Welch Allyn’s Connex CSS

Special report: Continuous monitoring has continuous benefits

May 21, 2014
by Lauren Dubinsky, Senior Reporter
At the time that Florence Nightingale founded modern nursing in the mid- 1800s, nurses would measure and manually record blood pressure every few hours with large, bulky instruments. But more than 150 years later, hospitals are increasingly looking for solutions to continuously and noninvasively monitor patients’ vital sign measurements in low-acuity areas, or areas with non-critical patients.

“We can stop the Florence Nightingale approach to nursing, which is sending nurses every two to four hours to check the vital signs on all these patients,” says Gary Manning, vice president of global sales and marketing development at Sotera Wireless. “With the ability to monitor all vital signs continuously we can eliminate that step, therefore freeing up more time for the nurse to be involved in more of the information.”

But nurses are not the only ones who benefit. Hospitals can avoid costly ICU transfers and long hospital stays, and patients can find satisfaction with the better outcomes and shorter stays. Naturally, manufacturers have picked up on this interest and created their own unique solutions.

Show me the evidence
ECRI Institute has noticed this interest over the past year after an increasing number of hospitals requested information about the technology. “A lot of them are interested in introducing continuous monitoring solutions in care areas previously covered by nurses conducting spot checks with vital signs monitors,” says Timothy Wong, project engineer of the health devices group at ECRI.

Patients in low-acuity areas traditionally involve the nurses checking the patients’ vitals every few minutes or hours depending on facility protocol and the patient’s acuity. But deterioration can occur between checks and lead to an ICU transfer.

“We traditionally have seen cases in which a particular patient’s decline was not detected until the patient was quite sick, or in rare cases, could not be revived — there was a suspicion that if we had more information about this patient they might have been caught earlier,” says Erin Sparnon, engineering manager of the health devices group at ECRI.

CMS data from Medicare patient discharge records between 2005 and 2007 showed that respiratory failure and the failure to prevent deterioration were two of the three medical indicators that accounted for 26 percent of the 97,755 reported deaths and over $1.82 billion in excess Medicare costs.

A Vanderbilt University Medical Center study published in 2010 evaluated continuous vital sign monitoring of post-surgical hospital patients. Over the two-year controlled study, 1,270 patients were evaluated. Results showed an 85 percent reduction of unplanned ICU transfers and a 69 percent reduction of unplanned step-down unit transfers for the patients in the study versus non-study patients on the same floors during the same time period.

The medical center concluded that if all of the patients on the study floor were enrolled in the study, the hospital could have saved over $10 million.

With the growing need to reduce hospital costs as well as pressures due to increased health issues among patient populations, these continuous monitors are looking more and more attractive to health care facilities. “There is a heightened awareness of people wanting to monitor patients on the general floor because patients are getting older and sicker, they’re having more potent drugs administered and more difficult procedures,” says Sotera’s Manning.

Solutions to the rescue
ECRI has identified a host of continuous monitor products targeted for use in low acuity areas that they have placed in three main categories. The categories are noncontact monitoring solutions, bedside monitors similar to traditional monitors, but without detailed cardiac monitoring capabilities, and wireless modules that the patient wears. The new Connex Clinical Surveillance System falls into the bedside monitor category and it’s the result of extensive partnerships between Welch Allyn, Masimo, Covidien and EarlySense. It combines a vital signs monitor, acoustic respiration monitoring, end-tidal carbon dioxide technology and contact-free motion, heart and respiratory rate monitoring.

From the start, Welch Allyn decided they didn’t want to compete with the big companies, so they decided to work in partnership with them. “It really made sense to pull them into the Connex system,” says Dave Perkins, senior manager of global marketing programs management at Welch Allyn.

The Connex Vital Signs Monitor measures pulse rate, pulse oximetry and temperature and can be configured as a traditional or continuous spot-check monitor. Based on the hospitals patient population, the facility can choose additional surveillance devices.

For instance, if a hospital wants a respiration monitoring they can choose from Covidien’s Capnography, Masimo’s Acoustic Respiratory Monitoring or EarlySense’s contact- free sensing. The sensor is placed under the mattress and it also measures pulse rate and motion levels.

Clinicians can view all of this information in the patient’s room from the device itself, the Connex Central Station on hallway displays, a mobile device and within the electronic medical record.

