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Telemetry is widely-used by hospitals and health systems as a means of providing continuous cardiac monitoring for designated patients. While internal development of these programs has been the norm, the ongoing management of these internal programs has absorbed significant resources for many hospitals and hospital systems. As a result, health care organizations are increasingly turning to remote telemetry monitoring (RTM) services in an effort to decrease internal resource burdens while simplifying and enhancing care delivery. Marcia Murphy, Vice President of Clinical Operations and Nursing for Advanced ICU Care, sits down with DailyNurse.com to discuss this developing trend.
How have hospitals traditionally addressed cardiac monitoring in house?
In-patient cardiac monitoring is often relied upon by hospital bedside teams as a means of continuously evaluating hospital patients with certain medical conditions, those with cardiac-related co-morbidities, and individuals on specific medications who require that extra layer of observation. This monitoring is frequently provided to patients throughout the facility and is rarely restricted to a cardiac unit. Traditionally, a high-quality in-house program relies on trained technicians or nurses who are responsible for the real-time monitoring and interpretation of patient cardiac data transmitted via waveforms and the engagement of additional clinical personnel when changes or abnormalities are noted. In some instances, hospitals use an on-unit approach, while others use a centralized facility-specific approach. Both approaches can eat up significant management time and can create a wide range of clinical and administrative inefficiencies.
What are the potential limitations of such an in-house approach?
Launching and maintaining an on-site telemetry program is neither simple nor self-sustaining. Rather, programs can often pose a significant burden to clinical leadership who are more accustomed to supervising clinicians at the bedside than monitoring teams in a “clinical bunker”. On-going management, supervision, and 24/7 staffing of the telemetry program includes continuous recruitment efforts, periodic training, and detailed direct management of an hourly workforce. In the case of an on-unit approach in which dedicated telemetry technicians are not assigned, the time available for continuous monitoring can vary and therefore the quality and consistency of monitoring can fluctuate. For example, nurses tasked with bedside patient responsibilities as well as telemetry monitoring can be inundated with perpetual tugs on their time, forcing difficult decisions regarding exactly where their bandwidth is best spent.
What does a remote telemetry monitoring model look like versus a build your own approach?
I feel that implemented appropriately, RTM delivers both the enhanced clinical benefits associated with a specifically trained and focused monitoring team as well as the elimination of the bulk of related administrative costs and headaches. In addition, RTM can free up both budgeted headcount and space in the hospital.
With a partnered telemetry model, hospitals benefit from the same 24/7 continuous cardiac monitoring by certified technicians or nurses that one would expect in an in-house program. Utilizing telemetry monitoring systems that allow for remote patient observation, trained personnel can monitor hospitalized patients’ cardiac functions, review alerts and when necessary collaborate with bedside care teams to assess patients that require clinical attention. In these instances, recruiting, hiring, training, and productivity management for the monitoring personnel are all off-loaded to the selected clinical services partner.
Rather than working to sustain a fully staffed and well-managed telemetry program, a partnered solution allows hospital leadership to focus on clinical improvements and allows nurses to attend to patient care rather than the constant monitoring alerts. Further, working with a telemetry partner enables an on-demand monitoring resource supply that flexes based on a hospital’s census and patient risk profile. This approach assures that cardiac care is not constrained by staffing unavailability and, conversely, the risk of costly overstaffing and operational inefficiencies due to mis-estimated patient census expectations.
How have care teams traditionally reacted to the adoption of a RTM solution?
In my experience with Advanced ICU Care since we introduced our RTM services, client acceptance has generally been very positive. As with any change, the disruption of the status quo needs to be thought through and managed in advance. What I think is key to the success of our telemetry partnerships is building collaboration and ensuring that bedside nursing teams know what to expect and understand both the programmatic and personal benefits that come with such a program. In selecting an RTM solution, it is important for the bedside leadership team to screen for a partner that listens well and is focused on appropriate collaboration.
I also think it’s important to reinforce the fact that the bedside nurse’s voice ultimately leads on all care-related decisions. RTM is a supportive function intended to allow bedside nurses to focus on the treatment of their individual patients more closely which should be viewed as a positive benefit. Just as with any introduction of new methods or processes into the delivery of patient care, there will be a smoother implementation and improved synergy among stakeholders with proper communication that reinforces how the telemetry process adds additional support for the bedside care team.
How does remote telemetry monitoring lessen the resource burden on care teams?
At the end of the day the primary goal of telemetry monitoring is to ensure that hospitals and health systems are offering outstanding care 24/7 to some of their most at-risk patients throughout the facility. With RTM dedicated remote telemetry technicians make this possible by allowing bedside care teams to make care and treatment for patients with urgent needs their top priority. This is accomplished by removing the distraction of the bedside caregiver’s valuable time driven by simultaneously managing all cardiac monitor alarms. Having all readings monitored in a central place around the clock allows bedside nurses to be more focused on their patients and their care delivery and diminishes false alarms and the alarm fatigue frequently experienced on units outfitted with telemetry infrastructure. These high-quality, remote telemetry programs include trained telemetry technicians that provide real-time interpretation and immediate notification to the appropriate nurse or physician. Ultimately, remote telemetry monitoring allows a nursing staff to focus on our number one goal: providing the very best possible patient care.