ECRI Institute has addressed many new technologies in each edition of its annual Top 10 Hospital C-suite Watch List. Some have panned out, some have not, and some, like Google Glass, continue to be studied for new health care uses. As ECRI Institute celebrates its 50th anniversary of separating fact from fiction in health care, we trust that this 9th edition of the Watch List will help you better understand some of the technology and infrastructure changes in patient care this year.
This year’s list includes topics such as direct-to-consumer genetic testing, which is changing the face of what front-line clinicians encounter when patients walk in with test results they received on their own, asking, “What do variants of unknown significance mean? Should I be worried?” Below ECRI highlights two of the issues highlighted on the list; Acuity-adaptable Rooms and Insertable Cardiac Monitors.
Acuity-adaptable Rooms: Will Staff Accept This Patient-centered Care Model?
Each time a patient is moved from intensive care to a step-down unit, from a telemetry unit to a regular med/surg unit, there is a risk to both the patient and the staff, as well as an impact on the patient’s anxiety.
These patient handoffs are known to cause a risk with medication, and health care leaders are looking at ways to reduce or eliminate handoff risks. Some hospitals are experimenting with an acuity-adaptable care delivery model wherein a hospital keeps a patient in the same room from admission to discharge, regardless of acuity level. The aim is to improve workflows, enhance care continuity, improve patient safety, decrease length of stay and reduce costs. Every patient handoff avoided when an intrahospital transport is eliminated is probably associated with a reduced risk exposure, either via minimized medication errors, preventing patient falls or overburdening nursing staff that remain on the unit while one accompanies a patient transport.
Also, acuity-adaptable units eliminate the holding costs associated with keeping a patient in an intensive care unit while he/she awaits transfer to a step-down or telemetry unit.
While acuity-adaptable models make intuitive sense, many challenges exist in staffing, infrastructure and workflow to actually improve patient outcomes. Just ensuring and maintaining staff competencies across all care levels requires a major rethink of nursing and hospitalist support models. How does a hospital using an acuity-adaptable model ensure that its highly trained critical care nurses are willing to work at lower care levels and, conversely, does every staff member have to be Advanced Cardiac Life Support certified?
Generally, hospitals that have implemented acuity-adaptable models focus on a particular type of patient to “house” in such a unit; cardiac, transplant and oncology patients are likely patient groups that can be coordinated across acuity levels in one area.
For acuity-adaptable models to work, the medical equipment used for patient care is directed to the patient instead of transferring the patient to another unit. For that reason, some hospitals focus on step-down through discharge rather than critical care through discharge. The equipment intensity from step-down through discharge is much more manageable.
Infrastructure wise, acuity-adaptable rooms generally include shower facilities in the toilet area and, depending on local building codes, may have to adapt for nursing staff being able to view the patient’s head in a critical care setting to a need for more privacy as the patient improves.
Some hospitals using acuity-adaptable rooms are reporting significant cost savings per patient. In value-based medicine, these will be important to sustain.
WHAT YOU NEED TO KNOW
Insertable Cardiac Monitor: Can You Get in Front of Stroke by Going Inside the Heart?
About 6 million people in the United States have atrial fibrillation (AF), the most common heart arrhythmia often leading to stroke. For patients with AF, long-term continuous heart monitoring by electrocardiograph can help long-term medication management. Such monitoring is typically done using a Holter monitor for 24 hours to 7 days. However, Holter studies require placing several electrodes on the chest and abdomen and for the patient to carry a recorder, which patients find inconvenient. Also, Holter monitoring analysis is performed retroactively and requires multiple additional steps by both the patient and caregiver for data analysis and interpretation.
Enter the Confirm Rx™ Insertable Cardiac Monitor (ICM) (Abbott Laboratories, Abbott Park, IL, USA). The small device is an implantable loop recorder cardiac monitor. This ICM is the first of its type to interface directly with a patient’s smartphone, which proactively transmits data to the patient’s physician. While a Holter monitor is worn externally and can be bulky, the ICM is implanted and connects via Bluetooth to the patient’s smartphone. Because the ICM transmits the data via a smartphone, the patient no longer needs to use a separate bedside telephone transmitter, and the transmitted data are fully encrypted and secure.
At intervals programed by the treating physician, the smartphone app automatically uploads patient data to the Merlin.net Patient Care Network for clinician access. Besides being able to detect AF, the device can also record the heart’s electrical activity, which the patient controls by pushing a button on the app. This feature is useful when the patient has physical symptoms such as chest pain or syncope. The small device – 49 mm x 9.4 mm x 3.1 mm (about 2 inches x 1/3 inch x 1/10 inch) – weighs 3 grams. The Confirm Rx has no contraindications for use.
Implanting Confirm Rx is similar to implanting a pacemaker or ICD. The procedure is usually performed under local anesthesia, but patients with certain medical conditions may warrant moderate sedation. In 2017, the estimated worldwide ICM market was approximately $800 million and was expected to grow by $100 million a year.
This article is excerpted from ECRI Institute’s 2018 Top 10 Hospital C-Suite Watch List. To download the full report, visit www.ecri.org/2018watchlist.
For more information on ECRI Institute’s evidence-based health technology assessment or consulting services, contact firstname.lastname@example.org, or call (610) 825-6000, ext. 5889.
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