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The aging patient population means one thing to most health care providers: more acute care patients that will require monitoring. With overcrowded emergency departments, critical care units filled to capacity, and monitored beds at a premium, management at Sutter Health in Sacramento, CA, felt it needed a new approach.
Robert Slepin, vice president of information systems and CIO at Sutter Health Central, says the system’s outmoded patient monitoring system limited its ability to effectively care for patients. "The old system, although suitable within a critical care setting, was only able to monitor patients on a single floor," says Slepin. It also had few features. For instance, the ability to store noteworthy changes in a patient’s heart rhythm was limited to 10 events, and it could provide just two lead wires of data.
"We needed the ability to monitor more beds on our two-campus medical center in a cost-effective manner," he adds. "Sutter Health needed a system that would allow us to flexibly adjust our bed configuration to meet demand in peak census seasons. We were struggling to meet the demand for telemetry beds, so expansion at a reasonable cost was our primary business. Our vision was to turn telemetry into a service rather than a physical unit."
The answer to the needs of increased flexibility, expanded monitoring capacity, cost effectiveness, and high-quality care couldn’t be met simply by replacing the old system with a newer model. So Sutter Health went looking for an alternative — a way to increase flexibility, expand monitoring capacity, and assure high-quality patient care, all without adding more costly critical care beds. These challenging objectives forced Sutter Health to consider a unique alternative: wireless telemedicine.
Initially, Sutter was working with Hewlett Packard. Debora Cale, RN, nursing director at Sutter General Hospital, says it has a "great product, and it works well in the Intensive Care Unit (ICU) setting." But the products it offered didn’t meet all of the goals. One of the department heads suggested Sutter look at the company VitalCom, which had an open network that would allow for expansion and contraction, as future needs warranted. The company, based in Tustin, CA, also offered wireless technology and collected real-time patient information from the monitoring devices Sutter already had, says Slepin.
With the wireless infrastructure technology and a new approach to monitoring, Sutter Health would be able to leverage both personnel and clinical expertise by providing monitoring services to Sutter General Hospital from a central, mission control-style center located at Sutter Memorial Hospital, 2.5-miles away. According to Slepin, this allows Sutter to concentrate technical resources in one location and avoid hiring a separate, highly skilled and expensive staff. Not only was this attractive from a cost-benefit perspective, he notes, but an enterprisewide monitoring approach would allow Sutter to easily expand as its monitoring needs increased and provide standardized, high-quality monitoring care across the enterprise.
An evaluation team consisting of biomedical engineers, monitor technicians, nursing directors, and a physician reviewed VitalCom’s proposal for a wireless infrastructure that would enable enterprisewide monitoring. But there was still skepticism among some physicians, says Cale, so two medical directors went on a field trip to an Arizona facility, where the system was already in use. "This was unsafe, uncharted territory, according to the physicians," Cale says. "It was a challenge to convince the cardiologists that the quality of care would not be impacted with a multiple-unit monitoring approach."
Careful transition was critical, she notes, so Sutter used a multiphased approach to system implementation, going live on just one telemetry unit the first year. During the second year, it integrated another unit onto the system and established a mission-control style monitoring center, where certified technicians monitor all patients from a single location around the clock. "We then did lots of auditing of data when we went live," Cale says. "We also met with the entire cardiology section prior to going live to let [the staff] know how we would implement and where they could bring concerns. We phased in slowly, so the buy-in got easier."
It was a big change in the care strategy, and a backup system was in place for critical situations. Cale explains that the safeguard included an arrhythmia phone and an enterprisewide paging system. By taking a systemwide monitoring approach, Sutter Health was able to expand monitoring services to 55 beds on multiple units.
In 1999, Sutter Health’s monitoring needs again changed and, as expected, expanded. There was an increasing desire to move patients out of the ICU, but keep a constant watch on them via telemetry monitors while they recovered in other, less-expensive units. The VitalCom product in use, PatientNet, was expanded to an orthopedic telemetry unit at Sutter General Hospital to accommodate this requirement.
Then in 2000, Sutter decided to use another VitalCom product, SiteLink, to link an off-site facility into the mission-control room at Sutter Memorial Hospital. This helped to avoid additional costs by using the same certified technicians in the mission-control center to monitor these new patients located miles away. By this time, the clinical staff were already comfortable with the enterprise monitoring approach, so the transition to off-site monitoring was a smooth one. "Now we’re seamlessly monitoring on other units and floors within the medical center and on units at the Sutter General campus two-and-a-half miles away," Cale says.
The cost over seven years has been a little more than $2 million, including $1.2 million for equipment. But there have been clear benefits as well. Using sophisticated wireless technology and an advanced telemedicine solution, Sutter can monitor up to 96 patients throughout the network from one location. Also, by centralizing monitoring functions, Sutter was able to double the number of monitored beds without adding additional monitoring technicians, saving the cost of eight technicians, or about $160,000 per year.
From a quality perspective, because all monitoring care is provided from a single location by trained and certified technicians, Sutter has achieved a standardization of monitoring quality across the enterprise, and there is a 98% compliance rate on missed rhythms. Patient safety and quality of care has been optimized with instant wireless transmissions of critical patient information, enabling care providers to receive data faster; resulting in quicker, more knowledgeable interventions. Within six months, the length of time for nurses to answer the arrhythmia phone dropped from seven to eight rings to 1.2 rings, resulting in quicker response time to critical patient events.
In addition, the expanded features and capabilities of the system — multilead viewing, storage of more rhythms, 24-hour disclosure and trending of significant events — give cardiologists a more complete picture of the patient’s status, often enabling them to intervene earlier and improve the patient’s outcome. "We will consider the possibility of expanding PatientNet into other Sutter hospitals across the enterprise," says Slepin. "Also, we are excited about the Internet access technology and plan to evaluate that option for our physicians."
Cale agrees. "Our ultimate goal is to be able to add other units in the medical center."
Down the road, Slepin plans to integrate information from the PatientNet system with their existing Eclypsis Sunrise Clinical Manager clinical information system. "Our long-term vision is to build a comprehensive electronic medical record within each region. In the short run, the more data points we can offer our physicians at the point of care to support clinical decision making, the better."
[For more information, contact:
• Debora Cale, RN, Nursing Director, Sutter Medical Center, 52nd and F Streets, Sacramento, CA, 95819. Telephone: (916) 733-1724.
• Robert Slepin, Vice President of Information Systems/Chief Information Officer, Sutter Health Central, 52nd and F Streets, Sacramento, CA, 95819. Telephone: (916) 733-8646.
For more information on the VitalCom systems, contact the company at (800) 888-0077 or visit its web site at www.vitalcom.com.]