At Augusta University Health, Wearable Technology Enables Real-Time Monitoring of At-Risk Patients
Effectively monitoring patients for early signs of deterioration is an ongoing and critical challenge at hospitals and health systems, and many patient care organizations are leveraging health information technology solutions, such as clinical decision support software applications, to help detect early signs of patient deterioration and enable earlier intervention.
Augusta University Medical Center (AUMC), an academic medical center based in Augusta, Georgia, has taken a leap forward into connected health innovation to leverage medical-grade wearable technology to improve patient monitoring, particularly for at-risk patients in low-acuity settings. Working with its technology partner, Amsterdam-based Royal Philips, AUMC has implemented a monitoring solution enabled by medical-grade, wearable biosensors and paired with analytics software to help predict when a patient’s condition is deteriorating.
AUMC is considered to be one of the first hospitals in the country to use the next-generation biosensors in a clinical environment and use of the technology as a part of patient care began last fall and is still ongoing. AUMC, a 478-bed hospital, is part of Augusta University Health, formerly Georgia Regents Health System (GRHealth), which also includes Children’s Hospital of Georgia, more than 80 outpatient practice sites and a critical care center, housing a 13-county regional Level 1 trauma center.
According to Kevin Dellsperger, M.D., Ph.D., vice president and chief medical officer at Augusta University Health System, the biosensor, a medical-grade, self-adhesive, single patient-use wireless device worn discreetly on the chest, automatically and continuously measures key vital signs, including respiratory rate, to alert caregivers to intervene quickly. “[The biosensor] is capturing heart rate, respiratory rate, skin temperature and also it captures steps,” Dellsperger says. “So if you want a patient to have a goal of walking 500 steps on a care unit, we get to validate that, as opposed to a patient saying they walked 500 steps.”
Nurse at AUMC applying wearable biosensor
The wearable biosensor also has a position sensor, Dellsperger says, to indicate whether a patient is in a sitting or lying position and, the technology uses algorithms to detect whether a patient suddenly moves from a standing position to the ground, to indicate that there has been a fall.
The continuous, real-time data on patient vital signs is helping nurses fill in the gaps, Dellsperger says. In the general care units, nurses typically check vital signs every four hours, but patients can exhibit subtle signs of deterioration over a matter of hours, so nurses and clinicians need continuous data to effectively track patient status, Dellsperger says, noting that nurses on the hospital’s general care units are typically caring for up to six patients at a time. “We were missing enough data points to where we needed more continuous data, and that’s where the wearable biosensor came in. It adheres to the patient’s chest and it transmit data to a Bluetooth device and then transmits wirelessly into our Guardian [IntelliVue Guardian] system and then ultimately into our electronic medical record (EMR). And, that system fills that gap in for us.”
The research project using wearable biosensors is a continuation of AUMC’s technology partnership with Philips. The AU health system is four years in to its 15-year, $300 million partnership with Philips in which the two entities are working together to leverage technology solutions across the entire enterprise. Two years ago, AUMC implemented a monitoring system developed by Philips, IntelliVue Guardian Solution, which uses an algorithm to follow patient vital signs to help detect trends and help identify “predictable codes,” or those patients who progress to a cardiac or pulmonary arrest who might have been caught before crashing.
When Dellsperger joined Augusta University Health in 2013, he says he recognized there was a need to improve clinicians’ ability to monitor patient status. “I had been at AU Health for about two or three months and we had a couple of patient events and when we did the root cause analysis, I quickly saw that when you graph the vital signs, the patient didn’t get sick five seconds before they arrested as you could see a trend line that was apparent on retrospect, but not so apparent prospectively,” he says. “And, in a couple of cases, the vital signs stayed in the normal range, so a nurse or a doctor would look at it and say ‘That’s normal, the patient is okay.’ But, in reality, that patient was exhibiting signs of deterioration and I said ‘What can we do to make it better?’”
