Continuous monitoring system improves outcomes, reduces cost at acute care facilities

Use of continuous monitoring system technology (CMST) in the hospital results in uninterrupted improvement in clinical outcomes and lower cost on acute care medical, surgical, and telemetry units, a recent study has shown.

“Opportunities exist to promote optimized adoption and use of CMST at acute care facilities to sustainably improve clinical outcomes and reduce cost,” the researchers said.

In this interrupted time series evaluation, the researchers explored whether optimized clinical use of CMST could sustain improvements in intensive care unit (ICU) utilization, hospital length of stay, cardiac arrest rates, code blue events, mortality, and cost across multiple adult acute care units.

A total of 20,320 patients in the postoptimized use cohort were compared with 16,781 counterparts in the preoptimized use cohort. The former showed a significantly reduced ICU transfer rate compared with the latter (1.73 percent vs 2.25 percent), which corresponded to 367.11 ICU days saved over 2 years. This led to an estimated cost savings of at least USD 2.3 million. [Am J Med 2022;135:337-341.E1]

Length of stay in the hospital among patients who transferred to the ICU was also reduced (8.37 vs 9.64 days; p=0.004). However, the rates of cardiac arrest, code blue, and mortality remained comparable between the post- and preoptimized use cohorts.

“We found an association between clinically optimized use of CMST and improved clinical outcomes for hospitalized patients,” the researchers said. “The dramatic improvements in ICU transfer rates, length of hospital stay, and cost savings were sustained over a 2-year period across all adult medical-surgical units at the study site.”

Alarm management

Device alerts can help save lives, but they can also cause alarm fatigue and compromise safety when configured without clinician management, according to the researchers.

The Joint Commission instituted in 2014 a National Patient Safety Goal on alarm management to attend to these problems, including the noise associated with alarm signals and the information displays that can desensitize staff, which may result in missed or ignored alarm signals. [www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2021/simplified-2021-hap-npsg-goals-final-11420.pdf]

“It is well established that to improve patient-centred outcomes, monitoring devices must be coupled with clinical action and treatment and end-user engagement in design, and implementation of monitoring systems is needed,” the researchers said. [Crit Care 2005;9:566-572]

“Although the exact mechanism is unknown, we hypothesize that when implemented in partnership with clinical staff, CMST alerts were more broadly perceived as meaningful and brought nurses to the bedside to assess patients,” they added.

Engagement with end-users is necessary to improve CMST use and to achieve clinically meaningful outcomes with such system, according to the researchers. [J Patient Saf 2021;17:56-62; Int J Nurs Stud 2018;84:19-27]

“Additional studies are needed to evaluate generalizability to other types of facilities and CMST technologies,” the researchers said. “Larger studies are also needed to evaluate optimized CMST use's impact on rare events, including cardiac arrest, code blue, and mortality.”