The Role of Specialized Monitoring Technologies in Improving Patient Care

John Harvey, MD, Medical Director
John Harvey, MD, Medical Director
The all-digital Oklahoma Heart Hospital in Oklahoma City takes many steps in making things easier for the staff in the cath and EP labs. Perhaps you will be able to apply some of their techniques to your EP lab! The Oklahoma Heart Hospital in Oklahoma City opened in August of 2002 as the first all-digital hospital in the state likely the first in the nation and is among only a handful of such facilities worldwide. A partnership between Mercy Health Center and Oklahoma Cardiovascular Associates, the $75-million, 204,000-square-foot building was designed every step of the way with the heart patient in mind. More than 60 million people in the United States suffer from some form of cardiovascular disease, according to the American Heart Association. Unfortunately, Oklahoma ranks second in the nation in deaths from cardiovascular disease. Although no one is certain why the heart disease mortality rate is so high, it appears that Oklahomans smoke more, exercise less and eat poorly. At the Oklahoma Heart Hospital, our team of cardiologists, heart surgeons and healthcare professionals is making great strides in decreasing heart disease in Oklahoma. We ve seen technology play a major role in providing the best possible cardiac-focused patient care. We are a paperless and filmless facility that provides instant access to all patient records and medical images throughout the hospital and at remote locations. The Oklahoma Heart Hospital also provides: A maximum of four patients to one nurse. That ratio provides the flexibility to create more intimate care and allows nurses to be assigned based upon patients needs. A critical path from the emergency room to the cath lab, to the operating room in 45 minutes. That s crucial considering that the national average time from the ER to surgery is more than two hours. Patient rooms that double as critical care rooms so patients aren t needlessly transported from one place to the next. Studies show that when patients are moved, it creates stress. An atmosphere that welcomes family members. Every patient room is equipped so one family member can stay overnight (even critical care patients). There are also no restrictive visiting hours at the Oklahoma Heart Hospital. Designed with the process of cardiovascular care in mind, we have 78 in-patient private rooms, 15 day-patient beds, three open-heart operating rooms, one peripheral vascular operating suite, four catheterization laboratories and one electrophysiology lab. The third floor is designed as a clinic, containing 24 physician offices and 36 exam rooms, as well as imaging and diagnostic procedure rooms. We have 34 physicians who practice in the cath labs and a mix of respiratory therapists, nurses and cardiovascular technologists. Oklahoma Heart Hospital utilizes unique technologies, including continuous monitoring systems that are adaptable to each patient s needs. This technology positively impacts our hospital s ability to improve efficiencies, and ensure patient information is available where and when it s needed. A Monitoring System On the Go In a typical heart care setting, patients are routinely transported at least five times during their stay and with each move, their heart monitor is disengaged and then reattached. This process can take upwards of 20 minutes, during which time vital patient information can be lost. At Oklahoma Heart Hospital, we move patients as little as possible. Exams such as echocardiograms, vascular studies, dialysis and endoscopes are performed right in the patient s room. When a patient does need to be moved to the labs or OR, there is no loss in care or patient information. The Oklahoma Heart Hospital also utilizes highly specialized monitoring technology to address the transport and information challenges specific to cardiac patients. The Infinity Patient Monitoring System (Siemens Medical Solutions, Malvern, Pennsylvania) provides the hospital with uninterrupted vital sign monitoring from admission to discharge. Any important clinical event that may take place during transport is stored on the monitoring information network, so caregivers can track the event, analyze it, and intervene on the spot. This data is available to clinicians at all times. Instead of using transport monitors, the monitors move with the patients. This means greater safety, more workspace for our team and more time to provide patient care. Our patients are very often critical; every moment counts when you are treating cardiac patients. The ability to monitor and correlate lab, radiology exams, nuclear studies and sequential ECGs on all patients is really valuable, says Debbie Flynn, RN, the cath lab resource nurse. Monitoring in the Cath Labs When moving patients to and from the cath labs with ordinary monitors, there may be periods when patients are unmonitored or under-monitored as leads are detached and reconnected or while patients are temporarily connected to a transport monitor with limited capabilities. With the monitoring system at Oklahoma Heart Hospital, patients do not have to be moved around to accommodate equipment availability. Instead, the monitors move with the patients. Since the monitor records and saves information in transport, the chance of lost data is eliminated. In the cath lab, when patients leave the procedure table, nurses customarily disconnect their monitors and re-connect them to transport monitors, slowing down the flow of patients into the cath lab. But the time it takes to usher another patient onto the procedure table at Oklahoma Heart Hospital is under eight minutes. This helps eliminate unnecessary patient apprehension, which often occurs when patients are forced to wait for cath lab procedures. Since one monitor always stays with the patient, we are also able to use it to track events in the cath lab. Later, when the patient is stable, clinicians can go back and analyze the data. With our monitoring system, information is automatically downloaded and can be quickly checked. It can also handle advanced monitoring and can be customized specifically for the cath lab. For example, our nurses can customize the monitoring system to measure arterial pressure. The monitoring platform also provides real-time information accessible from various points within the hospital. A nurse on a patient floor of the facility can monitor a patient when he is on the clinic level which cuts down response time should an emergency situation occur. With an experienced team of registered nurses, radiologic technologists, cardiovascular technologists, we have performed more than 3,351 cases in the past 10 months (1,480 of which were interventional with an additional 419 implantable devices). The monitoring system allows us more time to attend to our patients and less time on paperwork and equipment management. Patients interaction with their physicians is key to a smooth recovery. Complete Picture of Integrated Patient Information Continuous monitoring means there are no gaps in the clinical picture. When a physician wants to see how a patient is reacting to anesthesia or to see if he has to change ventilator settings, the information is all right there. He can see the pattern and trends on a long-term basis. The patient data acquired and recorded by the monitoring system is integrated into an electronic medical record system, supplied by Cerner (Kansas City, Missouri). The system integrates information from the monitors, our picture archiving and communications system (PACS), and cardiology devices. Everything is done on a computer, from inputting orders to reporting patient progress. Physicians and staff have immediate access to treatment information on workstations throughout the hospital. In addition to the monitoring system and PACS, our hospital uses Siemens cath labs and CT scanner. Because these technologies run on syngo ®, a common software platform that allows users to communicate between modalities, everything talks to each other, which is critical to making a digital hospital reality. At Oklahoma Heart, our goal is for all information on every single patient to reside online. For example, any one of our physicians can look at an echocardiogram for a patient who came in three months ago in a matter of seconds, without having to search for paper or film files. Or a physician can bring up these old images in a lab workstation during a procedure. Tooting Our Own Horn (A Little) Our biggest success of all has been the patient responses from all corners, including central and western Oklahoma, as well as southern Kansas and northern Texas. If I was going to rate the Oklahoma Heart Hospital on a scale of one to ten with ten being the best, I would say my experience was a 100, says Mickey Morrow, a pharmacist from Sulphur, Oklahoma, who underwent a procedure at the Oklahoma Heart Hospital. It s indescribable. I ve seen it firsthand. There s nothing to compare it to in Oklahoma. It s one of the top heart hospitals in the nation. Everybody was so professional and everything went like clockwork. It was tender loving care at its best. The original version of this article was reprinted with permission from: Cath Lab Digest 2003;9:88-92.