Caregivers find remote monitoring during COVID-19 pandemic an unexpected patient safety benefit

Date:
February 25, 2022
Source:
University Hospitals Cleveland Medical Center
Summary:
Experts say remote pulse oximetry and heart rate monitoring improve
patient safety, lower mortality, increase accuracy.



FULL STORY ==========================================================================
In an opinion article appearing online Feb. 25 in the Journal of the
American Medical Association, authors from University Hospitals and
Case Western Reserve University write about the unexpected patient
safety benefit resulting from remote monitoring of patients during the
COVID-19 pandemic.


========================================================================== Peter Pronovost, MD, PhD, Melissa Cole, MSN, and Robert Hughes, DO,
discuss that although COVID-19 placed excessive psychological and
moral stress and work demands on patients, clinicians, health care organizations and society, the pandemic also advanced patient safety in
an unexpected way.

Prior to the pandemic, routine monitoring of patients with continuous
pulse oximetry and heart rate devices was dependent on the patient's
location within a hospital, usually the intensive care unit (ICU). Pulse oximeters are small electronic devices that clip onto a finger and measure
the saturation of oxygen carried in red blood cells. Studies have shown
that monitoring with these devices is associated with reduced death rates.

As the pandemic flooded hospitals with patients and filled ICUs, many
patients received care outside of the ICU in emergency departments or
general medical and surgical units. And, some medical centers advised
patients with milder symptoms to stay home.

"One of the major lessons gained from the pandemic was that patients could
now be monitored based on risks and needs rather than location in the hospital," said Dr. Pronovost, Chief Quality and Clinical Transformation Officer at UH and Clinical Professor of Anesthesiology and Perioperative Medicine at Case Western Reserve School of Medicine. "Home monitoring
and hospital at-home models offer the potential to transform care and potentially allow a substantial proportion of hospitalized patients to
receive care from home." In their paper, the authors review benefits of
remote monitoring in the hospital and at home, explore the technology
advances that made it possible, describe how government payment policy
changes made home monitoring sustainable, and discuss what health systems
could do to launch a home monitoring program.



==========================================================================
Ms. Cole, Vice President of Integrated Delivery Operations at UH, said
that continuous remote monitoring of hospitalized patients in general
medical settings not only improves outcomes, but increases accuracy.

"Technological advances have made it possible to monitor some of these
patients either at home or in skilled nursing facilities. Things such
as wireless monitors, cloud-based platforms and telehealth have allowed
health systems to seamlessly use at-home continuous pulse oximeters to
monitor patients and help them avoid hospitalizations," said Ms. Cole.

The authors write that an analysis projected remote monitoring to be potentially associated with a lower mortality rate in COVID-19 patients compared with patients without at-home monitoring: "...a mortality
rate of 6 per 1,000 patients with COVID-19 compared with 26 per 1,000
patients without at-home monitoring." They write that this analysis also projected 87 percent fewer hospitalizations, 77 percent fewer deaths,
and reduced per-patient costs of $11,472 compared with standard care.

"The combined use of telehealth, home health, and remote monitoring could
bring some hospital-level-monitoring services to patients in their home,"
said Ms.

Cole.

Despite these advances, however, the authors find that broad hospital
and home monitoring services are not widely used by health systems. They outline several barriers that health systems must overcome.

"Health systems need to consider implementing continuous pulse oximetry
and heart rate monitoring for all hospitalized patients and emergency department patients," said Dr. Hughes, Medical Director of System
Operations and Logistics for UH and Assistant Professor of Emergency
Medicine at Case Western Reserve School of Medicine. "With increased
census, sicker patients and decreased staffing for most clinical roles, patients are at heightened risk for unrecognized deterioration. Continuous monitoring with a centralized team to monitor could improve safety and
reduce workload on clinicians," he said.

Other recommendations are for health systems to create a service line
to coordinate this work, to maximize value by learning how to combine
and integrate these various technologies, and to create protocols for
selecting and enrollment that match the patient's risks and needs with
the various types of monitoring.

At University Hospitals, Ms. Cole said experiences from the pandemic
helped pave the way in 2021 for UH's Hospital@Home program, the first
of its kind in the health system.

"During the early days of the pandemic, we introduced UHRemote, a remote patient monitoring system that allowed us to keep tabs on COVID-19
patients' heartrate and blood oxygenation levels. A team of nurses, each
with multiple screens, watched dashboards of patient data and received
alerts from wearable devices if a patient's numbers were too high or too
low. We learned much from the more than 2,200 patients we cared during
that year, and often heard how grateful they were to not be isolated
from family and alone in the hospital. We combined the experiences from UHRemote with the decades of experience of our Home Health teams, added
in a few more services, and UH Hospital@Home was born," she said.

========================================================================== Story Source: Materials provided by University_Hospitals_Cleveland_Medical_Center. Note: Content may be
edited for style and length.


========================================================================== Journal Reference:
1. Peter J. Pronovost, Melissa D. Cole, Robert M. Hughes. Remote
Patient
Monitoring During COVID-19. JAMA, 2022; DOI: 10.1001/jama.2022.2040 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/02/220225121802.htm

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