Continuous monitoring beyond the ICU

Post-operative & post-acute care

Continuous monitoring of patients is primarily associated with intensive care units (ICUs). Patients are physically connected by wires and pads to cumbersome health monitors that read their vitals 24/7. Once stabilized, they are discharged to post-operative and other relevant wards where patient to nurse ratios can reach 6:1. There, patients are manually monitored, or spot-checked every four-eight hours by an often-understaffed ward. The time-lapse between clinical assessments is crucial since warning signs in deteriorating health condition may occur before symptoms appear and medical staff is made aware, possibly causing health complications, or relapse and readmission to the ICU in the best-case scenario. Since fluctuations in vital signs occur before adverse events, it is imperative to detect them in a timely manner to enable early and adequate intervention.?

Keeping track of vitals around the clock in general hospital wards, not just ICU, enables medical staff to be ahead of the game. Health trends, only possible with continuous monitoring, provide medical staff with clinical insights into the patient’s health status and medical progression. Indeed, recent studies in neonates suggest that analysis of continuously monitor-recorded vital signs trends can predict imminent clinical deterioration or disease such as sepsis and may also predict long-term neurological or respiratory outcomes. Respiratory rate is considered the most important predictor variable in detecting health decline.

The importance of respiratory rate

Respiratory rate (RR) is the early predictor of preventable patient deterioration (not heart rate, not blood pressure) and ironically, it remains the most inaccurately measured and recorded vital sign. Furthermore, there are no regulations or standards requiring the accurate recording of respiratory rate.

Respiratory rate is defined as the number of breaths per minute. Normal respiration rates for an adult person at rest range from 12 to 18 breaths per minute (bpm). Tachypnea (respiratory rate > 20 bpm) is often the first sign of eminent cardiac arrest, systemic inflammatory response syndrome, sepsis, shock, and respiratory insufficiency, 22–24 while bradypnea (respiratory rate < 8 bpm) is an early indicator of narcotic and sedative complications. Respiratory rate is an important indicator of a severe instability in many body systems, not just the respiratory system. In summary, high respiratory rates are indicative of anxiety, fever, respiratory disease, heart problems, and dehydration. Low respiratory rates may suggest drug overdose, obstructive sleep apnea, and head injury.

Getting a heads-up on patient trends

The three predictor variables mentioned above are difficult to detect through routine visits where spot-checking is commonly deployed. Spot-checking does not provide a complete picture regarding the patient’s health state, nor does it capture trends that foretell impending pathophysiology. However, it is crucial for triage and safety measures in public venues or emergency departments for example, where the general health status of the person can be assessed at any given time.

Chronic disease management

Chronic disease is the most common cause of death and disability worldwide. According to the Centers for Disease Control and Prevention, chronic disease affects an estimated six out of ten adults in the US alone and costs the nation 3.8 trillion dollars in related costs. However, these numbers dramatically change with age. Research from the National Council on Aging shows that a staggering 80% of older adults suffer from a chronic disease and 90% of adults 55 years of age and above are susceptible to suffer from hypertension or high blood pressure. The long-term nature and frequent need for monitoring in chronic disease makes deployment of continuous remote monitoring systems capable of robust, efficient, and straightforward measurement of vitals imperative to track trends of the patient’s condition. The use of such monitors ultimately leads to better care and personalized treatment and saves money to healthcare.

Aging in place

The US Census Bureau projects that the American population 65+ will nearly double from 2016 and reach 95 million by 2060. The unprecedented turn of events in 2020 has encouraged the elderly to accept remote patient management to minimize risk of infection. In fact, a study conducted by the Centers for Medicare & Medicaid Services indicates that telehealth services increased to 1.7 million (from just 13,000) during 2020. As the aging population is on a steady rise, many are choosing the comfort of their own home as opposed to a nursing home. Thus, constant health monitoring is an ideal support system for those seeking to age at home while maintaining their independence and ensuring high quality of care.

Neteera and continuous monitoring

Early detection of deteriorating health requires continuous monitoring. Keeping constant tabs on variables for trend analysis and clinical insights is a core feature of Neteera 130, in addition to allowing for spot checking as needed. Neteera 130 presents a contact-free, hands-free, cable-free, and disposables-free approach to safely facilitate rapid and accurate detection of fluctuations in health condition in real time, thereby safeguarding and improving lives.

#remotepatientmonitoring #diseasemanagement #nurses #digitalhealthcare

References

1.??????Kumar, N. et al. (2022) Ped. Res. 87, 210.

2.??????Churpek, M.M. et al. (2016) Crit. Care Med. 44, 368.

3.??????Cretikos, M.A. et al. (2018) MJA 188, 657.

4.??????Elliott, M. (2016) Int. Arch. Nurs. Health Care 2, 050.

5.??????Loughlin, P.C. et al. (2018) Jt. Comm. J. Qual. Patient Saf. 44, 494.

6.??????https://www.cdc.gov/chronicdisease/about/index.htm

7.??????https://www.census.gov/library/publications/2020/demo/p25-1144.html

https://mhealthintelligence.com/news/cms-9-million-used-telehealth-during-early-days-of-covid-19