Sutter Health System wireless strategy brings telemedicine to life

The aging patient population means just one thing to most health care providers: more acute care patients that will require cardiac monitoring. With overcrowded emergency rooms, critical care units filled to capacity, and monitored beds at a premium, Sutter Health System leaders knew they needed an entirely new approach for the future, in order to continue providing the high quality care for which the health system is renowned.

The Challenge

Robert Slepin, Vice President of Information Systems and CIO at Sutter Health Central, recognized that their outmoded patient monitoring system was limiting Sutter's ability to effectively care for patients.

"The old system, although suitable within a critical care setting, was only able to monitor patients on a single floor," said Slepin. Its lack of features was also a problem – the system could store just 10 events (noteworthy changes in a patient's heart rhythm), and provide only two lead wires of data.

"Also," continued Slepin, "we needed the ability to monitor more beds on our two-campus medical center in a cost-effective manner." Sutter Health was looking for a system that would allow them to flexibly adjust their bed configuration to meet demand in peak census seasons.

Slepin and his team recognized that simply replacing an antiquated monitoring system with new equipment would not achieve their business objectives.

"We were struggling to meet the demand for telemetry beds, so expansion at a reasonable cost was our primary business driver," noted Slepin. "Our vision was to turn telemetry into a service rather than a physical unit."

In short, they were looking for a way to increase flexibility, expand monitoring capacity, and assure high quality patient care – without adding more costly critical care beds. These challenging objectives forced Sutter Health to consider a unique alternative: wireless telemedicine.

A Strategic Solution

With a bit of research, Sutter Health uncovered some surprising news. "We discovered we could improve our monitoring services and save costs within the organization with a new wireless infrastructure. The system was open, so it collected real-time patient information from the monitoring devices we already had," said Slepin.

With the wireless infrastructure technology and a new approach to monitoring, Sutter Health would be able to leverage both personnel and clinical expertise by providing monitoring services to Sutter General Hospital from a central "Mission Control"-style center located at Sutter Memorial Hospital 2 1/2 miles away. According to Slepin, this allowed Sutter to concentrate technical resources in one location and avoid hiring a separate, highly skilled, expensive staff. Not only was this attractive from a cost-benefit perspective, but an enterprise-wide monitoring approach would allow Sutter to easily expand the system as their monitoring needs increased, while providing standardized, high quality monitoring care across the enterprise.

An evaluation team consisting of biomedical engineers, monitor technicians, nursing directors and a physician reviewed VitalCom's proposal for a wireless infrastructure that would enable enterprise-wide monitoring. After attending site visits to see the system in action, it was clear that VitalCom's PatientNet solution would meet the desired objectives.

Clear, at least, to the evaluation team. "This was unsafe, uncharted territory according to the physicians," said Debora Cale, RN, BS, a nursing director at Sutter General Hospital. "It was a challenge to convince the cardiologists that the quality of care would not be impacted with a multiple-unit monitoring approach."

Cale understood that a careful transition was critical. Thus, they used a multi-phased approach to system implementation, going live on just one telemetry unit the first year. During the second year, they integrated another unit onto the system and established a mission control-style monitoring center, where certified technicians monitor all patients from a single location, around the clock.

"This was quite a shift in care strategy from what we were used to," commented Cale. So a backup system was put in place for critical situations. This safeguard included an arrhythmia phone (also known as the "Bat Phone") and an enterprise-wide paging system. By taking a systemwide monitoring approach, Sutter Health was able to expand monitoring services to 55 beds on multiple units.

In 1999, Sutter Health's monitoring needs again changed and, as expected, expanded. There was an increasing desire to move patients out of the ICU, but keep a constant watch on them via telemetry monitors while they recovered in other less-expensive units. PatientNet was expanded to an orthopedic telemetry unit on 4 North at Sutter General Hospital to accommodate this requirement.

Then in 2000, Sutter decided to use VitalCom's innovative SiteLink® product to seamlessly link an off-site facility into the mission control room at Sutter Memorial Hospital. This created a true enterprise-wide monitoring infrastructure. With SiteLink, Sutter Health avoided additional costs by using the same certified technicians in the mission control center to monitor these new patients located miles away.

By this time, the clinical staff was already comfortable with the enterprise monitoring approach, so the transition to off-site monitoring was a smooth one.

"Now, we're seamlessly monitoring on other units and floors within the medical center, and on units at the Sutter General campus 2 1/2 miles away," said Cale.

Wireless telemedicine has become a reality.

The Vision Realized

Today, Sutter is realizing all its original goals, and some unanticipated benefits as well. Using sophisticated wireless technology and an advanced telemedicine solution, they can monitor up to 96 patients throughout the Integrated Health Delivery Network (IHDN) from one location. Also, by centralizing monitoring functions, Sutter was able to double the number of monitored beds without adding additional monitoring technicians, saving the cost of one FTE per year – that's thousands of dollars saved annually.

What's interesting is that PatientNet has delivered more than a technical solution. It has inspired enough confidence in physicians in the quality of monitoring and the mission control approach that they are comfortable moving their patients out of the ICU sooner. As a result, PatientNet facilitates quicker movement through the ICU.

From a quality perspective, because all monitoring care is provided from a single location by trained and certified technicians, Sutter has achieved a standardization of monitoring quality across the enterprise. In fact, a 98% compliance rate was achieved for no missed rhythms by having a trained technician monitor patients from a single location.

Patient safety and quality of care is optimized with instant wireless transmissions of critical patient information that enable care providers to receive data faster, resulting in quicker, more knowledgeable interventions. Within six months, the length of time for nurses to answer the arrhythmia phone dropped from 7-8 rings to 1.2 rings, resulting in quicker response time to critical patient events.

What's more, the expanded features and capabilities of the system – multi-lead viewing, storage of more rhythms, 24-hour disclosure and trending of STs – give cardiologists a more complete picture of the patient's status, often enabling them to intervene earlier and improve the patient's outcome.

Looking Toward the Future

"We will consider the possibility of expanding PatientNet into other Sutter hospitals across the enterprise," said Slepin. "Also, we are excited about the Internet access technology and plan to evaluate that option for our physicians."

Cale agrees. "Our ultimate goal is to be able to add other units in the medical center."

Down the road, Slepin hopes to integrate information from the PatientNet system with their existing Eclypsis Sunrise Clinical Manager clinical information system. "Our long-term vision is to build a comprehensive electronic medical record within each region. In the short run, the more data points we can offer our physicians at the point of care to support clinical decision-making, the better."

Source: VitalCom Inc.