Test unit uses infrared sensors to monitor patients
Big brother is a caregiver
When told to think of what the hospital floor might look like in the future, subacute providers might imagine robots delivering medications, state-of-the-art equipment, and less invasive surgical procedures. But contrary to the science fiction imagination is a futuristic attempt at redesigning care delivery at Baylor University Medical Center in Dallas.
Baylor, in conjunction with Milwaukee-based Marquette Medical Systems, is proving that it is possible to plan for the future while realizing immediate results. Since implementing its floor of the future,’ Baylor has improved staff efficiency and productivity, improved the quality of care, and reduced costs.
Baylor is testing the use of new patient/staff communication technology combined with remote physiological data capabilities on a specially designed post-acute unit. Although the technology is still in test stage, Baylor plans to expand the concept hospitalwide in early 1998.
Improving staff efficiency is a problem not unique to Baylor. Staffing efficiency consistently ranked among the top concerns of readers who responded to the 1997 Subacute Care Management Reader Survey.
In fact, Baylor has saved $125,000 by eliminating two monitor technician positions on its 21-bed telemetry unit. The system will be expanded to the subacute unit later this year. But Baylor’s unlikely hero in developing a futuristic care delivery model doesn’t involve a robot but rather the replacement of a centralized monitoring unit.
"We’re tweaking and refining the system until December 1997 on the test unit, but the tracking system for staff and patients that we’re using could go anywhere, especially for subacute units where patients are encouraged to ambulate," adds Jim Benney, RN, BSN, clinical manager of the test unit at Baylor.
Administrative staff at Baylor decided to test and evaluate the new approach to monitoring rather than simply replacing an older system, says Rich Roa, PhD, project manager at Baylor. "We wanted to optimize staffing and technology. At the same time, we wanted to work synergistically with our chosen vendor to determine which technology was window dressing and which was the meat’ of the system," he adds.
Baylor is the flagship of the Baylor Health Care System. The medical center consists of five connecting hospitals in downtown Dallas.
The old and the new
After the evaluation process was complete, Baylor chose Marquette to develop what both organizations have dubbed the hospital "floor of the future." The agreement allows Baylor to use established Marquette products and serve as a test site for new technology.
"The mutual goal is to create a distributed monitoring care strategy for subacute patients that maximizes quality of care while lowering costs," explains Paul Oehler, Marquette’s business group manager for wireless products.
Baylor’s subacute unit, for example, will be using Marquette’s latest monitoring system, which is a wireless system that allows caregivers to care for more patients, sicker patients, and mobilized patients via remote statistical information. Nurses receive electrocardiogram readings on patients through pagers.
"This is an actual reading, not a coded system. We receive three seconds of pre-event and three seconds of event on each reading," notes Benney.
One example of new technology to be tested at Baylor is Marquette’s sensor system. Infrared light waves are captured by sensors throughout the facility from small badges worn by patients or affixed to equipment.
The staff testing the equipment did not feel that the technology created a sense of Big Brother’ watching over each employee. "We didn’t have any sense of trepidation because the staff helped design the system so that it actually helps them and proves, for example, how quickly they respond to a patient requesting pain medication," explains Benney.
Several trends in health care are requiring hospitals to re-evaluate how patient hospitalization and monitoring is conducted. The trends are forcing hospitals to move from centralized monitoring strategies to a more distributed care system, says Oehler.
The trends affecting patient hospitalization include:
• Sicker patient groups. Increasingly, procedures are done on an outpatient basis, and inpatients are often critically ill, which requires intense, continual monitoring in subacute patient areas.
• New patient management strategies. Recommendations from both providers and payers encourage patient ambulation to reduce overall length of stay in the hospital, which requires hospitals to track ambulatory patients’ locations and vital signs.
• Increased patient load. Nurses are caring for more patients, which requires spending more time on the floor and away from the central monitoring station.
Roles were redefined
Benney’s vision of the unit included reducing the nursing staff while increasing the care technician staff.
"Other units within Baylor use a 70% nurse to 30% unit assistant formula. I wanted to create a unit using 60% nurses and 40% care technicians, which was a new position for the hospital," explains Benney.
Unit assistants at Baylor provide basic daily care to patients, but Benney and his staff wanted to expand the role to include basic nursing functions to provide quicker response to patient needs and free nurses to focus on higher acuity patients.
"Our care technicians can do simple oxygen set-ups, phlebotomies, and physical therapy technician skills. Likewise, nurses delegated several tasks, including sterile dressings, tracheotomy care, tube feedings, and foley insertions," notes Benney.
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