The scene is repeated often in a hospital critical-care unit. It starts in the middle of the night, when a heart monitor sets off an alarm at the bedside of a seriously ill patient. It might not be anything to be concerned about. It might be reason to get plenty concerned, and fast. Or it might not reveal much by itself but could be alarming given other readings during the past several hours.
A cardiologist is roused from sleep by the nurse's phone call and must spend time garnering information from the clinicians on duty, perhaps receiving a fax of the alarm report with a static snippet of an electrocardiogram.
Erring on the side of caution, the doctor might dress and drive to the hospital, preferring to get for himself the feedback available only at the unit.
Specialists on staff at a Kansas City, Mo., healthcare system now have an alternative to that common chain of events, made possible by a secure Internet connection to all the monitoring information in a hospital.
A new invention enables cardiologists from the Mid America Heart Institute to sign onto a World Wide Web site and gain live access to the same monitors and databases they otherwise would be able to see only at the inpatient facility.
The waveforms are dynamic instead of static, and the doctor can see both the current situation and the readings that first prompted the alert. He also can get a look at readings stored during the past 24 hours.
That can save doctors a trip, save nurses precious time normally spent on the phone, and possibly save a patient by allowing doctors to size up a situation and intervene before a condition can deteriorate.
"It's another good piece of information for a physician to make a timely decision," says David Pettijohn, vice president of strategic accounts at VitalCom, the Tustin, Calif.-based telemetry-systems company that designed it.
The Web-browser feature is the latest enhancement of access to a network of vital-sign monitors and wireless transmission capabilities connecting the heart institute with caregivers and the hospitals it serves.
The institute, headquartered at 510-bed Saint Luke's Hospital, is part of eight-hospital Saint Luke's Shawnee Mission Health System.
Benefits near and far. Using remotely monitored vital-sign measurement devices, the institute has extended its expertise to three small community hospitals in the system: 58-bed Saint Luke's Northland Hospital in Kansas City, Mo.; 75-bed Saint Luke's South in Overland Park, Kan.; and 38-bed Wright Memorial Hospital in Trenton, Mo.
That remote capability has allowed expansion without the expense of onsite units, established a referral relationship with the institute, and freed space at the community hospitals for other revenue-producing services that help the facilities take better care of people in their communities, says David Zechman, the heart institute's vice president of cardiovascular services.
Meanwhile, a roster of remote monitoring features helps keep physicians and nurses in touch with the fragile health of patients without having to hover over them or stick close to a central bank of monitors, Zechman says.
"Physicians are asking for tools that help them do things more efficiently," he says. Doctors have time pressures, and the Internet connection and other mobile contact points allow them to, for example, see patients at their practice while keeping track of what's going on at the hospital, he says.
The single connection to the monitoring network also simplifies matters for physicians who admit patients to several hospitals in the healthcare system, says Frank Sample, VitalCom's president and chief executive officer.
Instead of having to deal with multiple computer systems and different monitoring setups at each hospital, a doctor can sit down to a browser-equipped PC, dial a number to an Internet server, type in a security code and get information on all monitored patients no matter where he or she is or where the patients are, Sample says.
The vital signs are combined with information systems data and subjected to analysis by "expert systems," all of which provide a bigger picture of a patient's status and change over time, he says.
Physicians using the Internet feature can delve through a patient's readings during the past 24 hours to examine whether a prescribed course of care is having the desired impact. "They don't have to go to the hospital and grab a medical chart to see what's happening," he says.
The business case. In the larger scheme of things, the Internet access is one more tool to bring about a level of efficiency that allows better management of patient flow through the healthcare system, Sample says. Hospitals are becoming concentrations of high-acuity care, and inefficiency can add up quickly.
"Diminishing reimbursements and other cost pressures, along with nursing shortages, have demanded that healthcare organizations continue to capture more patient-care efficiencies while assuring quality to a more-sophisticated consumer," he says.
One way to get more for less is to concentrate expertise centrally and provide the means to make it available across a healthcare network. A core feature of the monitoring network is a mission control center that receives feeds from all devices in operation and posts technicians to watch and react to monitored activity.
At Saint Luke's Shawnee Mission, an immediate result of monitoring centrally has been a decrease of 6.3 full-time-equivalent telemetry technicians, saving $180,000 a year in salary and benefits, Zechman says.
The move also has had ripple effects at the hospitals. One benefit is a savings of $140,000 in the past year for wages formerly paid to temporary nurses, a domino effect of covering for technicians assigned to a particular hospital who called in sick.
In those cases, an experienced nurse would have to be pulled from floor duty to handle the monitoring, and a temp agency would have to be called to fill the nurse's spot, Zechman says.
With no monitoring operations onsite, hospitals no longer needed to reserve as much space for the task of onsite scrutiny. At Wright Memorial, a three-bed critical-care unit was converted to a cardiac rehabilitation service, something the community didn't have before, he says. Plus, patients requiring monitoring were being served by the more-sophisticated technical and medical capability of the heart institute, he adds.
Zechman expects the broad access to detailed information to speed up the discharge process, by giving doctors and nurses more information to make timely clinical decisions.
In one example, the 24-hour database built into the monitoring process can prove retrospectively that a patient is stable enough to discharge.
Normally patients recovering well from procedures and responding to treatment have to be monitored for a full day to establish that their vital signs are stable. Usually they're connected to what's known as a Holter monitor to establish that stability, which means keeping them around another day to collect continuous readings.
But with an archive in place, a doctor can avoid ordering a Holter monitor if the patient's readings of the previous day already indicate a stable condition, Zechman says. That validates a discharge decision and makes the bed available sooner.