Better monitoring saves lives

More than wireless remote vital sign monitoring.

In 2013, the National Institute for Health and Care Excellence (NICE) reported that patients and their families should feel that a hospital was a place of care and comfort, somewhere they would be looked after[1]. It suggested that monitoring patients by checking them and their health regularly while they were in hospital and taking action if they showed any signs of becoming worse would help avoid more serious problems.

Unfortunately, NICE’s evidence of the reality of hospital care pointed to the contrary.

The report found that patients who are, or become, acutely unwell in hospital may receive suboptimal care[2]. This may be because deterioration in their condition is not recognised or despite indications of clinical deterioration, the seriousness of their condition is not appreciated nor not acted upon sufficiently rapidly. Communication and documentation are often poor, experience might be lacking and provision of critical expertise, including admission to critical care areas, may be delayed.

The report said the key priorities for implementation included:

• A clear written monitoring plan which specifies which physiological observations should be recorded and how often
• A physiological track and trigger system should be used to monitor all adult patients in acute hospital settings and physiological observations at least every 12 hours, unless a decision has been made at senior level to increase or decrease their frequency for an individual patient.

Why is patient safety relevant to healthcare and how can patient monitoring help?

There is now overwhelming evidence that significant numbers of patients are harmed from the healthcare they receive resulting in permanent injury, increased length of stay in hospital or even death. We have learnt over the last decade that adverse events occur not because people intentionally hurt patients but rather that the system of healthcare today is so complex that the successful treatment and outcome for each patient depends on a range of factors, not just the competence of an individual healthcare provider. When so many people and different types of healthcare professionals (doctors, nurses, pharmacists, social workers, dieticians and others) are involved this makes it very difficult to ensure safe care, unless the system is designed to facilitate timely and complete information and understanding by all the health professionals[3].

It is now widely accepted that 1 in 10 patients admitted to hospital will be unintentionally harmed in some way[4]. To put that into context in the extreme case, there are more deaths annually as a result of the care people receive than from road accidents, breast cancer and AIDS combined. Some of these adverse events will be inevitable complications of treatment, however, at least half of these events are thought to be preventable.

Although the 10% figure of harm happening to admitted patients is well known, this level of error would be completely unacceptable in many other industries (eg aviation), so when it comes to the healthcare industry, zero harm should be the target. Yes, of course, people make mistakes but often it is less error by an individual than the organisation’s failure at other stages in the process to capture and correct that error that leads to a serious outcome[5]. That’s why the focus on patient safety is so much about leadership, culture and process. Technology can play a key enabling role in this but is not the answer in itself.[6].

In the UK, reviews of case records have shown that last year there were 1.2 million reported care incidents[7], and in 2012/ 2013, there were 850,000 reported adverse events[8] - these figures are reflected in similar records around the world. In 2012, deaths from potentially avoidable causes accounted for approximately 23% of all deaths registered in hospitals in England and Wales[9]. While medical errors have not been as extensively studied in outpatient settings, it is estimated that as many as 35% of outpatients experience an adverse drug event[10] [11] [12] [13] [14] and that 13% of all adverse events identified during hospitalisations occur during outpatient care[15] [16].

Recent financial estimates also suggest that adverse events cost the UK £2.5 billion in 2012/2013 in extra hospital days alone and nearly £1.2 billion was paid out to cover clinical negligence claims in 2013/14. Other costs, such as suffering of patients, their families and the healthcare workers involved, are incalculable[17].

Dealing with the effects of patient safety related issues is a very expensive diversion of healthcare funds. In addition to the ensuing distress for patients, families and frontline staff and the greater bureaucratic burden for management, the financial implications add enormously to the pressures on the NHS, limiting its ability both to treat more patients and to provide higher quality services.

One of the traditional roles of doctors and in particular nurses involves patient surveillance. This includes checking patients for changes in their condition, recognising early clinical deterioration and protection from harm or errors.[18]

It is well documented that prompt detection and reporting of changes in these vital signs is essential, because delays in initiating appropriate treatment can detrimentally affect the patient’s outcome[19]. For more than 100 years, nurses have performed this surveillance manually and have used a paper-based system to record patients’ vital signs: temperature, pulse, blood pressure, respiratory rate and, in recent years, oxygen saturation[20].

However, this can be extremely time consuming and with increasing patient survival rates, which have resulted in an increasingly complex and older patient population[21], we need to better equip staff and healthcare organisations to cope with the additional pressures that this will bring.

Technology Can Improve Patient Monitoring

There is a pressing need to improve patient safety, the way patients are monitored and how patients’ data is collected and analysed. Except for those in intensive care wards, most patients in UK hospitals are inadequately monitored. Even high dependency patients often fail to receive the necessary higher intensity monitoring, due to a number of factors including suitable beds and nursing resource.

Patients in general wards have their ‘obs’ taken at long (up to 8 hourly) intervals, during which time significant negative changes in a patients’ status can occur. Such infrequent monitoring makes it almost impossible to identify trends that might have been able to predict the patient’s deterioration.

In a study by the Royal College of Physicians in 2012, it was found that better patient monitoring could save 6,000 lives each year in England and Wales[22].

In another study, by the BMJ in 2012, it was also discovered that remote monitoring can achieve: 20% reduction in emergency hospital admissions; a 14 per cent reduction in elective admissions; 14 per cent reduction in bed days; 8 per cent reduction in tariff costs; 45 per cent reduction in mortality rates”[23].

It is clear that remote patient monitoring is the key to establishing an effective healthcare model based on continuous patient knowledge. It is more than just a system for tracking key patient metrics. The ideal patient monitoring solution can deliver continuous visibility into a patient’s health status by translating the data obtained on a continuous basis into useful clinical knowledge through the use of automated decision support tools. Clinicians and nurses can then use that deeper knowledge to make better and more informed decisions.

