​The Challenge

Several years ago, Cedars-Sinai Medical Center (Los Angeles, CA) determined that its cardiac monitoring program would not sufficiently meet the future needs of the facility's patients. The facility projected that the demand for cardiac monitoring would exceed the available number of monitored beds—a situation that could lead to delays in delivering care. And it wished to improve the continuity of care by allowing patients to remain within diagnosis-appropriate care areas and be monitored remotely, rather than requiring that they be transferred to a monitored bed in a different care area.

The Solution

To address this challenge, Cedars-Sinai embarked on a multiyear effort to transition from a care-area-based (decentralized) cardiac monitoring program to a centralized monitoring model. Under the centralized model, specially trained technicians located in a cardiac monitoring center (CMC), referred to as the "Cockpit," observe the monitor displays for all monitored patients. Previously, staff in each care area were responsible for observing the displays for the patients in their care area.

The program also involved upgrading the monitoring network (1) to increase the number of bedside and telemetry monitors that were available and (2) to extend monitoring capabilities to additional care areas. These changes expanded Cedars-Sinai's cardiac monitoring capabilities from 154 to 288 beds, with cardiac monitoring now available in 22 care areas (up from 6) outside the ICU. Now, the facility can monitor all telemetry, step-down, medical, and surgical patients across the organization from one central location.

Cedars-Sinai cites the following benefits associated with its transition to a centralized monitoring model:

• Patients can be monitored within the care area that is appropriate for their condition or for the procedures that they receive. They no longer need to be transferred to and from dedicated monitoring areas. This also eliminates the potential for waits and delays due to bed unavailability within the monitored care areas.

• Patient care environments are quieter. "Printer noise, staff conversations as team members consult with each other about alarm signals and the patient's history," and other noises associated with cardiac monitoring have been shifted to the CMC, explains Jennifer Jackson, the health system director at Cedars-Sinai.

• Nurses have been able to spend more time on other patient care activities now that they have been freed from the constant need to be tethered to a monitoring screen or be within earshot of audible alarms.

• Patient data analysis (e.g., ECG interpretation) is performed by CMC staff with expertise gained through specialized training and repeated practice working under the supervision of a registered nurse. CMC staff are also able to identify changes in trended data, and they have developed skills in troubleshooting equipment.

Designing a program that would yield such benefits required the analysis and reengineering of a wide range of processes. Examples include reviewing and revising alarm configuration, notification, and response protocols; assessing and maintaining equipment functionality; managing transmitter frequencies; and verifying the integrity and uninterrupted flow of data into the electronic medical record (EMR), to name a few. Additionally, implementation required testing the technology and conducting a multiphase, interdisciplinary education program.

Lessons Learned

This change in the way care is conceptualized and delivered—involving, as it did, the convergence of medical technology and information systems—demanded collaboration between medical, clinical engineering, and IT professionals. Cedars-Sinai was well positioned to achieve this level of cooperation because of its clinical technology services department, which merges the clinical engineering and IT functions into a unified department. Staff in this department routinely perform a variety of functions, from assessing and improving the reliability, safety, and effectiveness of medical equipment to serving on multidisciplinary care teams and participating in patient safety, quality improvement, and risk management activities.

In addition to successful collaboration across a number of disciplines, Cedars-Sinai cited the importance of firmly established leadership and management support to help coordinate efforts, as well as the engagement of frontline staff in developing workflow processes and related policies and procedures, all with a focus on safe care delivery and patient and staff satisfaction.

The Cedars-Sinai team observed that its implementation approach has empowered nurses and monitoring technicians, built their skills, and provided them with immediate access to clinical and technical resources. The approach has created a supportive work environment and has facilitated a team-oriented approach to care delivery.

Congratulations and thanks to the people who submitted Cedars-Sinai Medical Center's application for the Health Devices Achievement Award and who helped lead this initiative: Zahra Ghasemi, Vahan Adamov, and Jennifer Jackson.