Devices & Technology

Robots and Remote Monitoring Programs Earn National Recognition

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By Kim McCarten, contributor

October 14, 2011 - ECRI Institute researches the best approaches to improving the safety, quality and cost-effectiveness of patient care, and their sixth annual Health Devices Achievement Award has recognized the work of three facilities excelling in these areas.

These facilities have implemented innovative programs with cutting-edge technology to improve outcomes and expand the training of their respective staffs.

Nena Jones, RN, CCRN, is the ICU/CCU nurse manager at award-winning Grande Ronde Hospital in La Grande, Ore., a 25-bed, critical access hospital.

The facility’s biggest challenge? Its rural location.

"We're surrounded by three mountain ranges," said Jones, "and the next hospital is two to three hours away." In winter, "the roads can be closed for hours."

It's not just weather conditions, but the stress and cost of transferring patients that needs to be avoided. And small hospitals have their own inherent challenges.

"We have an excellent group of physicians and nurses," said Jones, "but if they've been working here for 20 years, they haven't worked at a larger facility in that [amount of time]," which would give them regular exposure to a wide variety of cases.

Grande Ronde is using a medical robot, which allows staff to offer the latest protocols, remote assessment and treatment to patients in La Grande.

"Five or six years ago, a doctor at St. Alphonsus Hospital [in nearby Boise, Idaho], obtained a robot through a Department of Defense grant, and approached Grande Ronde" to find "other ways to use it."

The program began with training for OR nurses, who could “beam in” and follow large surgeries at other facilities, and have their training monitored by specialists from across the country.

Grande Ronde Wins Award
Grande Ronde Hospital staff using telemedicine technology to do patient assessment and treatment. Photo courtesy of GRH.

"Via cameras, hardware and the monitoring system, and using the robot, we can access these intensivists," their knowledge and information, said Jones.

The OR nurse training was the basis of the grant obtained by Grande Ronde that covered the cost of implementation.

"It's definitely improved care for our patients and improved what we're doing in every case," said Jones.

But ICU "is just a piece of the program" she explained. This process is also being used by cardiology, ER, dermatology and oncology.

"The fastest growing component is tele-oncology," said Jones. "If a patient did their initial intake in Walla Walla, Wash., and they live in La Grande, their doctor can follow up with them from here."

Participating physicians, critical care nurses, specialists and intensivists can examine a patient and communicate with them and the staff through the robot and screens, which are "like the best quality Skype you'll ever see," according to Jones.

The primary group that her IC unit works with is located in St Louis.

Doctors and nurses can get a "really good look at patients, order labs, procedures ... there are a lot of different ways this type of interaction can be used."

"It was a big change," Jones admitted, “but once we figured out the workflow, how [remote staff] was going to get information to us, how we were going to get information to them, interacting with the robot ... has become pretty automatic."

Grande Ronde staff members continue to tweak the program and have monthly assessment meetings.

"We've gotten to know [the remote staff], and they've gotten to know us."

Patients have adjusted, too, especially in critical situations. “We tell patients we have a group of intensivists that we work with in St Louis and we've asked them to come by and 'see you,'" Jones said. "We tell patients it will help us determine if we need to move them or if we can safely keep them here [in La Grande]." This can reduce any anxiety of wondering whether they should be in a larger facility.

"There are times when we do need to transfer patients," Jones continued, "but so many times, we can manage patients here. The costs are less and the risk of transferring or moving a patient is less."

"Professionally, having access to this has elevated what we're able to do here and with all the training we've had, we've been able to improve our outcomes and our ability to meet challenges," said Jones.

Indian River Medical Center (IRMC) in Vero Beach, Fla., was a finalist in ECRI’s annual competition, winning recognition for their remote telemetry monitoring program, which has effectively turned all of their nurses into cardiac nurses in addition to their specialties.

Kathy Clark, RN, CCRN, CNML, nurse manager of intermediate cardiac care, cardiac step-down and telemetry monitoring services at IRMC, explained that, with this program, "Our med-surg nurses are now all arrhythmia-trained nurses."

IRMC is monitoring patient heart function and oxygen saturation remotely, in real time, which is shortening hospital stays and allowing staff to respond more quickly to both subtle and critical changes.

"We invested a lot to give [nurses] arrhythmia and clinical considerations class," Clark said. Training took place over the course of several weeks, and helped staff become comfortable with the clinical considerations of cardiac monitoring.

"Previously, someone not getting their specialized care probably stayed in the hospital a day or two longer to accommodate the day or two they spent in cardiac care," she added. "Now, [patients] get upstairs post-operatively, and where a cardiac nurse might say 'You don't have to get out of bed today,' the orthopedic nurse will say, 'You are getting out of bed!’"

By allowing nurses to track both disease-specific and cardiac/oxygen conditions, patients can stay where they are, reducing workload for nurses because there is less transferring of patients between units.

"We anticipate that over the first year-and-a-half of this program, we eliminated 1,500 patient transfers. That's extraordinary [in terms of] patient safety," Clark said, not to mention reducing the costs associated with transfers.

The program has reduced risk, too, because real-time monitoring allows nurses to know if a patient is in distress more quickly. IRMC added STAT communication capability on each med-surg floor, so if a monitor tech, who is watching the monitors around the clock, "sees something they're worried about, we can overhead page STAT onto any hallway.” Nurses aren't burdened with carrying another phone, pager or beeper.

The multiple benefits of the program--improved response and communication, not to mention improved outcomes and lower costs--have been proven.

ECRI Institute also recognized finalist Boston Medical Center for their remote monitoring/cardiac telemetry alarm standardization. The Institute made the formal award presentation on October 14, 2011.

For more information, visit the ECRI Institute site.

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