Reducing telemetry use while improving patient outcomes: University health network experience with the implementation of oximetry-based monitoring system

Introduction: Unrecognized clinical patient deterioration (CPD) is a precursor to preventable morbidity and mortality among hospitalized patients. The current standard of intermittent vital signs and physical assessments is inadequate for detecting early CPD and thus prevention of cardiopulmonary events. Continuous oximetry monitoring using a SafetyNet monitoring system (SNMS) may help facilitate early recognition of CPD and early intervention. However, some of the concerns regarding continuous monitoring systems include cost and alarm fatigue. We hypothesized that deployment of SNMS at our institution would result in improved detection of patient deterioration, fewer Intensive Care Unit (ICU) transfers, and reduced telemetry usage.Methods: We conducted a post hoc analysis of data from a quasi-experimental quality improvement project that took place on medical-surgical units (MSUs) at a large, tertiary referral center between January 1, 2015, and December 31, 2016. The 24-month study period included a 12-month pre-SNMS period (January–December 2015) and a 12-month post-SNMS period (January–December 2016). Clinical data were collected on two adjacent MSUs (“P8” and “P9”) with “P8” serving as the control unit where SNMS was not deployed. The primary study outcome was rate of ICU transfers tracked as transfers per 1000 patient-days. Telemetry usage and nonclinical alarm burden were our secondary outcomes. Estimated cost-saving analysis was also performed based on the reduction of ICU transfers.Results: The 24-month study period encompassed 21,189 patient-days on the P9 MSU (11,702 pre-SNMS and 9487 post-SNMS) and 23,388 patient-days on the P8 MSU (13,616 pre-SNMS and 9772 post-SNMS). The median case-mix index (a measure of patient acuity based on comorbidities) was higher for P9 than P8 during the duration of the study (2.08 [interquartile range (IQR) 1.98–2.17] vs. 1.67 [IQR 1.64–1.76], respectively). The rate of ICU transfers per 1000 patient-days on the P9 MSU declined from 11.7 during preintervention period to 8.8 post-SNMS implementation (P < 0.03), whereas the comparison unit demonstrated no change. Mean telemetry usage post-SNMS implementation significantly decreased on the P9 unit (21.6 to 16.5 per 1000 patient-days, P < 0.01). Based on the observed difference of 38 ICU transfers between pre- and post-SNMS periods, the estimated cost savings for our Network were $902,386.Conclusions: The current standard of inpatient monitoring through intermittent vital sign sampling, physical examination assessments, and continuous telemetry for patients deemed to be “high-risk” is ineffective in detecting early CPD. This study suggests that implementation of SNMS may help reduce ICU transfers (and associated costs) while at the same time decreasing the reliance on telemetry monitoring.The following core competencies are addressed in this article: Interpersonal and communication skills, Practice-based learning and improvement, Systems-based practice.