In order to improve and streamline throughput in intensive care, the University of Pittsburgh Medical Center (UPMC) was considering a flexible cardiac monitoring system. To justify the potential purchase, we implemented an extensive testing program to determine whether such a system would truly make an impact on hospital costs, staffing and patient care.

As a result of the tests conducted, we selected Welch Allyn's patient monitoring system because it demonstrated return on investment (ROI) in a little more than three months while shortening length of patient stay with the surgical population, improving patient safety, alleviating ICU overcrowding, decreasing emergency department diverts and decreasing hospital operating expenses overall.

Demonstrating need

UPMC had a definite need to streamline throughput in the hospital, beginning with the ICU. The hospital had only one step-down monitoring unit, which was designed to care for high-acuity patients as they transitioned from ICU to the general floor. The step-down unit featured a specialized nursing staff and in-depth monitors for high-acuity patients. Many times, however, the step-down unit became overcrowded because patients in transition needed some monitoring, but not at the high level the step-down unit provided. Those mid-range patients, in effect, had no appropriate place to go or suitable level of monitoring available, so they taxed the step-down unit's nurses, who were specially trained and paid a higher wage.

Throughput solutions

The best opportunity to improve throughput was to provide flexible cardiac monitors on the general floor. This allowed transitory patients to be monitored appropriately without utilizing a step-down bed.

Welch Allyn offered an easy-to-use, rugged and reliable monitor that we thought would fit our needs at UPMC. To obtain administration's backing for this purchase, we needed to conduct a study to prove that the vendor's product would meet our needs and demonstrate ROI.

To move ahead on this initiative, we held product acquisition meetings to determine the potential value of the technology and plan the testing procedure we would implement. We selected another vendor's monitoring system as the comparative solution for the testing period and had the two vendors install their systems over a period of two months.

Overcoming challenges

Several challenges had to be overcome in implementing cardiac monitoring on the general floor. First, the med-surg nurses felt they did not have the expertise to monitor these patients. Some feared that patients would be triaged inappropriately, potentially leading to dangerous situations that they were not trained to handle. The nurses knew they needed training to understand cardiac rhythm monitoring and to know when to ask for intervention, so we had to provide them with ample information and training to make them comfortable with the monitors.

Administrative red tape was another challenge. We needed to prove beyond a shadow of a doubt that the monitors would benefit the hospital financially and practically. Finally, we had to coordinate across multiple departments including biomed, information systems, administration and cardiac care to implement the test.

Implementation steps

To help us with implementation, Welch Allyn sent nurses to provide in-service training for all our staff. Additionally, our internal nursing education personnel conducted a 12-hour course for all nurses to make sure they understood the assessment tools available.

It was also important to introduce the monitors to our physicians. We demonstrated the monitors to the medical executive committee and held an open house for UPMC physicians and the medical residents to make sure they were on-board with the change.

Finally, some technical details needed to be resolved. The monitors were linked to a central station, and required us to have two certified cardio technicians in the hospital at all times to watch the central station, change the monitor's batteries every six hours, and ensure that the process ran smoothly. We hired the technicians and purchased red, one-way heart phones for the floors using monitors. These special phones were a direct connection to the cardio technicians so they could immediately alert nurses to patient problems identified.

Monitoring results

Based on the internal research conducted, we chose Welch Allyn monitors over the competing system. The main reasons we chose them include the following:

• We recognized a quick ROI (approximately 3.2 months).
  
• Welch Allyn monitors deliver a high level of cost savings and incremental revenue opportunities (approximately $1,122,834/year).
  
• The system is user-friendly, which simplified our training process.
  
• The company responded well to all our questions and demonstrated its knowledge about the market, making it the best overall solution for our hospital.

Juli Patterson is a nurse manager at UPMC in Pittsburgh.