How mobile continuous monitoring can help improve patient care and the clinician experience in general care units

Insights, interviews, and best practices by clinicians for clinicians. Welcome to GE HealthCare's Clinical View Podcast.

Stephanie Kovalick: Thank you for joining our conversation today on how mobile continuous monitoring can improve patient care and the clinician experience in general care units. I'm Stephanie Kovalick, Chief Strategy Officer at Sage Growth Partners, and I'm joined today by Dr. Bernd Saugel, Professor of Anesthesiology and Vice Chair of the Department of Anesthesiology in the Center of Anesthesiology and Intensive Care Medicine at the University Medical Center, Hamburg-Eppendorf, Hamburg, Germany. Today, we will be discussing some of the less obvious but equally critical positive ripple effects of continuous monitoring beyond early detection of deterioration.

Professor Saugel, thank you very much for joining us today. I'd like to get started by having you share a little bit more about your clinical and academic background, and also why we should be invested in change at hospitals. Why does there need to be a next generation of monitoring in general care wards and hospitals?

Prof. Bernd Saugel: Thank you for having me. My background primarily is anesthesiology and intensive care medicine, but I'm also board certified in internal medicine. Currently, I serve as a Professor of Anesthesiology and Vice Chair of the Department of Anesthesiology at the University Medical Center in Hamburg, Germany.

My research focus is hemodynamic monitoring and management to improve patient safety and patient-centered outcomes in patients having major surgery. I'm involved in research on optimizing patient outcomes in both perioperative and critical care settings, but our work more and more now focuses on improving continuous monitoring technologies and adapting them to broader clinical environments like general care wards. As for why we need change in hospitals, well, the reality is that general care wards are often seen as safer and less critical compared to intensive care units or operating rooms, but they can be very dangerous places.

The way we monitor our patients today in these wards, using intermittent spot checks by nurses every four to eight hours, leaves patients unmonitored for most of the time, and thus vulnerable to periods of unmonitored deterioration. And recent research shows that many adverse events and complications in hospitals just occur on general wards, and patients usually develop abnormal vital signs hours before serious complications, such as a cardiac arrest, occur, but without continuous monitoring, these early signs of deterioration usually go unnoticed. And this is where the next generation of monitoring comes in by integrating wireless, variable, and continuous monitoring systems.

We may detect vital sign trends earlier and intervene before they become life-threatening.

Stephanie Kovalick: So that's great. So there are a lot of really interesting clinical implications of continuous monitoring. Let's talk about some of the different kinds of impacts that continuous monitoring might have in the general care unit, starting with the patients themselves.

Beyond the data we get about their vital signs and kind of the clinical impacts, how might continuous monitoring improve the overall experience for the patient?

Prof. Bernd Saugel: Well, continuous monitoring isn't just a technological upgrade. It's maybe a fundamental paradigm shift in how we deliver care in general wards to our patients. And it may move us from kind of a reactive to a proactive patient management strategy because continuous monitoring has the potential to transform the patient experience in general care units, going beyond just providing data about their vital signs.

I think one of the biggest drawbacks of traditional monitoring, the way we monitor patients today is that patients are often tethered to the bed by bulky equipment, which is counterproductive, of course, to their recovery because keeping patients immobile just for the sake of monitoring can lead to complications and reduce mobility and result in longer hospital stays. And this is particularly a problem for patients who would otherwise benefit from early mobilization. And the solution to this challenge probably is wireless and variable monitoring.

And these technologies would allow patients to move freely around the ward without being confined to their beds. And early mobilization, again, is an important thing and promotes faster recovery. And I would say from a psychological perspective, patients who can move around tend to feel more independent and in control of their recovery.

And this can have a positive impact on the mental wellbeing, reducing feelings of anxiety and helplessness. And yeah, so in short, wireless continuous monitoring may enhance both the physical and emotional aspects of patient care and improve overall outcomes and create a more comfortable and empowering hospital experience for the patient.

Stephanie Kovalick: Yeah, that's really interesting. If we think beyond the patient, in a 2021 study in hospital pediatrics, which is the official journal of the American Academy of Pediatrics, the researchers found that the parents of hospitalized children felt that continuous monitoring provided them with some added reassurance and also helped them feel that they were participating in their child's care. Do you agree that a positive impact on families is another positive ripple effect of continuous monitoring?

Prof. Bernd Saugel: Yeah, that is an interesting aspect. Continuous monitoring may indeed have a positive impact on families because patient families often feel anxious and helpless, particularly because they can't be with their loved ones all the time. And continuous monitoring may provide a sense of reassurance that their family member is being closely monitored even when they are not physically present themselves.

