovascular service managers decided to update the hospital’s monitoring systems and considered the options that were available, says Zechman. "One approach would have simply been to replace the existing setup with more advanced stand-alone equipment. But we wanted to explore the option of standardizing monitoring with an enterprise approach throughout the health system."

With an enterprisewide approach, a centralized and dedicated cadre of technicians with a higher level of training would monitor patients at multiple locations 24 hours a day. Information technology managers at St. Luke’s researched existing commercial technology and chose VitalCom Inc. of Tustin, CA, to create its system.

The VitalCom system provided enterprisewide monitoring in addition to a real-time information infrastructure that allows patients to be monitored throughout the health care enterprise, Zechman explains, including remote locations. All of this is done from one central unit, allowing St. Luke’s to monitor patients throughout the entire integrated health care delivery network as well as potentially provide services to hospitals outside the network on a fee basis.

The quality of patient care quickly improved with the implementation of the new system. Now, instead of requiring unit clerks and even nurses to watch monitors, St. Luke’s relies on a group of trained technicians who review all data from every monitor throughout the system, says Zechman.

Round-the-clock surveillance

"They work around the clock, following standardized guidelines and procedures to notify clinicians of critical events," he says. Each technician can monitor up to 48 "channels," and St. Luke’s currently has 128. A channel is a signal coming from a monitoring instrument, each of which can produce a number of channels of data.

At the beginning of each shift, technicians note the rhythms from each of their patients. They repeat the process hourly to pick up any changes that might be a signal of something more serious to come. "This level of detail and uninterrupted attention often results in the detection of subtle shifts that are easily overlooked using conventional monitoring methods," he continues. An integrated paging system alerts caregivers within seconds of an alarm. Technicians are also better able to detect false alarms, and they only notify caregivers when appropriate.

Zechman says the system is very user-friendly. That helped get buy-in from physicians, nurses, and other staff. So far, three facilities outside of St. Luke’s have been linked to the system. "Now patients are monitored in the most appropriate care setting. The technology instantly sends patient data from remote facilities to St. Luke’s centralized monitoring room."

The new system allows the health system to better share resources and expertise among its facilities, he says. "In addition to increasing patient monitoring care and making it more efficient and consistent across the enterprise, we have been able to reduce technical monitoring staff at St. Luke’s Hospital by 4.3 full-time employees and have not needed to increase monitoring staff at the remote facilities."

Other benefits that have yet to be quantified include reducing length of stay and reducing costs for unnecessary patient transfers. "All in all, the implementation of enterprise monitoring has significantly improved patient care, reduced costs, and has helped to increase the reputation of St. Luke’s," he adds.