By Matt Phillion
It happens more than we’d like: Patients require transport from one area to another, be it from their room to an imaging lab or to the ICU, and somewhere along that trek—in a hallway, an elevator—they require emergency intervention. The patient is stabilized and completes their journey, but it’s a stressful situation for patient and provider alike.
A study on transporting intensive care patients found that out of 262 transports, 26% had an adverse event—many of which were serious, including oxygen desaturation or hemodynamic instability. How can clinicians work to avoid these situations? And how can organizations leverage the electronic medical record (EMR) to analyze how and when they happen?
“I think it’s something clinicians know has inherent risk, as part of the day-to-day moving of patients through the hospital,” says Teresa Soman of Capsule, a Philips company. “Patients are on the move, and acute care patients are on the move more than they used to be.”
More movement, more risk
The way healthcare has changed, Soman says, puts sicker patients in the hospital, even in lower-acuity care settings. By extension, this means patients being moved are in a sicker state, which could increase the risk of incidents during transport.
“Clinicians tell me the patients in lower acuity, going to another care area such as radiology or physical therapy, aren’t being monitored when they’re out of the nursing unit,” she says. “Monitoring patients may catch a change in condition sooner if the data is being captured and reviewed when they are not on the nursing unit.”
There’s also the impact of the inherent stress of being moved around as a patient, which can add to the severity of the event. And, of course, very often, the transport staff who are moving the patients are not primary caregivers.
“It’s often a secondary care provider moving the patient who may not know the signs to look for, so by the time they spot those signs, the patient is in a bad state and the caregiver has to go find someone to help,” says Soman. “And they can’t leave the patient to go find that help.”
Data lost in transit
In many cases, patients must be disconnected from monitoring devices for transport. Though this is a necessary step, it means that should an adverse event happen, that data could be lost.
“I’ve seen hospitals try to put transport monitoring on the patient,” says Soman. “You put it on them while moving, but someone is still monitoring that monitor and looking at the data.”
Often the data from those monitors never makes its way back into the EHR or other systems to proactively monitor the patient. But there are ways to avoid these problems.
“What we’ve found was being able to monitor the patient and continue to send patient data with accurate time stamps on it while the patient was on the move, we could monitor that data,” says Soman.
Organizations like Capsule provide wireless transmission of the data to the network, enabling patients to be monitored on the move. “By associating the patient to the device, we can continue to feed the EHR,” she says. This includes alarm systems to notify providers if the patient trends downward. The time stamp enables the organization to have better tracking records to improve their ability to respond to patients in distress.
Barriers to entry
Healthcare can be slow to change, Soman notes, and often driven by regulatory requirements. “[New] changes in care delivery or protocols need to be evidence-based.” Liability feeds into the pace of change as well, requiring all the bases to be covered before any implementation occurs.
“Until policies and procedures are adjusted, everyone will keep doing things the way they did before. Even though implementing new technology is intended to drive efficiency in patient care, it can create a situation where sometimes they do both at the same time—follow the old process and the new,” says Soman.
Staff on the floor are well aware of the stress of moving patients around the facility, though. The patient might have their heart monitor with them on the bed itself, but not transmitting data until they reach their next destination.
“The nurses I talk to call this period of time when moving a patient a marathon race,” says Soman. “You get the patient there as quickly as possible. We’re hoping that with the adoption of technology and monitoring, it creates a more predictable process as the patients are moved around the hospital.”
Better monitoring can help decrease stress on the patient, too. “You’re alleviating stress on the patient on both ends,” says Soman.
The benefits of monitoring, for patient and organization
Soman says that while better monitoring during transport secures better outcomes for the patient, there are monetary incentives as well.
“The old-school me, in my earlier career, would say that having this information helps in case of litigation,” she says. “There won’t be a gap regarding when the patient decompensated. A gap in the record drives attorneys on one side of a lawsuit crazy and excites the lawyers on the other side.”
But there is also evidence that more continued monitoring drives better compensation. “If the organization provides continued monitoring, during transport, this can potentially drive better reimbursement from CMS,” she says.
Apart from the financial aspect, the data captured during patient transport creates a more complete record. That means more ability to analyze outcomes and provide better results for patients, which is the core aspect of any improvement to healthcare.
“Providing more data in real time to doctors and nurses creates a less retrospective tool and offers more real-time value,” says Soman. This expands beyond individual patient data, however, and can help build a bigger picture for overall patient information.
“The other noteworthy technology evolution we’re seeing is organizations are deploying research databases, in combination with artificial intelligence,” says Soman. “We see these initiatives growing as a way to justify change and create evidence-based medicine. Providing the data to a research database, not just the EMR for documentation, could help to improve the whole transport process.”
One potential improvement: identifying the best time to move a patient. Right now, the doctor orders the move, but with the data to support research on patient transport, more predictive care models can emerge—knowing the optimal vital signs that signal a patient is eligible for a move, for example.
“I was talking with a physician who said that with the right data, he could tell within 15 minutes of moving a patient from the OR to the ICU which patients would go septic,” says Soman.
Soman sees a shift where solutions will offer real-time surveillance of the patient, even from an ICU command center rather than an individual nurse on the floor.
“I envision a future with real-time visibility of the patient status, knowing that a patient is ready to move and changing the parameters of what to look for in the vital sign values during the move,” she says. “Surveillance and alarm solutions are key to keeping a better eye on patients.”
This could also feed into improvement in another challenging arena: alarm fatigue. “Device alarms go off all the time, for all reasons,” says Soman. “Knowing which alarms are relevant and need to be prioritized is key.”
It is often difficult for caregivers to know what they are walking into when a patient decompensates and the alarm is sounded for assistance. “My friends who are physicians talk about how they’re walking in blind. They know they’re being called to a code, but if you have some data available up front, you have more insight into what’s going on with the patient instead of going in cold,” she says.
Looking to the future, better surveillance data of patients in transit could even make use of augmented intelligence to help improve outcomes. “These are all smart ways we’re utilizing data to help clinicians take action,” says Soman.
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at firstname.lastname@example.org.