Tuesday, January 29, 2013

Changing the alarm paradigm at EarlySense

Many hospitals employ telemetry systems to monitor at-risk patients.  These devices use electronic leads that are attached to the patient and send continuous signals of important bodily functions.  Results are presented on dedicated video monitors near the nursing station, and alarms sound if designated parameters are detected.  However, an undesirable aspect of these systems shows up as "alarm fatigue," a phenomenon described in this article in Patient Safety and Quality Healthcare.  An excerpt:

Alarm fatigue happens when too many alarms occur in a clinical environment, causing clinicians to miss true clinically significant alarms. Users report that more than 350 alarms per patient per day result from monitoring systems alone in some acute care environments, but less than 5% of these alarms require clinical intervention to avoid patient harm (AAMI, 2011). Nuisance alarms represent the 95% of alarms that do not require a clinical intervention. Reducing the overall occurrence of nuisance alarms is essential in creating and maintaining a safe clinical environment. Furthermore, solving this vexing problem is essential to improve patient safety systems. Experts in rapid response agree that improving the early detection of deteriorating patients is required to make rapid response systems an effective tool. A recent consensus article recommends continuous vital signs monitoring as a mechanism for strengthening rapid response systems, but only if nuisance alarms are addressed (DeVita et al., 2010).

During my recent trip to Israel, I learned of a new company, EarlySense, that has been established to provide an innovative approach to continuous monitoring.  There are several compelling aspects of the company's product and reporting system.

First, it is contact free, with no leads or cuffs. A flat sensing plate is placed under the patient's mattress and uses advanced signal processing techniques that detect not only heart rate and respiration, but also patient movement.  Second, the results for all of the monitored patients are presented in a simple graphical display.  (Oximetry results are also integrated in.)  When a parameter is out of range, a visual alarm is posted on screens at the bedside, the nursing station, other central locations, and also to the nurse's handheld device.  Distracting noises are avoided.

It seems to me that this is a good approach and potentially a big deal.  I like several features.  The lack of electronic connectors means that the perennial problem of detached leads--setting off alarms--is avoided.  The ease of patient monitoring and the relatively low cost means that all patients can be monitored, not just those usually categorized as high-risk.  Doing so can avoid quality and safety problems.  For example, the movement of an otherwise stable patient who might be subject to bed sores can be monitored on a regular basis to help avoid those decubitus ulcers.  Likewise a patient who is a fall risk can be seen to be engaged in inappropriate movement well in advance of the notice that would occur with the traditional bed alarm, one that goes off only when s/he gets out of bed.*  Or, a "regular" patient who might suffer some unexpected distress, say choking, will be noticed under this system.

We are all excited and interested in new technologies that can improve quality, safety, and results in health care.  What is unusual are new approaches that are reasonably priced, that have the potential to cover their own costs (or more), and that can easily be integrated in to the fabric of life on a hospital floor or unit.  I am encouraged, too, by the type of people who have joined the company's medical advisory board, including patient quality and safety experts Robert Wachter and David BatesOn all these fronts, it looks like the folks at EarlySense are headed in the right direction.
* One of my biggest safety worries--for the staff--has been watching nurses run down the corridor to "catch" a patient after s/he has left the bed!  
"Addendum dated February 26, 2013.  Disclosure:  Following publication of this article I was invited to, and was pleased to accept, membership on the EarlySense Advisory Board."

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