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Readers Write: Expanding the Horizon of Clinical Surveillance

January 9, 2019 Readers Write No Comments

Expanding the Horizon of Clinical Surveillance
By Janet Dillione


Janet Dillione is CEO of Bernoulli Health of Milford, CT.

Pay-for-performance programs, like the Centers for Medicare & Medicaid Services (CMS) Hospital-Acquired Condition Reduction Program (HACRP), determine provider reimbursement based on a hospital’s ability to meet key patient safety and performance measures. To reap the financial incentives—and avoid the penalties—of HACRP, more hospitals are “investing in clinical surveillance solutions that utilize real-time patient data to reveal deteriorating patient conditions at an early stage,” according to a report released in November by AGC Partners, a multi-vertical research and investment firm.

Continuous surveillance traditionally has been the near-exclusive domain of hospital departments that care for high-acuity patients with the greatest risks for deterioration, such as the ICU. However, the persistence of preventable catastrophic events, such as post-surgical opioid-induced respiratory depression (OIRD) — which accounts for more than half of medication-related deaths in care settings — suggests that the ability to monitor patients continuously and communicate insights to clinical teams in real-time must extend beyond the ICU.

According to a new KLAS report on the subject, “clinical surveillance tools hold the promise of giving caregivers clinically actionable insights that decrease mortality, reduce readmissions, and improve overall patient outcomes, and clinicians expect these alerts to be embedded directly within their workflow.”

However, successfully broadening the utilization of this technology can be complex and disruptive and can bring new uncertainties to the entire organization.

How Scalable is Continuous Surveillance?

For many health systems, continuous surveillance can be broadly used with existing technology infrastructure, especially organizations with critical care units or ICUs. Optimizing that infrastructure’s capabilities and incorporating it into existing clinical workflows is the real heavy lift, but advances in monitoring technology, use of real-time physiological data and smart alarms, and sophisticated analytics and the ability to route that information to remote clinicians show promise for scaling continuous surveillance to a number of patient care departments, including telemetry, maternity, med-surg, and even beyond the walls of the hospital.

Additionally, health systems exploring the viability of continuous surveillance are using their EHRs as a natural starting point. Multivariate, real-time data from medical devices aggregated with retrospective data from EHRs, provides a holistic and complete source of objective information on a patient that can be used for prediction and clinical decision making.

Does It Save Lives—and Costs?

Hospital investments in clinical surveillance and analytics solutions are driven by organizations that are migrating toward value-based care models and are trying to achieve the objectives of value-based care, including improving care quality and outcomes, reducing clinical variation, and reducing healthcare costs.

Similarly, patient safety in the era of value-based care is increasingly defined as preventing adverse events before emergency interventions or costly escalations are required. However, most common monitoring practices are reactive, not proactive –interventions are often applied only after a patient has deteriorated.

A number of hospital-acquired illnesses (HAI) could be prevented by continuous clinical surveillance. Sepsis and respiratory compromise are among the most costly in terms of resources and morbidity and mortality.

  • Industry costs. Respiratory failure that requires emergency mechanical ventilation occurs in 44,000 patients per year in the United States. The cost to US hospitals for opioid-induced respiratory depression (OIRD) interventions is estimated at nearly $2 billion per year.
  • Hospitalization costs. Respiratory compromise ($22,300), ranks in the top five of 20 conditions that have the highest aggregate costs per stay due to the high frequency of hospitalization.
  • Length of stay. Ventilator-associated complications (VAC) can lead to longer stays in the ICU and greater rates of readmission. VAC complications add approximately $40,000 in costs to each case, $1.2 billion in total costs annually.

Will Clinicians Adopt It?

Technology implemented without proper consideration of impacts on workflow and user ability to fulfill their core responsibilities can have deleterious effects on its overall efficacy.

Involving direct-care staff is critical to the success of any new technology. How will this new technology impact how nurses deliver patient care? What adjustments in workflow and practice need to be made, at go-live and beyond? Starting with these questions fosters buy-in from the staff who will be utilizing this equipment. If end users are not involved in the selection, adoption, and implementation of a technology, then the likelihood that they will become owners of that product is significantly lower.

According to a clinical surveillance report released this year by Spyglass Consulting Group, “hospitals recognize the importance of real-time capabilities to enhance patient safety and improve care quality.”

Ultimately, the ability to safely manage patient populations across the enterprise, reduce the cost of care, and align with reimbursement and regulatory incentives are driving and accelerating adoption. Clinical surveillance has arrived in healthcare and the future looks bright.

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