And continuous monitoring may help families know that their loved ones are getting a very high level of care with real-time data being captured and reviewed all the time and they understand that early signs of deterioration will be caught and be reacted on. And additionally, when the patient is mobile because of wireless verbal monitoring, it may further enhance the experience of both the patient and the families because the patient can interact more freely with their loved ones. For example, they can take a walk together or visit the cafeteria, and this mobility may make family visits more engaging and meaningful.

And continuous monitoring may help build trust in the healthcare system in general because families and patients then know that the patient's condition is continuously monitored and that interventions can be made immediately when needed.

Stephanie Kovalick: Yeah, that's great. So a pretty significant impact on the patient experience, the family experience. If we bring it around to the clinician's point of view, how do you think continuous monitoring can affect the clinician's day-to-day experience?

Prof. Bernd Saugel: Well, continuous monitoring may improve the day-to-day experience for clinicians, nurses, and doctors on general care wards, particularly as we all over the world have the problem of staff shortage and patients being more and more complex, sicker, and older. And by providing real-time, reliable monitoring data, this will help to reduce kind of the cognitive burden for clinicians because clinicians then could focus on higher priority tasks rather than manually checking the vital signs every few hours. And it may also enhance the confidence in clinical decision-making because when continuous monitoring provides accurate vital sign monitoring and timely and smart alarms, then clinicians can be more assured that they are catching early signs of deterioration and can respond to them properly and are not only alarmed when there is a life-threatening condition.

Stephanie Kovalick: So increasing confidence, that's great. You also said it allows them to kind of reinvest some of their time into kind of higher-order tasks and activities. To round out the discussion, how would this change where they spend their time?

Prof. Bernd Saugel: Well, I think that continuous monitoring has the potential to shift the focus of the clinicians towards those patients who actually require most of the attention because currently our nurses perform routine spot checks on all patients, again, typically every four to eight hours, and this is mostly regardless of the condition of the patients. So my personal perspective on this is that not every patient on a general care ward needs to be checked every four to eight hours, but that there are some patients who need high-frequent or continuous monitoring. So if you imagine, for example, taking care of 30 patients on a given general ward, there are probably five patients who require continuous monitoring, those who are the sickest patients.

Five patients may be there who require monitoring only every hour or so, and probably 20 patients for the rest of the 20 patients, for them it would be enough to measure a vital sign once a day. So currently nurses routinely measure everybody's vital signs every four to eight hours, whatever the patient's condition is, and this is where continuous monitoring would make a big difference because continuous monitoring may help you identify those patients who actually acquire most of your attention. And by identifying patients who need more frequent attention and which those are the ones who are kind of hemodynamically instable or develop alteration in the vital signs, clinicians could then focus their time and energy on these patients who are at the highest risks.

And this change would also allow clinicians to spend more kind of personalized time with the patients, improving both the patient's care and the clinician experience, and continuous monitoring may thus reduce the burden of unnecessary checks and let clinicians allocate their time more efficiently to those patients who actually need it.

Stephanie Kovalick: So the continuous monitoring, if I'm hearing you correctly, so there is an opportunity to improve outcomes, improve the patient experience and satisfaction, improve the clinician experience and also satisfaction, is it allowing them to really do the work that they're trained to and want to do and provide for their patients?

Prof. Bernd Saugel: This is an accurate summary, but of course we need to keep in mind that all of what we now discussed is kind of has some prerequisites. And this is of course that those monitoring systems are implemented in routine clinical care, that those monitoring systems provide all the vital signs accurately, and that we handle the alarms in a smart way so that we avoid alarm fatigue. But if those conditions are fulfilled, I would say that continuous vital sign monitoring in patients treated on general care wards has the potential to improve patient-centered outcomes, to improve the experience of patients and patients' families, and to make the work of clinicians on the wards easier and allow them to focus on those patients who are really sick.

Stephanie Kovalick: That's great, fantastic. Thank you so much for sharing these insights with us, Professor Saugel. Although monitoring is currently a pain point for hospitals, it's clear that the next generation of solutions has an opportunity to not only improve outcomes like we've talked about, but also improve the experience of clinicians, patients' families, and of course the patients themselves.

Thank you to everybody for listening to us today. It's been great, and we've enjoyed spending the time with you.

Thank you for listening to Clinical View Podcasts. Brought to you by GE HealthCare. Expand your view at clinicalview.gehealthcare.com.