Device Offers the Ability for Continuous Temperature Monitoring

By Matt Phillion

Infections remain one of the top drivers of readmissions, costing the skilled nursing industry over $3 billion annually, with more than 70% of facilities penalized under CMS rules. A new wearable device continuously monitors temperature to catch infections early in skilled nursing facility patients and other facilities, integrating with the EHR platform PointClickCare.

“The two areas where infection is hitting hardest, oncology and long-term care, is where we’re focused right now,” says Sam Barend, CEO of AION Biosystems, developers of the TempShield ™ wearable device. “In oncology, 50% of patients are dying of infection, while others are having infection cut their treatment short. They’re ending chemotherapy because of infections, and those numbers are even higher in more specific diagnoses.”

In long-term care, infection is one of the top three causes of hospitalization, Barend notes.

“These infections spiral rapidly. It’s an issue of time to treatment,” she says. “The current standard of care for identifying infection is broken in the U.S. It’s an oral thermometer.”

By the time a temperature is taken, Barend explains, the patient already doesn’t feel well—or it’s possible to miss spikes in temperature because there is no continuous monitoring.

“Even if you’re taking temperatures once over four hours, they can miss those spikes, and temperatures don’t just go straight up. They go up and down, so it’s possible to miss the whole story,” Barend says. “Those spikes are the spark before the flame and identifying them early can dramatically improve outcomes.”

“It’s one of the top three causes that sends a resident back to the hospital, and temperature is the one vital sign if you ask a nurse what they’d want as an early indicator,” says Rhonda Dempsey, chief nursing officer of Trilogy Health Services, where TempShield has been deployed.  “That’s the first vital sign that changes, and it’s the one we don’t know is happening, so with this device we can know early if something has changed.”

Trilogy was looking for a way to help their residents faster and intervene quicker in the event of an infection.

“We wanted to identify a shift early so they don’t end up back in the hospital,” she says.

Modernizing the standard of care

There have been attempts at changing the way temperature is monitored, Barend notes, but change has been difficult.

“Many have long believed that temperature should be taken when one feels ill,” she says. “But this approach assumes fever doesn’t show up until we feel sick. With TempShield we know this isn’t the case: Fever arrives three to five days before symptoms occur, providing significant warning signs for intervention.”

AION focused on patients for whom accurate temperatures is pivotal: Oncology, long-term care, skilled nursing, and similar patient populations.

“For oncology patients, it’s life or death, and it’s a matter of hours. They don’t have much time after you get the temperature,” Barend says.

Two focuses were accuracy of temperature, and making sure the product would be user-friendly enough that patients would be willing to use it.

“My dad had leukemia, and before he got sepsis, there were warning signs,” Barend says. “They wanted him to wear a Holter monitor, and he wouldn’t because it was uncomfortable. We need to have something for these elderly or immunocompromised patients. They have so much on their shoulders and they don’t want to be bothered by an uncomfortable device. We want them to be compliant, because if they won’t wear the device, what’s the point?”

“It has to be simple to use,” says Dempsey. “Something someone of any age can understand and also doesn’t interfere with the nurse’s workflow. Nurses are very busy and watching a lot of different data. They’re carrying a lot of responsibilities.”

How it works

When a patient is identified as clinically at risk for infections based on their diagnosis, a monitor is administered with the patient’s permission, which then automatically syncs up with the nurses’ dashboard. When the resident’s temperature spikes for an hour, it alerts the nurses that something is going on with the patient.

“Say the patient ordinarily runs a temperature of 97 degrees and has been up at 99 and stays there. The nurse will go in and assess the resident, call in the extender for specific orders,” says Dempsey. “We’ve caught early pneumonia, early sepsis, early CHF, early C. diff that hadn’t presented other symptoms yet. A little temperature change is the earliest sign that something has changed.”

“It’s like the check-engine light in your car, letting you know something is up before the car breaks down and you’re in trouble,” says Barend. “You’ve got this light flashing, and you have time to fix it before you’re in real trouble. That’s the beauty of it. There’s time to take action, which can be the difference between antibiotics or a hospitalization.”

This is even more the case with oncology patients, who will wear the device home.

“They may be away from doctors for a few weeks between appointments, and a lot can happen between treatments,” says Barend. “This allows you to see real, sustained spikes, so the clinical team can get a notification and have this data.”

It can also empower the patient to track their own status, she notes.

“They aren’t required to, but they can get text notifications or alerts to their phone, similar to a blood glucose monitor for diabetics. Immunocompromised patients need this kind of continuous monitoring, too,” says Barend.

When the patient is in a skilled nursing facility or long-term care the staff can monitor temperatures but for oncology patients, this is an opportunity to be as involved, or not involved, in their own monitoring as they want to be.

“It empowers patients to have a higher standard of care,” says Barend.

A recent study by AION showed a 95% patient satisfaction rate with the monitor, citing added peace of mind about their care.

“There was some concern among doctors and nurses that this would give the patient anxiety, constantly looking at their temperature, but it was one less thing they need to worry about,” says Barend.

The patient doesn’t need to look at their phone. The data can be sent to the clinical team directly.

“It’s an extra measure that the family can find comfort in,” says Dempsey. “It lets them know what we’re doing, that extra amount of monitoring so they’re engaged and involved in their care.”

Trilogy has been using the device for residents that come in from short-term rehab with the possibility of them going home with the device, handing it off to home health services.

“We’re looking at this as our next step to explore. It would be a natural transition,” says Dempsey. “It does have a 90-day battery life, so there’s no reason they can’t go home with it.”

“If you think about home health, they come in a couple of times a week and they’re on the hook if the patients are hospitalized,” says Barend. “But they don’t have a lot of visibility into those patients coming in a few times a week for a half hour. It’s a limited snapshot in time, so you don’t have trend data.”

The information taken in can be very isolated, particularly if the patient is feeling fine at that specific moment.

“We know temperatures go up and down, so they could miss something,” says Barend. “For home health, this gives them a treasure trove of data.”

On the flipside, it’s possible to see the benefits in a highly monitored space like the ICU.

“If you’re taking temperatures every four hours, you can miss it,” says Barend. “If you look at the stats, these little complications escalate into sepsis. A UTI can turn into sepsis. Pleural effusions can turn into sepsis, and we’re identifying that at a very high rate. All of these issues and complications can be related to a fever.”

The goal with the device is to dramatically improve the standard of care for this patient population, Barend explains.

“There’s no reason 50% of cancer patients need to die from infections. And think about the money spent to give patients a few more months of life; this can do much more,” she says. “Just in oncology, we could save over $140 billion in care in the U.S.”

It’s a small shift, but change can be hard, Barend says.

“The key is to get patients and providers excited about how this can not only improve patient care, but save lives, and make them more empowered,” she says. “And at the same time, making the jobs of the staff easier so they can make an impact without adding stress or worry.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.