A recent article describes new methods of using remote monitoring in intensive care units (ICUs). In most ICUs, the rooms are arranged so that one or more central nurses’ units allow direct sight into the patients’ rooms. There are also monitors at one or more of the nurses’ units so bells or alarms can sound if vital signs change for the worse. A problem with that arrangement is that, when things are busy, nurses may be in another patient’s room and not realize that a patient is having difficulties.
The newer designs for ICU’s incorporate a central monitoring unit where paramedics can monitor cardio-respiratory changes and can utilize cameras and audio systems to “see and hear” the patient. The paramedics thus have real-time visualization of the patient, can review vital signs, and communicate quickly with the care team if adverse events occur. The paramedics view patient’s vital signs on computer screens and video screens in a central location.
For example, if a patient’s oxygen saturation drops below 90, indicating risk of respiratory distress, the paramedic can see if a nurse if with the patient. If not, the monitoring paramedic can contact the patient’s assigned nurse. If faster action is required, the paramedic can activate a “rapid response team.”
The monitoring units have computer software that delivers text alerts of the patient’s alarms to the nurse’s cell-phone, and the paramedics can confirm the alarm signal quality is working and can visualize the patient’s clinical appearance.
Sophisticated software also allows more than alarms. For example, the electronic health record can be customized to tell the paramedic if a patient with a central line or port develops a fever of an elevated white blood cell count, and thus can trigger a review of the patient’s antibiotic status. If needed, the paramedic sends a text to the treating doctor to notify him/her of the risk factors that are present so that appropriate medications can be ordered before the patient’s condition deteriorates.
In the future, it is possible that this system can be used for real-time tracking of patients with chronic conditions, in their homes or community hospitals. The future of remote electronic monitoring is only limited by the imagination and innovation changes that hospitals, doctors, and computer specialists can apply to the task.