In ECRI’s wireless module category, there’s a new wearable monitor that weighs just over four ounces. Sotera’s ViSi Mobile System got FDA approval this past October and the company says it’s the smallest, bodyworn monitor that continuously monitors all vital signs.

It can measure full ECG, heart rate, respiration, skin temperature and noninvasive blood pressure —which sets it apart from the Connex CSS. Since it’s worn on the patient’s wrist, they’re monitored even when they leave their bed.

“Our goal is — let’s take all vital signs, all the time, continually without disturbing the patient and getting the caregiver a dashboard of every patient, every vital sign on all patients,” says Manning.

Like the Connex CSS, the information can be viewed from a central station, on a mobile device or within the EMR.

Uniquely beneficial
When the nurse straps ViSi to the patient’s wrist, they can be continuously monitored in any location within the hospital. Whether they’re in their bed, in the chair by the bedside, walking down the hall, in the bathroom or on transport to a different department, the nurses can monitor them.

But it’s not the only monitor that has that capability. Toumaz Group’s SensiumVitals does as well (iSirona, a NantHealth subsidiary, is the exclusive distributor of the device in North America). But it’s different from ViSi because it’s disposable, doesn’t measure blood pressure, and only measures vital measurements for up to five days.

Toumaz Group conducted a six month pilot at Saint John’s Health Center in Los Angeles monitoring 270 general ward patients from October 2012 to March 2013 to investigate the clinical and economic effects of the technology. They found that it leads to the early detection of deterioration in 12 percent of patients.

The early interventions shortened hospital stays by on average six days and they allowed the hospital to avoid more expensive acute treatments. The average cost savings were $9,000 for each patient.

EarlySense’s contact-free monitoring is one of the things that makes Connex CSS unique. Monitoring heart and respiratory rate is important for obvious reasons, but keeping track of body movement is equally important.

Patient falls are the main cause of hospital- acquired injury and longer hospital stays, according to the Centers for Disease Control and Prevention. The fact that it’s such a big problem makes it one of the nurses’ top concerns. “This is something they’re very in tune with, they’re always having to worry about it,” says Welch Allyn’s Perkins.

Pressure ulcers are another serious problem — about 1.3 to 3 million U.S. patients have pressure ulcers, according to ECRI’s 2008 Top 10 Health Technology Hazards. Additionally, CMS does not pay for pressure ulcers that occur in hospitals because they are believed to be preventable.

Contact-free monitoring is a sensor that goes underneath the patient’s mattress and has multiple levels of sensitivity. If the patient just got out of the operating room, the nurse would set it to the highest sensitivity, but if the nurse just wants to know when the patient is shifting around in bed, they would set it to a normal sensitivity level.

“Because it can sense patients moving around, it can give nurses that heads up that they really need,” says Perkins.

ViSi does not currently have this capability, but Sotera says that it is something they plan on offering in the future.

Lifting the burden
So the hospital saves money and the patient has better outcomes, but what about the nurse? On medical surgical floors, nurses can be in charge of up to eight patients at the same time.

“For you to keep track of all those patients and do all the paperwork you have to do and get ready to deliver meds and talk to physicians and talk to family members, it’s a really, really tough job on a med-surg floor,” says Perkins.

Having the continuous vital measurements in the hallways or in the palm of their hand can make a huge difference for nurses. “It benefits the clinician because they know the current status of their patients all the time and have the comfort of knowing that they’ll get timely information, they can respond quicker and without burdening the patient to get more information,” says Sotera’s Manning.

It also allows them to spend more time focusing on the actual information than on acquiring the information, he says.

Perkins says that he has received a lot of positive feedback from the nurses that use Connex CSS. “What we’ve heard is that it lets nurses do more of what they need to be doing — it’s usually what they call they’re critical nursing skills — where they’re looking at the data and trying to decide what it is, rather than just reacting to things, which they often have to do now,” he says.

Continuously monitoring patient in low-acuity areas has been shown to bring benefits to hospitals, patients and nurses but whether it will become a standard of practice in the future remains unknown.

Since the interest in the marketplace intensified about a year ago, ECRI said they will need to continue to monitor the technological development from the manufacturing side and the interest in hospitals to adopt the technology.

“This is definitely still a learning process for our side and the hospital side,” says ECRI’s Wong.

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