Remote monitoring has proven to be an unanticipated patient safety benefit during the COVID-19 outbreak, according to caregivers.
Authors from University Hospitals and Case Western Reserve University write about the unanticipated patient safety advantage of remote patient monitoring during the COVID-19 epidemic in an opinion piece published online Feb. 25 in the Journal of the American Medical Association.
Although COVID-19 placed undue psychological and moral stress and work demands on patients, clinicians, health care organizations, and society, the pandemic also increased patient safety in an unforeseen way, according to Peter Pronovost, MD, Ph.D., Melissa Cole, MSN, and Robert Hughes, DO.
Prior to the pandemic, patients were routinely monitored with continuous pulse oximetry and heart rate devices based on their position inside a hospital, usually the intensive care unit (ICU). Pulse oximeters are little electrical devices that attach to the finger and monitor the oxygen saturation in red blood cells. The use of these devices for monitoring has been linked to a lower death rate in studies.
Many patients were treated outside of the ICU in emergency departments or regular medical and surgical units as the pandemic overwhelmed hospitals with people and overflowed ICUs. Patients with lesser symptoms were advised to stay at home at several medical centers.
Dr. Pronovost, Chief Quality and Clinical Transformation Officer at UH and Clinical Professor of Anesthesiology and Perioperative Medicine at Case Western Reserve School of Medicine, said, “One of the major lessons learned from the pandemic was that patients could now be monitored based on risks and needs rather than location in the hospital.”
“Hospital at-home models and home monitoring have the potential to change treatment and allow a significant proportion of hospitalized patients to receive care at home.”
The authors go over the advantages of remote monitoring in the hospital and at home, as well as the technological advancements that made it possible, how government payment policy changes made home monitoring sustainable, and what health systems may do to start a home monitoring program.
Continuous remote monitoring of hospitalized patients in general medical settings, according to Ms. Cole, Vice President of Integrated Delivery Operations at UH, not only improves outcomes but also boosts accuracy.
“Some of these patients can now be monitored at home or in skilled nursing facilities because to technological advancements. Health systems may now use at-home continuous pulse oximeters to monitor patients and help them avoid hospitalizations thanks to innovations like wireless monitors, cloud-based platforms, and telehealth “Ms. Cole stated.
According to the authors, a study found that remote monitoring was associated with a lower mortality rate in COVID-19 patients when compared to patients who did not have at-home monitoring: “…a mortality rate of 6 per 1,000 patients with COVID-19 compared to 26 per 1,000 patients without at-home monitoring.”
They report that compared to normal treatment, this analysis predicted 87 percent fewer hospitalizations, 77 percent fewer deaths, and $11,472 in per-patient expenses.
“By combining telehealth, home health, and remote monitoring, some hospital-level monitoring services might be delivered to patients at home,” Ms. Cole added.
Despite these advancements, the authors discover that health systems do not widely deploy broad hospital and home monitoring services. They list a number of obstacles that healthcare systems must overcome.
“All hospitalized patients and emergency department patients should have continuous pulse oximetry and heart rate monitoring,” said Dr. Hughes, Medical Director of System Operations and Logistics for UH and Assistant Professor of Emergency Medicine at Case Western Reserve School of Medicine.
“Patients are at a higher risk of undetected deterioration due to greater census, sicker patients, and reduced staffing for most clinical responsibilities. Continuous monitoring by a centralized team could improve patient safety and reduce physician workload “he stated
Other suggestions include creating a service line to coordinate this work, understanding how to mix and integrate these many technologies to maximize value, and developing processes for selecting and enrolling patients that match their risks and needs with the various types of monitoring.
Ms. Cole noted that the pandemic’s lessons helped pave the way for UH’s [email protected] initiative, the first of its type in the health system, to launch in 2021.
“We deployed UHRemote, a remote patient monitoring device, during the early days of the pandemic to keep track of COVID-19 patients’ heart rate and blood oxygenation levels.
A group of nurses, each with numerous screens, monitored patient data dashboards and received warnings from wearable devices if a patient’s values were abnormally high or low.
We learned a lot from the more than 2,200 patients we looked for throughout that year, and we frequently heard how grateful they were not to be separated from their families and alone in the hospital. We blended UHRemote’s skills with our Home Health experts’ decades of knowledge, added a few more services, and UH [email protected] was formed “she stated