Published in the August 2010 issue of Today’s Hospitalist
HOSPITALIST EDWARD MA, MD, knows all about problems with bottlenecks and patient flow. At the hospital where he previously worked, patients were often warehoused in the ED for hours or shunted back and forth from unit to unit, waiting for or being moved in and out of a highly-prized telemetry bed.
At the suburban Philadelphia hospital where he currently practices, however, patient flow, bed assignments and continuity of care have been significantly less of a problem. Dr. Ma chalks that up in large part to a capability at the new facility that he’s come to appreciate: being able to offer remote telemetry anywhere in the hospital, thanks to telemetry packs that weigh only two pounds.
“I don’t have to drop everything I’m doing and rush down to the ED to see a patient who’s on the borderline of needing monitoring,” says Dr. Ma, president of The Hospitalist Consulting Group and one of six managing partners with Medical Inpatient Care Associates, a private hospitalist practice at The Chester County Hospital in West Chester, Pa. “Instead, I can have the ED send the patient to the general floor.” If, on the floor, he finds something that warrants monitoring, “I can ask for a pack instead of transferring the patient to another unit.”
The 238-bed hospital where Dr. Ma practices has 30 dedicated telemetry beds that in the past would always be at full capacity. Several years ago, the hospital purchased 30 remote packs as part of its Philips telemetry package, creating a virtual telemetry system.
“On many days, we’re maxed out on the telemetry packs, even when telemetry beds are still available,” says Dr. Ma. “That’s because hospital staff realize that ‘soft tele’ patients don’t need the same intensity of service that they’d get in the telemetry unit.”
Prior to implementing the remote system, the hospital struggled with long ED waits, low patient satisfaction scores and frequent ambulance diversions. At the same time, it was getting a cath lab and an open heart surgery program off the ground, increasing the need for telemetry monitoring.
Within a year of bringing in the remote telemetry equipment, the hospital saw its ambulance diversions drop by more than 37%, and patient satisfaction scores rose more than 13 points.
Help with observation patients
Hospitalists find the packs particularly useful when performing surgical comanagement in the orthopedic unit. Postoperatively, Dr. Ma points out, many hip or knee replacement patients may be a little tachycardic or have mild congestive heart failure or rapid atrial fibrillation.
“They don’t need intensive therapy “like continuous cardizem infusion “that would require us to move them to the telemetry unit,” he says. “We can keep them on the unit and monitor them for a few hours or a day or two, and patients continue to get the postoperative care they need from the orthopedic nurses.”
The packs have also stretched the hospital’s capacity for treating observation patients. Patients deemed to be at lower or moderate risk can be monitored in virtually any bed in the hospital.
From the hospitalists’ perspective, the real benefit of remote telemetry is the comfort level they gain being able to give the ED the OK to send patients to a medical floor without having to hurry to evaluate those patients first. Patients don’t run the risk of being sent inappropriately to a telemetry bed “or of having to be rushed to telemetry once they’ve already been sent to the floor.
Eliminating those transfers not only reduces the demand for telemetry beds, but it cuts down on bed cleanings and the number of times that nurses have to hand off patients to nurses in other units. The nurses can maintain better continuity, Dr. Ma adds, while patients appreciate not being moved multiple times or boarded in the ED while they wait for a particular type of bed.
“It allows us to be smarter when allocating resources,” he says.
Cardiac nurses and tech support
Data from the remote telemetry packs are monitored 24/7 by the same techs who watch data from the telemetry and post interventional beds.
And patients on remote packs are followed by a cardiac nurse who visits every one of the patients during his or her shift, tracks lab values, relays results to physicians and can decide to take a patient off remote monitoring. (The cardiac nurses provide 24/7 remote telemetry coverage.)
“They have to be very experienced nurses,” points out Tina Maher, RN, director of Chester County’s telemetry and post interventional unit and critical care support. While these nurses have specific dysrhythmia training, they typically also have critical care experience. “They are very autonomous in their role.”
The cardiac nurses and monitoring techs stay in touch via wireless telephones for routine calls, such as when a lead pops off.
“Then there is another phone that techs call if there is an urgent, life-threatening kind of rhythm, and that has a totally different ring,” Ms. Maher explains. All of the med-surg nurses and other staff know to respond to that ring immediately.
Making sure new staff know how to respond is, for Ms. Maher, the biggest hurdle in using the remote system. “The biggest problem is communication when you have so many people involved,” she says. “When you transition med-surg staff, you have to make sure that education is there.”
Expanding the program
According to Barbara Myers, RN, clinical manager for the post interventional unit and critical care support, the original investment certainly paid off in better patient flow and throughput.
The hospital, in fact, is planning to upgrade the entire system in the very near future. “The upgrade would include making the entire telemetry system wireless,” Ms. Myers says, “and that’s a significant investment.”
According to Ms. Maher, hospital administrators fully grasp the importance of remote telemetry in helping patient throughput.
“They’re certainly committed to the upgrade,” she says, adding that even with the remote packs, the hospital’s telemetry capacity is being taxed during the winter months with sicker patients. “We’re considering expanding the program.”
Phyllis Maguire is Executive Editor of Today’s Hospitalist.