Cargando…

A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration

The traditional paradigm of hospital surgical ward care consists of episodic bedside visits by providers with periodic perusals of the patient’s electronic health record (EHR). Vital signs and laboratory results are directly pushed to the EHR but not to providers themselves. Results that require int...

Descripción completa

Detalles Bibliográficos
Autores principales: Safavi, Kyan C., Deng, Hao, Driscoll, William, Nikolov, Milcho, Tolia, Kalpan, Wiener-Kronish, Jeanine P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkin 2021
Materias:
8
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415733/
https://www.ncbi.nlm.nih.gov/pubmed/33830955
http://dx.doi.org/10.1213/ANE.0000000000005530
_version_ 1783748028004302848
author Safavi, Kyan C.
Deng, Hao
Driscoll, William
Nikolov, Milcho
Tolia, Kalpan
Wiener-Kronish, Jeanine P.
author_facet Safavi, Kyan C.
Deng, Hao
Driscoll, William
Nikolov, Milcho
Tolia, Kalpan
Wiener-Kronish, Jeanine P.
author_sort Safavi, Kyan C.
collection PubMed
description The traditional paradigm of hospital surgical ward care consists of episodic bedside visits by providers with periodic perusals of the patient’s electronic health record (EHR). Vital signs and laboratory results are directly pushed to the EHR but not to providers themselves. Results that require intervention may not be recognized for hours. Remote surveillance programs continuously monitor electronic data and provide automatic alerts that can be routed to multidisciplinary providers. Such programs have not been explored in surgical general care wards. METHODS: We performed a quality improvement observational study of otolaryngology and ophthalmology patients on a general care ward from October 2017 to March 2019 during nighttime hours (17:00–07:00). The study was initiated due to the loss of on-site anesthesiology resources that historically helped respond to acute physiologic deterioration events. We implemented a remote surveillance software program to continuously monitor patients for severe vital signs and laboratory abnormalities and automatically alert the ward team and a remote critical care anesthesiology team. The primary end point was the true positive rate, defined as the proportion of alerts that were associated with a downstream action that changed the care of the patient. This was determined using systematic chart review. The secondary end point, as a measure of alarm fatigue, was the average number of alerts per clinician shift. RESULTS: The software monitored 3926 hospital visits and analyzed 1,560,999 vitals signs and 16,635 laboratories. It generated 151 alerts, averaging 2.6 alerts per week. Of these, 143 (94.7%) were numerically accurate and 8 (5.3%) were inaccurate. Hypoxemia with oxygen saturation <88% was the most common etiology (92, 63%) followed by tachycardia >130 beats per minute (19, 13.3%). Among the accurate alerts, 133 (88.1%) were true positives with an associated clinical action. Actions included a change in management 113 (67.7%), new diagnostic test 26 (15.6%), change in discharge planning 20 (12.0%), and change in level of care to the intensive care unit (ICU) 8 (4.8%). As a measure of alarm fatigue, there were 0.4 alerts per clinician shift. CONCLUSIONS: In a surgical general care ward, a remote surveillance software program that continually and automatically monitors physiologic data streams from the EHR and alerts multidisciplinary providers for severe derangements provided highly actionable alarms at a rate that is unlikely to cause alarm fatigue. Such programs are feasible and could be used to change the paradigm of monitoring.
format Online
Article
Text
id pubmed-8415733
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Lippincott Williams & Wilkin
record_format MEDLINE/PubMed
spelling pubmed-84157332021-09-13 A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration Safavi, Kyan C. Deng, Hao Driscoll, William Nikolov, Milcho Tolia, Kalpan Wiener-Kronish, Jeanine P. Anesth Analg 8 The traditional paradigm of hospital surgical ward care consists of episodic bedside visits by providers with periodic perusals of the patient’s electronic health record (EHR). Vital signs and laboratory results are directly pushed to the EHR but not to providers themselves. Results that require intervention may not be recognized for hours. Remote surveillance programs continuously monitor electronic data and provide automatic alerts that can be routed to multidisciplinary providers. Such programs have not been explored in surgical general care wards. METHODS: We performed a quality improvement observational study of otolaryngology and ophthalmology patients on a general care ward from October 2017 to March 2019 during nighttime hours (17:00–07:00). The study was initiated due to the loss of on-site anesthesiology resources that historically helped respond to acute physiologic deterioration events. We implemented a remote surveillance software program to continuously monitor patients for severe vital signs and laboratory abnormalities and automatically alert the ward team and a remote critical care anesthesiology team. The primary end point was the true positive rate, defined as the proportion of alerts that were associated with a downstream action that changed the care of the patient. This was determined using systematic chart review. The secondary end point, as a measure of alarm fatigue, was the average number of alerts per clinician shift. RESULTS: The software monitored 3926 hospital visits and analyzed 1,560,999 vitals signs and 16,635 laboratories. It generated 151 alerts, averaging 2.6 alerts per week. Of these, 143 (94.7%) were numerically accurate and 8 (5.3%) were inaccurate. Hypoxemia with oxygen saturation <88% was the most common etiology (92, 63%) followed by tachycardia >130 beats per minute (19, 13.3%). Among the accurate alerts, 133 (88.1%) were true positives with an associated clinical action. Actions included a change in management 113 (67.7%), new diagnostic test 26 (15.6%), change in discharge planning 20 (12.0%), and change in level of care to the intensive care unit (ICU) 8 (4.8%). As a measure of alarm fatigue, there were 0.4 alerts per clinician shift. CONCLUSIONS: In a surgical general care ward, a remote surveillance software program that continually and automatically monitors physiologic data streams from the EHR and alerts multidisciplinary providers for severe derangements provided highly actionable alarms at a rate that is unlikely to cause alarm fatigue. Such programs are feasible and could be used to change the paradigm of monitoring. Lippincott Williams & Wilkin 2021-04-08 2021-10 /pmc/articles/PMC8415733/ /pubmed/33830955 http://dx.doi.org/10.1213/ANE.0000000000005530 Text en Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle 8
Safavi, Kyan C.
Deng, Hao
Driscoll, William
Nikolov, Milcho
Tolia, Kalpan
Wiener-Kronish, Jeanine P.
A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration
title A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration
title_full A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration
title_fullStr A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration
title_full_unstemmed A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration
title_short A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration
title_sort remote surveillance platform to monitor general care ward surgical patients for acute physiologic deterioration
topic 8
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415733/
https://www.ncbi.nlm.nih.gov/pubmed/33830955
http://dx.doi.org/10.1213/ANE.0000000000005530
work_keys_str_mv AT safavikyanc aremotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT denghao aremotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT driscollwilliam aremotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT nikolovmilcho aremotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT toliakalpan aremotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT wienerkronishjeaninep aremotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT safavikyanc remotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT denghao remotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT driscollwilliam remotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT nikolovmilcho remotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT toliakalpan remotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration
AT wienerkronishjeaninep remotesurveillanceplatformtomonitorgeneralcarewardsurgicalpatientsforacutephysiologicdeterioration