The technology solution that AUMC implemented incorporates an Early Warning Score (EWS) that can help detect subtle signs of deterioration, which typically occurs six to eight hours before an adverse event. The technology monitors significant deviations in a patient’s vital signs, and automatically verifies the accuracy of the data by performing reassurance measurements. If early signs of deterioration have been detected, the system informs the responsible caregiver, including delivering the notification to a clinicians’ mobile device. AUMC initially implemented the technology on two units, cardiology and kidney transplant.
“Those were the two that had the highest arrest rates,” Dellsperger says. As a result of implementing that technology, AUMC has seen an 89 percent reduction in predictable codes. The medical center is now in the process of rolling out the technology to the entire hospital and synchronizing the roll-out to upgrades of its EMR system.
Dellsperger credits the reduction in predictable codes to not just the technology itself, but, perhaps more importantly, the performance improvements activities that AUMC clinician leaders developed to support clinicians’ use of the technology.
“We also saw improvements occur throughout the hospital because part of that program was to educate our staff about why people gradually deteriorate and educating them on how you have to keep looking back to see from where you came, to see where you might be going. We saw an improvement across the house, but especially in those two units,” he says.
AUMC clinical leaders trained nurses and clinicians to understand what the early warning scores signify and then redesigned care pathways. “Nurses were trained to understand that if you get a certain score, you don’t wait for an intern or a resident to answer your page and if they don’t answer their page in a certain amount of time, you escalate that and you call the attending or the service chief to get somebody there right away,” Dellsperger explains.
Clinical leaders also collaborated with IT leaders to close the communication loop by enabling nurses to get the monitoring alerts on their handheld devices in addition to the monitors at the nurses’ stations.
Dr. Dellsperger and nurses at monitoring station
While AUMC executive leaders have seen significant benefits of implementing the monitoring solution, Dellsperger notes that one of the biggest challenges of health IT is keeping up with the rapid changes and innovations, and remaining focused on the people and processes, and not just the technology. “Over the last 15 to 20 years, technology has just exploded, and it’s almost exploding faster than the caregivers can keep up, because you can’t keep changing your work process that much and not every change in your work process is actually beneficial to the patient,” he says. “It’s important to take a look back and say, “What health IT is valuable for the patient and what health IT doesn’t add significantly in value?’ If it doesn’t add mortality benefit, doesn’t add an efficiency benefit, doesn’t add a cost benefit and doesn’t shorten your patient’s stay in the hospital, then, if I’m a patient, I’m asking, ‘why are you doing all this fancy stuff to me?’”
He continues, “But at the same token, I’m concerned that the uptake of IT is so great that our staff are relying on the IT. There is a fine line between worrying about what the IT solution is telling you and you looking at the patient critically. Technology is a tool to make you do your job better, it’s not a tool to do your job.”
When it comes the intersection of IT and healthcare, it’s important to think about the end user—the nurses and clinicians—when implementing the technology as well as when designing it, notes Carla Kriwet, chief business leader, connected care and health informatics at Philips.
“Nurses chose their profession deeply out of conviction and they want to treat the patients; they don’t want to analyze and they don’t care about big data. The technology has to be practical, actionable and it has to increase the time with the patients and reduce the amount of reporting time. If it doesn’t tick that box, in my experience, you can try to force it in with CIOs who are excited about it, but in the end, the caregivers don’t want it, they want to look over the patients,” she says, adding, “I think for us as technology providers, ignoring that, thinking that technology will fix it, is wrong, because again, nurses are nurses for a good reason, they could have been IT experts if they had chosen to go in that direction.”
As Augusta Health pushes forward into next-generation connected health technologies, clinical and IT leaders have learned critical lessons about maximizing the benefits of health IT.
“I think the IT solution without the process and the teachings is not going to be as robust, and we saw that with [the Guardian solution] when we implemented it. Until we actually realized that we had to spend a lot more time training our staff, we weren’t going to get the benefit of it,” Dellsperger says.
