On average, a nurse oversees four to six patients on a general care floor rotation. Patients on these floors tend to be low-acuity; they usually suffer from non-critical ailments. However, today’s hospitalized patients are bringing increasing complexity with them. It has been reported that up to 17% of all hospitalized patients will experience an adverse event during their hospital stay.1
While much of the data available on continuous patient monitoring comes from intensive care units, increasingly, data has been reported on the importance of continuous monitoring for general care floor patients as well. When general care patients only receive manual vital signs measurements once every four to six hours, they may deteriorate significantly before the first signs of change are detected, and an intervention, such as transfer to the ICU, is contemplated.2 A lack of continuous monitoring for average-risk patients has been suggested as a contributing factor for unforeseen in-hospital adverse events and preventable mortality.3
Traditional continuous patient monitoring systems usually involve connecting a patient to telemetry or pulse oximetry to monitor respiratory and heart rate. These methods are typically used at hospitals to monitor higher risk/more acute patients, especially post-surgery. Nurses on rotation also check in with patients periodically to record their vital signs on their 8-12 hour shifts. All too often, the on-body sensors become disconnected or dislocated, causing a false alarm to sound. Nurses may hear these frequent nuisance alarms hundreds of times a day. Rather than alerting the nurses to a problem, the alarms usually signify an out-of-place ECG electrode, blood pressure cuff, or SpO2 sensor. This effect, known as alarm fatigue, is detrimental to both nursing practice and patient care, and has been implicated as a contributing cause to unnecessary patient mortality.
There is a growing need to provide monitoring in general care environments, which is why the technology creep of telemetry and SpO2 monitoring has migrated from the intensive care units and operating rooms into less acute environments. However, in the ICU and OR, there are specially trained caregivers, who are familiar with these advanced, often complex technologies. However, once these technologies enter general care environments, these same complexities, which are so beneficial in the ICU and OR environments, can become burdensome. This can cause complex staff-to-device interfaces and increased alarm activation, increasing the likelihood of alarm fatigue. The general care floors require a solution that keeps monitoring simple, with minimal effect on nursing workload.
Contact-Free Patient Monitoring
To combat these challenges, EarlySense has developed contact-free continuous monitoring solutions designed for patients on general care floors. The EarlySense technology is a combination of a unique piezoelectric sensor with algorithms that analyze large data sets collected on each patient. The technology is available as a full hospital monitoring solution, as well as an OEM Integration Kit.
Tucked under a patient’s mattress or within a chair, the sensor itself is a thin, ultra-sensitive device resulting from over a decade of development and clinical testing. At under 10mm of thickness, it is never seen or felt by the patient. The signal detected by the highly sensitive piezoelectric sensor stems from three sources: gross body movement, chest wall movement due to respiration, and recoil of the body due to heart pulse waves. These signals are acquired by the sensor and converted into electric signals. Then, patented detection algorithms analyze the signals, differentiate between them, and extract the required information to obtain continuous heart and respiratory rates and body motion, as well as sleep parameters.
Instead of having the nurse spot check the patient only four to six times a day, this continuous sensing solution collects around 160,000 patient readings per day. The rich, Big Data set enables advanced algorithms to identify the earliest warning signs of deterioration. Leveraging the system’s data and alerts, clinicians can identify patient deterioration several hours in advance of adverse events developing.
Studies have shown that continuous monitoring of respiratory and heart rate can help support the life-saving work of clinicians by indicating deterioration in advance of an adverse event. In fact, 70% of patients who experience circulatory arrest have respiratory problems within the eight hours leading up to the episode4, and 84% of patients who experience cardiac arrest have instability within eight hours preceding the event.5 Monitoring respiratory and heart rate – the two most important predictors of patient adverse events – allows clinicians to perform more effective interventions on behalf of patients.
In a recent scientific poster presentation at the Academy of Spinal Cord Injury Professionals (ASCIP) 2015 Educational Conference, a Veteran’s Affairs Spinal Cord Injury Center reported significant clinical results achieved by implementing EarlySense’s continuous patient monitoring solution. Most significantly, early detection of patient deterioration decreased mortality by 83% following a Medical Response Team activation.6
The benefits of this type of continuous monitoring system for the patient are clear: no need to wear sensors, which can be uncomfortable and restrictive, better care from clinicians, and a faster recovery time. The benefits for clinicians are even more impactful. By combining advanced algorithms with contact-free sensing, false alarms are reduced by a factor of over 50.7 There are no complex waveforms to read and no setup required for the system to start monitoring each new patient, so the critically important need to maintain simplicity in general care solutions is achieved.
Clinicians utilizing these systems are able to enhance the care they give by fully leveraging the accurate information they receive to provide the right intervention at the right time. Using EarlySense, clinicians are notified of critically important patient data directly on their mobile devices. In hundreds of cases around the world, clinicians reported a dramatic improvement of care by utilizing the system and intervening effectively to prevent risks such as respiratory depression, cardiac arrest, and sepsis. Hospitals benefit by providing clinically proven technology to reduce the incidence of cardiac and respiratory arrest and decrease rates of mortality, patient falls, pressure ulcers, and hospital readmissions.
The clinical and economic benefits of utilizing a continuous patient monitoring system far outweigh any initial cost of installation. The ability to proactively treat patients by leveraging continuous monitoring saves lives every day.
1 Görges et al., 2009; Siebig et al., 2010
2 Bates, D.W., Zimlichman, E. BMJ Qual Saf, “Finding patients before they crash: the next major opportunity to improve patient safety.” 23 September 2014.
3 Brown, HV et al, The American Journal of Medicine. 2014; 127: 226-232
4 Schein R.M. et al, Chest 1990; 98: 1388-92.
5 The ACADEMIA study. Kause J et al. Resuscitation 2004
6 Becker’s Spine Review, “VA Spinal Cord Injury Center sees 83% decrease in mortality with monitoring system: 5 things to know” http://www.beckersspine.com/spine/item/27067-va-spinal-cord-injury-center-sees-83-decrease-in-mortality-with-monitoring-system-5-things-to-know.html
7 Brown, HV et al, The American Journal of Medicine. 2014; 127: 226-232