Indian River Medical Center (Vero Beach, FL) was selected as a finalist for ECRI Institute's 6th Health Devices Achievement Award for its development of a remote cardiac telemetry program, extending cardiac care to other care areas (e.g., orthopedics, oncology) that are more appropriate for the patient's primary diagnosis.
The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. ECRI Institute announced the winner and two other finalists for the 6th award in September 2011. Learn about the other submissions that achieved recognition.
The Concept
Indian River Medical Center (IRMC), of Vero Beach, Florida, has implemented a remote cardiac telemetry program for patients who, in addition to their primary diagnosis, have a cardiac condition that is stable. The program allows these patients to be placed in diagnosis-specific care areas (e.g., orthopedics, oncology), where they can receive the care appropriate for their primary diagnosis, while still receiving the necessary cardiac monitoring through telemetry. The program has improved patient care, and it has saved money by reducing patient transfers and decreasing average patient length of stay.
Before the implementation of the remote telemetry program, if a physician felt that a med/surg patient would benefit from cardiac monitoring, a decision had to be made: Should the patient be in a cardiac unit, where he or she would not receive regular disease-specific care, or should the patient be in a disease-specific unit, with cardiac care limited to assessments every four hours? By allowing med/surg patients to receive both disease-specific care and continuous cardiac monitoring, the program has eliminated this dilemma.
The remote telemetry program has three main components: hardware, staffing, and staff education. On the hardware side, IRMC added central stations and telemetry transmitters to cover diagnosis-specific units where telemetry was not previously available. The facility also equipped the telemetry devices with the capability to monitor blood oxygen saturation. With regard to staffing, IRMC hired additional monitor technicians, allowing the facility to provide redundant 24-hour coverage. These technicians watch the monitors and provide support to nurses as needed. The staff education component involved having every med/surg nurse participate in a four-hour basic arrhythmia and clinical considerations course.
Facility-wide length of stay has decreased by 0.63 days (14.4%) since implementation of the remote telemetry program. Furthermore, IRMC has averted more than 2,000 patient transfers to date (by not having the patients in question spend a day in cardiology and then move to the appropriate disease-specific unit, as had been done previously). IRMC expects the savings generated by these improvements to recoup at least part of the up-front costs of the program. In addition to these quantitative outcomes, IRMC has documented incidents in which remote telemetry has enabled nurses to intervene early and avoid complications. For example, one patient had postoperative pain that was picked up early due to an increased heart rate. Another patient had slightly decreased blood oxygen saturation that signaled early fluid overload, atelectasis (collapse of part or all of a lung), or narcosis. A third patient had atrial fibrillation that was causing a high heart rate, but the condition was detected before any physical compromise.
The project's impacts are felt at many levels, said Kathy Clark, nurse manager for IRMC's intermediate cardiac care and cardiac step-down units. "Our patients, our staff, and our medical center as a whole benefited from this project. Any time we can enhance the care provided to our patients, bring quality care to the bedside, and eliminate the non-value-added work and risk associated with patient transfers, we all benefit. This has been an extraordinary house-wide project, with quality, financial, and team-building benefits."
Best Practices
IRMC is not the first facility to use remote telemetry to provide cardiac monitoring in disease-specific care areas. But by documenting the benefits, IRMC provides a compelling case for this approach to monitoring patients. IRMC also shows that a successful remote telemetry program includes more than just hardware—the additional monitor technicians and the education for med/surg nurses were both essential to this program's success.