Covenant finishes pilot study on remote monitoring

Covenant finishes pilot study on remote monitoring

URBANA — Some patients need some extra surveillance when they're in the hospital, but the extra eyes and ears watching more at-risk patients aren't necessarily in the same building — or even the same city — as the patients are.

Presence Health hospitals have been using remote patient monitoring for adult intensive care unit patients for a decade, and Presence Covenant Medical Center recently completed a pilot study using a similar system to also remotely watch over patients at higher risk of falling.

Medical specialists at a Presence Health facility in Bolingbrook are doing the watching for both ICU and fall-risk patients using video and voice technology. Intensive care specialists, for example, monitor intensive care patients' vital signs and can examine them by camera if necessary and alert the care team at the hospital if something is wrong, according to Dr. Jared Rogers, CEO of Covenant and Presence United Samaritans Medical Center.

The doctors and nurses in Bolingbrook "see the heart, respirations, blood pressure on their monitor just like we see it locally," he said.

Using remote monitoring for fall-risk patients means medical personnel in Bolingbrook can spot a patient about to get out of bed alone and quickly advise the patient to stay in bed until the nurse arrives to help, Rogers said.

Covenant, like many other hospitals, has used medical staff as bedside sitters to watch over patients identified as fall risks, "but if you do this a lot, it's pretty labor-intensive," Rogers said.

Covenant's experiment with remote-monitoring fall risks worked well enough to be considered for use at other Presence hospitals, he said. Remote monitoring prevented 15 patient falls at Covenant over 69 days, according to Covenant.

Patient falls take a big toll on both the patients and the health care system in general.

One-third of patients who fall during hospital stays are injured, extending the time of their hospitalization by an average 6.3 days and adding about $14,000 to the cost of care, according to the Joint Commission, an accrediting agency for hospitals. Some 11,000 annual hospital patient falls in the U.S. are fatal.

Medicare began cracking down on patient falls in 2008, including those falls on its list of events that should never happen in hospitals and limiting reimbursement for falls that result in certain injuries.

At Covenant, patients considered to be fall risks are identified when they're admitted and identified with such things as bracelets and yellow socks, according to Lori Lamarra, Presence Health's regional director of risk management.

Bedside sitters are also still used for some of the fall-risk patients at Covenant, since the hospital lacks enough equipment to use remote monitoring for all those patients, she said.

Covenant reduced its patient falls last year over the previous year, Lamarra said, but some patients are still prone to falls at all hospitals for a variety of reasons. They're ill. They're medicated. They're in unfamiliar environments in rooms full of hospital equipment, she said. In some cases, patients' mental states have changed due to their injuries and illnesses.

A fall is considered any unplanned descent to the floor, Lamarra said, and that even includes those times when a health care worker lowers a patient to the floor to avoid an accidental fall.

Rogers said patients who are fall risks are monitored remotely or in person, regardless of whether they have family members at the bedside with them.

"It shouldn't have to be the family's responsibility to keep them from falling," he said.

Covenant and United Samaritans also recently began using an audio-visual system similar to the one used to prevent patient falls at Covenant to connect vascular neurologists in Joliet to emergency room doctors to evaluate and get faster treatment to patients who have suffered strokes.

"If someone presents with a stroke, we can have a vascular neurologist talking to the family and examining the patient," Rogers said.

The first stroke patient at United Samaritans who was assessed this way was quickly started on clot-busting drugs within 12 minutes of arriving through the hospital doors, Rogers said.

Elsewhere, the use of remote monitoring varies by hospital.

Carle specialists consult with patients in rural communities via telemedicine using two-way voice and video communications. But Carle Foundation Hospital does all monitoring for its own hospital patients in-house, even when a video monitor is used, according to Carle spokesman Mark Schultz.

Sarah Bush Lincoln Health Center in Mattoon began using remote monitoring for its critical care patients this month, using a large national provider of tele-ICU services, Advanced ICU Care.

That service uses critical care-trained doctors and nurses to monitor patients' vital signs and test results and communicate with in-hospital staff, according to Sarah Bush Lincoln.

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