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Imagine, for a moment, a 500-bed hospital. Imagine 500 patients. Imagine the ventilators, heart rate monitors and dialysis machines to which they are linked. Then imagine the results of their imaging studies. Finally, imagine the unceasing flow of data generated.
Regardless of one's imaginative powers, medical devices clearly produce astounding amounts of valuable patient data. What's more astonishing, arguably, is that many facilities still use hand transcription and keying to get data from a device to the electronic medical record (EMR).
Medical device integration (MDI), or device connectivity, automates this process by funneling data from medical devices directly into an EMR, profoundly influencing quality, care delivery and clinician workflow and efficiency. More importantly, the benefits of MDI are intrinsically related to patient safety.
Decrease Documentation, Increase Direct Care
A lot changes when hospitals automate medical device data flows. For one, nursing documentation responsibilities are greatly reduced. In the absence of MDI, however, nurses spend a disproportionate amount of their time documenting data rather than taking care of patients. A 36-hospital time-and-motion study published in a 2008 issue of The Permanente Journal revealed that nurses spent just 81 minutes per shift on patient care and 148 minutes - or nearly twice as much time - on documentation.
Because MDI lightens clinicians' documentation workloads, it enables them to spend more time doing what they do best: delivering direct care. Clinicians at MetroSouth Medical Center in Chicago experienced this following the hospital's integration efforts. According to MetroSouth Nurse Informaticist John Ratko, MDI is saving nurses in the cardiac recovery unit approximately two hours per shift.
"What do you do with two hours of found time per nurse? Increase direct care. It's all about getting the nurse away from busy work and back to the patients," says Ratko.
What does time spent delivering direct care have to do with patient safety? A lot. Studies show that direct-care time significantly affects clinical outcomes. In fact, the National Foundation for American Policy (NFAP) stated in its piece "Deadly Consequences: The Hidden Impact of America's Nursing Shortage" that "greater registered nurse hours spent on direct patient care were associated with decreased risk of hospital-related death and shorter lengths of stay."
Patient Data Capture
When it comes to patient safety, the EMR can only be as good as the data chain feeding it. If the data in the EMR is wrong or out of date, the system is nothing more than a rapid-access gateway to inferior data.
How does flawed information make its way into the EMR? Consider the data chain. Without MDI, patient data is hand-keyed into the EMR. This approach is relatively error-prone, and data entry errors simply have to be expected.
Here's the good news: Device connectivity reduces the risk of inaccurate transcriptions through seamless data capture. No handwritten notes. No transcribing. No paper.
It's important to note, however, that although automated data is technically error-free, that data will be of little value if it flows into the wrong patient's chart. Just as data from paper charts can end up in the wrong patient file, so, too, can automated data flow into the wrong digital record. For this reason, device integration applications rely on association solutions to ensure accurate patient identification and increased safety.
Specifically, some association solutions are patient-centric, using barcode or radio frequency identification (RFID) methods. Others rely on location-specific associations such as bed or room numbers to match patients to device data. In ever-changing hospital environments, however, the former leads to superior data accuracy, reliability and patient safety because patient-to-device association reduces the risk of patient data being delivered to the wrong record. When device data is tied to a bed or location, where different patients come and go, there is the potential for data to be attached, or "associated," to the wrong patient.
Real-Time Data, Enterprise Wide
Just as data accuracy improves with MDI, so does data latency. Because automation funnels patient data to the EMR faster, clinicians have access to near real-time information about their patients. This, in turn, allows them to make better-informed decisions related to patient care.
Take bedside patient monitors, for example. In the absence of device connectivity, clinicians typically acquire a patient's vital signs from the device, write them down on paper, then enter them later into the EMR in multiple-patient batches.
How much later? The answer will vary from facility to facility, but the time lag can be substantial. When Decatur, Texas-based Wise Regional Health System (WRHS) hired a third-party consulting firm to assess its performance in this area, it found that an average of 12 hours passed between the time a patient monitor generated data and that information was validated and available in the EMR. But after implementing a device connectivity solution, WRHS improved turnaround to just two hours.
Enhanced Alarm Systems
When it comes to patient safety, few issues carry as much weight as clinical alarms. Fortunately, just as device connectivity enhances access to real-time data in the EMR, it improves clinical alarm systems.
More specifically, connectivity between devices, communications systems and information systems within a hospital augments alarm systems through extensions and descriptive alerts.
Consider a perfectly configured, clinically relevant, audible alarm. Imagine it sounding behind a closed door in a room at one end of an L-shaped, variable acuity unit. The clinician on duty, however, is at the other end of the L helping another patient and cannot hear the alarm.
In an integrated hospital, this alarm could reach the clinician in a number of ways. Perhaps the alarm is extended to a fully integrated communications system that routes the alarm to the clinician's smart phone. In a similar fashion, perhaps the clinician notices the alarm while viewing another patient's monitor. Because the two patients' monitors are integrated, the clinician becomes aware of the alarm even though it isn't audible.
Likewise, alarm messages can be bundled with descriptive text in integrated hospitals. For example, clinicians can receive alerts indicating not only that a threshold has been crossed, but also by how much. This description would give clinicians the information they need to make informed decisions about how to respond and keep patients safe.
No doubt, patient safety is a sensitive issue. This is as it should be, as a patient's well-being is paramount. Fortunately, device connectivity can improve patient safety through increases in direct care, accurate device data captures, up-to-date EHRs and integrated alarm systems.
Dave Dyell is CEO of iSirona, a provider of simplified solutions for medical device connectivity.
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