A comprehensive remote patient monitoring program collects, transmits and analyses key biometric and behavioural data, generates alerts when an intervention is needed, and delivers meaningful information to a single page on the care team’s secure web portal. The patient’s care team can then use this real-time data continuum to proactively connect the patient with the right intervention at the right time, whether they are in hospital or in other care settings, including the home.

Isansys Lifecare has developed an award-winning digital platform that will significantly improve patient safety.

The Patient Status Engine (PSE) is an innovative, continuous vital sign acquisition, analysis and prediction platform which can provide low cost, continuous, high resolution monitoring for all patients in hospital and at home.

The system, which integrates a range of advanced, medically-certified wireless wearable vital sign sensors with secure networking technologies and predictive analytics, can create new applications and care pathways through data-driven physiological biomarkers, for example, for the early detection of sepsis in chemotherapy patients at home.

The Isansys PSE not only meets the demands of healthcare providers for innovative, market-ready solutions that can enable improved patient monitoring and alerting but also addresses crucial patient safety issues. These include: reducing the number of avoidable deaths and adverse events in hospital; cutting lengths of stay; discharging patients earlier and with greater confidence; and enabling new pathways to keep patients out of hospital in the first place.

Through the acquisition of continuous real time phyiological and other biomarker data sets from individual patients, Isansys PSE builds up large data sets to provide reliable and highly relevant data for immediate or subsequent analysis. Clinicians can then use these predictive algorithms as new tools to see what is happening to their patient and how their treatment can be altered or adjusted accordingly.

For the first time ever, the idea of real patient-centred care becomes possible because a patients’ physiological “image” is measured and their responses to treatment collected in real time.

No matter where patients are located, whether in hospital or at home, their current status, including their responses to treatment, will immediately be visible to their care team. In addition, through the power of data driven healthcare and predictive algorithms, their future status can also be predicted. This not only provides a new way to measure patient outcomes but also gives clinicians a new set of quantifieable measures to optimise patient care.

Conclusion

The effectiveness of clinically validated remote patient monitoring is clear, and it is becoming evident that systems that use wireless, sensing, information and other digital technologies to collect and analyse patient data show great promise in supporting and informing care teams to deliver better care, improve patient safety and enhance clinical outcomes.

The Patient Status Engine has the capability to monitor and analyse physiological data faster, and in more detail in order to provide a rich source of knowledge that can be used to ensure adherence to clinical guidelines with real time alerts.

These technologies can also help to reduce the costs associated with avoidable patient deterioration, medical errors, readmissions to intensive care wards and admissions (and readmissions) to hospital and, most importantly, save lives.

[1] NICE Guidelines, Introduction, 2007, reviewed December 2013, http://www.nice.org.uk/guidance/cg50/chapter/introduction

[2] NICE Guidelines, Introduction, 2007, reviewed December 2013, http://www.nice.org.uk/guidance/cg50/chapter/introduction

[3] http://www.who.int/patientsafety/education/curriculum/who_mc_topic-1.pdf

http://www.who.int/patientsafety/journals_library/Improving_Patient_Safety.pdf, p4

[4] http://www.health.org.uk/public/cms/75/76/313/2593/Levels%20of%20harm.pdf?realName=PYiXMz.pdf, p4

[5] Reasons, J. (1990) Human Error. Cambridge: University Press, Cambridge

[6] Reason, James (1997). Managing the risks of organizational accidents. Aldershot: Ashgate. ISBN 1840141042

[7] http://m.hsj.co.uk/5081758.article

[8] http://proqualis.net/sites/proqualis.net/files/5_getting-started-at-the-national-level-from-demonstration-to-spread.pdf

[9] http://www.ons.gov.uk/ons/rel/subnational-health4/avoidable-mortality-in-england-and-wales/2012/stb-avoidable-mortality--2012.html

http://www.j-biomed-inform.com/article/S1532-0464(03)00068-6/fulltext

[11] Hutchinson, T.A, Flegal, K.M., Kramer, M.S, Leduc, D.G., and Kon, H.H. Frequency, severity and risk factors for adverse drug reactions in adult out-patients; a prospective study. J. Chronic Dis. 1986; 39: 533-54

[12] Hanlon, J.T., Schmader, K.E., Koronkowski, M.J. et al. Adverse drug events in high risk older outpatients. J. Am. Geriatr. Soc. 1997; 45: 945-948

[13] Gandhi, T.K., Burstin, H.R., Cook, E.F. et al. Drug complications in outpatients. J. Gen. Intern. Med. 2000; 15: 149-154

[14] Honigman, B., Lee, J., Rothschild. J. et al. Using computeriized data to identify adverse drug events in outpatients. J. Am. Med. Inf. Assoc. 2001; 8: 254-266

http://www.j-biomed-inform.com/article/S1532-0464(03)00068-6/fulltext

[16] Brennan, T.A., Leape, L.L., Laird, N.M. et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I.N. Engl. J. Med. 1991; 324: 370-376

http://www.nhsla.com/aboutus/Documents/NHS%20LA%20Annual%20Report%20and%20Accounts%202013-14.pdf

[18] Rogers et al, 2008

[19] Chalfin et al, 2007

[20] Ahrens, 2008

[21] James et al, 2010

[22] Royal College of Physicians, ‘National Early Warning Score (NEWS): Standardising the assessment of acute illness severity in the NHS, 2012

[23] BMJ, June 2012, Effect on Telehealth on use of secondary care and mortality: Findings from the Whole System Demonstrator Cluster Randomised Trial