By Julie Andrews and James Laskaris
Physiological patient monitoring is a critical tool for measuring the health of patients and their reaction to a therapy.
The basic technology has been around since the early 1950s, with systems that provide ECG waveforms, alarms, and heart rate information. Next-generation systems targeted the operating room and critical care areas by adding EEG, invasive pressures, temperatures, and ECG parameters. Starting in the 1970s, the monitoring systems added arrhythmia analysis and trending. Current-generation systems target remote monitoring, early warning for diseases (a form of AI), and the interfacing of monitoring to an EMR (to access Big Data).
The U.S. market is expected to surpass $6 billion by 2023, reflecting a growth of more than 25 percent in the last seven years. Driven by new technology the monitoring market is evolving to focus on providing solutions for value-based care, improving operational effectiveness, and leveraging big data — three significant challenges for healthcare providers.
With the focus on outpatient care, only the sickest of patients are admitted to the hospital. Currently over 5 million patients are admitted to an ICU for intensive monitoring each year. As the patient population ages, this number will continue to grow. Though telemedicine is slowly gaining CPT codes and reimbursement, one challenge to patient monitoring is the lack of direct payment for the use of the technology in an inpatient setting. This can be significant, considering that an 8-bed system starts at $120K and can easily reach over $200K for an integrated system. Payback for this investment is seen in early detection and monitoring treatment, which translates to a shorter length of stay at lower cost.
Five major factors are involved in the purchase of patient monitoring: level of technology, integration ability, standardization, mobility, and cost. Various monitoring systems are stronger in some operations than others, and these factors may weigh more or less heavily depending on their importance to your facility. I recommend that you rate these factors in order of importance relative to your needs. This will help point you to a system that best fits your needs.
Choosing the right mix of patient parameters, software, and networking can be a challenge. According to the American Hospital Association the life expectancy of a patient monitor is 7 years. So, selecting a system will have long-term repercussions. Monitors range from the simplest blood pressure cuff to advanced multi-parameter screens used in the most complex of operating room scenarios. With this variety and range in options as well as pricing, how does one decide on an appropriate monitor for a specific area of care? Providers must decide how much monitoring is too much or too little and at what cost. Historically this was based on a clinician’s input. Now such decisions are made by a team of clinicians, physicians, clinical engineering, administration members, IT, and financial representatives.
Selecting advanced patient parameters can be import to patient outcomes. One prime example is EtCO2. Once only an OR parameter, EtCO2 is now finding its way into the ICU, ED, and general medical surgical areas of care. A study in Scientific Reports (2019) supported using EtCO2 monitoring in patients undergoing general anesthesia, which has been the norm, as well as those under procedural sedation. Monitoring that leads to earlier detection and intervention of potential respiratory depression can improve patient safety by reducing sedation-related adverse events such as delayed recovery, permanent hypoxic injury, and even death.
By using the monitor to assist in the prevention of adverse patient events, both the patient and facility benefit. The same EtCO2 module can be key in preventing failure to rescue scenarios throughout the acute care and ambulatory care areas. Value-based care can be directly affected by selecting the appropriate monitoring parameters in each area of care. This one parameter can help to increase reimbursement tied to delivery of care, improve patient throughput, and most important, improve quality of patient care.
Allied healthcare professionals and acute care providers alike have myriad options available to customize the monitoring in their areas of practice. The consistent challenge is whether that monitor and associated parameters will be able to connect with the guiding facility’s electronic health record (EMR). If the sharing and transfer of data stops at the door of the provider, then the value of the monitor has been greatly diminished. However, if that monitor has the capability to share the patient data within the total healthcare system, the patient care cannot only be improved but be made more efficient.
Does this mean that every procedural area, both in and out of the acute care setting, needs high-end, multi-parameter monitoring? No. The ability to customize monitoring from today’s major vendors allows monitors to be designed to fit each care area and to be portable between areas. It is inefficient use of capital funds to over-purchase patient monitoring. The most cost-effective strategy is to look at the varying levels of care within a facility and purchase a monitor that can be integrated with modules to provide the level of assessment for each particular patient.
The bottom line is: hospitals are treating sicker patients, and patient monitoring, if configured effectively, can be a key tool in improving outcomes and operational effectiveness. The challenge of this technology is matching the right system to an evolving patient mix and keeping in mind that it is a decision that a hospital will have to live with for many years.
About the authors: Julie Andrews is a clinical analyst at TractManager. James Laskaris is a senior clinical strategist at TractManager.