Remote patient monitoring is continuing to live up to its expectations at Dartmouth Hitchcock Medical Center, officials announced on Monday. The center saw a decline in length-of-stay and mortality rates, and recognized an estimated $1.4 million in annual savings on one floor alone, after implementing post-surgical monitoring technology.
The pulse oximetry and clinician notification system technologies, provided by the Irvine, Calif.-based Masimo, were implemented in all post-surgical, general floor units at the medical center. The center has continued to see reduced rescue events and transfers to the intensive care unit (ICU) and experienced significant cost savings. Furthermore, hospital officials have announced that no patients have died as a result of respiratory depression from opioids since the Masimo Patient SafetyNet system was instituted in December of 2007.
The results confirm and expand the findings from the original 2010 landmark Anesthesiology publication of the study at Dartmouth Hitchcock, showing that use of these remote monitoring technologies in a single orthopedic post-surgical unit led to a significant reduction in rapid response activations and intensive care unit (ICU) transfers. After the original study, Dartmouth Hitchcock mandated continuous monitoring for all patients in medical and surgical units when they are not directly observed by a healthcare provider.
After expanding post-surgical monitoring to the general and thoraco-vascular post-surgical units, Dartmouth Hitchcock reported:
- Fifty-seven percent overall reduction in rescue events over all units (4.4 to 1.9 per 1,000 patient days)
- One-hundred-sixty-eight ICU days saved in the thoraco-vascular unit in the first 12 months after implementation - 10 more days per year than the original orthopedic unit
- Twenty-one percent decrease in average length of stay of a patient with transfer to the ICU (total 5.1 days decreased, 1.8 days in the ICU and 3.3 days on the general floor) in the original orthopedic unit
- $1.48 million in annual opportunity cost savings in the original orthopedic unit due to the decreased ICU transfer rate (compared to initial costs just $167,993 for equipment and training and annual operational costs of just $58,261 for implementation and disposable sensors)
- $58,459 saved per patient who was not transferred to the ICU in the original orthopedic unit ($76,044 vs. $17,585)
"Retrospective reviews demonstrated that adverse [patient] events are preceded by a period of physiologic instability of six to eight hours," according to study authors Andreas H. Taenzer, MD, and George T. Blike, MD. "Therefore, identification of at-risk patients by spot checks every six hours for 10 minutes, which observes vital signs only five percent of the time, begs for improvement. ... While monitoring cannot prevent all physiologic deterioration, it can function as a 'patient safety airbag.'"
[See also: Remote patient monitoring market to reach $9.3B .]
Dartmouth Hitchcock continues to investigate ways to further improve patient safety by expanding monitoring beyond pulse oximetry in higher risk populations such as post-operative patients on supplemental oxygen, in whom pulse oximetry can be a late indicator of respiratory depression. The study authors also reported their initial experience in evaluating Masimo rainbow Acoustic Monitoring for noninvasive and continuous monitoring of respiration rate with a cloth sensor that is easily and comfortably applied to the patient's neck: "These (acoustic) monitors are better tolerated than our earlier trials in the immediate post-operative phase with chest straps for respiratory rate monitoring or nasal cannulas for end tidal CO2 monitoring, but not as well as finger pulse oximetry probes."
"When we invented Masimo SET pulse oximetry over twenty years ago, we believed that by solving the motion artifact and low perfusion problem we could improve patient outcomes and reduce cost of care by taking noninvasive monitoring to new sites and applications, such as the general floor of hospitals," said Joe Kiani, Masimo Founder and CEO. "We applaud the exceptional work of the clinicians and investigators at Dartmouth Hitchcock Medical Center in showing the world that post-surgical monitoring with Masimo SET pulse oximetry and Patient SafetyNet do in fact help clinicians save lives and costs on the general floor. In today's healthcare climate, this is the perfect combination for hospitals under pressure to improve quality and reduce costs at the same time."