Surveillance Monitoring: Current Challenges and Solutions
Surveillance monitoring is still under development
Surveillance monitoring is an emerging market, and like many such markets, there is no established and accepted framework for an ideal solution. In fact, much about surveillance monitoring—who to monitor, what parameters to choose, when to declare a patient as clinically deteriorating, when to intervene, and what interventions to undergo—has yet to be fully determined. Despite this uncertainty, basic requirements for surveillance monitoring are relatively well-understood.
The requirements fall into four areas:
- Specific physiological parameters and data to be monitored
- Frequency of data collection
- Timely availability of the data to clinicians
- Ability to identify deteriorating patients and trigger a response
It is also critical that surveillance monitoring solutions not contribute to alarm fatigue by generating false/positive and nuisance alarms.
Because the mechanisms of deterioration are not fully understood, there has yet to emerge a definitive list of ideal physiological parameters for detecting it. Frequently, basic vital signs are indicated as required for surveillance monitoring, including heart rate, blood pressure, respiratory rate, temperature, and pulse oximetry.
Not all surveillance monitoring solutions use these vital signs. The methods and accuracy of data capture can also vary considerably. Innovations such as continuous, noninvasive blood pressure measurement and new types of respiration sensors stand out as examples of advancements in physiological parameters. Besides physiological data, some surveillance monitoring solutions include other information for identifying deterioration, such as diagnostic test results, progress notes, and observations.
The elapsed time from the beginning of detectable deterioration to arrest and failure to rescue is highly variable: a few hours for some patients, a day or more for others. Because of this variability, most surveillance monitoring solutions provide continuous monitoring. Some surveillance monitoring solutions take a different approach and use spot data. In these solutions, the frequency of data collection is offset by claims of greater predictive ability. This approach uses algorithms to analyze spot and other types data to indicate deterioration earlier than other approaches. With these predictive algorithms, collecting data just once or twice a shift provides warning of deterioration on par with continuous monitoring solutions.
Some surveillance monitoring solutions present monitored data in the form of scores or indexes that indicate levels of deterioration, known as “early warning systems.” Other systems accomplish this through innovative visualizations.
Technology solutions
There are more than 20 surveillance monitoring solutions on the market or in development. Solutions can be divided into three categories: patient-worn monitors, remote sensing monitors, and specialized clinical decision support systems.
Patient-worn monitors
Patient-worn monitoring solutions can be divided between conventional patient monitoring systems and wireless sensor solutions; both are worn on the patient’s body. These solutions rely mostly on miniaturization to create a device that is cost-effective, small, lightweight, and easily tolerated by patients.
Conventional patient-worn monitors include a display and user interface for setting alarm limits and managing the device; wireless sensor-based devices do not have a display or interface on the device itself. Conventional monitors use wired connections to sensors attached to the patient. Typical parameters include ECG, heart rate, respiration, spot or continuous NIBP, SpO2, skin temperature, and motion and posture monitoring.
Due to their similarity to larger multi-parameter patient monitors, conventional patient-worn surveillance monitors are familiar to users. They tend to provide more physiological parameters than wireless or remote sensing solutions. Presently, the whole-product solution—e.g., central stations for remote surveillance, mobile clients for alarm notification, EMR integration, and larger bedside displays—tends to be more complete than other monitoring solutions.
But some of the things that contribute to conventional patient-worn monitors’ success can actually be limitations. The monitors can be lost or accidentally left on the patient at discharge due to their small size. And applying one of these devices to the patient is more involved and time-consuming than using some of the other solutions.