Tim O’Malley

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Beyond the terrible toll the novel coronavirus has taken on our friends and loved ones, COVID-19 has brought to light how our healthcare system has been challenged in the face of a pandemic and a surging influx of patients. 

The strain has been felt in both in-patient settings and post-acute environments. Reports have emerged on shortages of personal protective equipment and other technologies, while health staff have been challenged to implement new treatments and protocols all while dealing with a novel virus.

The ongoing concern about how to prevent further spread of infection has dominated news channels and sparked a call for change. From my conversations with healthcare providers, many healthcare facilities are investing in various tools, technologies and training programs to help treat COVID-19 patients while simultaneously protecting their frontline workers from contracting the virus.

There has been an unprecedented rise in the use of telehealth technologies to remotely monitor and care for patients over the past few months in response to this need. In fact, the number of telehealth patient visits has increased an estimated 

50-175 times during COVID-19, with 57% of providers

 viewing telehealth more favorably then before the pandemic. This shift demonstrates a seismic change in the provision of care, illustrating an approach which may very well signal the beginning of a new standard of care moving forward.

While COVID-19 has catapulted telehealth and remote patient monitoring into the spotlight, the need for patient monitoring reform long surpasses the recent coronavirus outbreak.

Unfortunately, established patient-caregiver ratios are and have been disproportionate for a long time, with ratios becoming less favorable for patients throughout the duration of care. For example, a 1:1 patient-caregiver ratio occurs only in specific wards, such as high acuity, critical care and medical, surgical, specialty and cardiac ICUs. Once a patient is moved to a recovery Post-Anesthesia Care Unit (PACU), this ratio stretches to 1:2 and even to 1:4, which can potentially lead situations where care givers might not have the bandwidth to provide patients with optimum care. This is therefore a need for caregivers to have access to continuous monitoring solutions to support them in providing more accurate, individualized attention to patients.

Additionally, the vast majority of global health teams currently use outdated and inefficient “spot checking” methods to monitor patients in general care patient wards. The problem with this approach is that important, life-

 changes in patient status can occur in between these spot checks, leaving health staff in the dark.

Continuous monitoring, on the other hand, provides ongoing collection of key vitals to a display outside of the patient’s room, alerting health staff immediately if something is amiss. These continuous readings create crucial opportunities for early intervention. There is tremendous value in offering health practitioners accurate, continuous patient data to provide them with a full picture of patient health. This way, they can stay informed of patient statuses and identify key trends and deviations in patient vitals to provide more proactive care.

To worsen the disproportionate ratio dilemma, the introduction of the novel Coronavirus pandemic took the US healthcare ecosystem by storm. The highly contagious nature of the pandemic caught healthcare providers off guard, forcing staff into a scramble to manage and care for high volumes of infected patients. In fact, a number of hospital physicians in the New York area relayed to me the chaotic scenes they witnessed, with staff heavily relying upon any monitoring system they could find, including available continuous monitoring platforms, to monitor patients’ hemodynamic status. This chaos continued until mid-April, when healthcare providers learned more about the virus and how to combat it, and subsequently saw significant reductions in infected COVID-19 patient numbers.

Within the post-acute care realm, due to the lack of adequate tools, foresight and strategic vision to deal with COVID-19, patients were unable to take normal routes to recovery and deteriorated more significantly, leading to a shift from post-acute care prior to almost exclusively acute care. After enduring these unprecedented chaotic scenes, certain healthcare providers were able to reflect on the situation and adequately prepare for the next mini-wave of the pandemic in June, where we saw a much more manageable return to mostly post-acute care.

The heaviest toll was experienced in Skilled Nursing Facilities (SNFs), 

with more than 40% of U.S. COVID-19 deaths linked to nursing homes

. COVID-19 has been especially lethal for elderly patients, as they experience increased comorbidities, which when combined with the virus can cause rapid declines in patient condition. Consequently, the impact on nursing homes was not only harmful for patients, but also to the industry, with families forced to bring their loved ones in to their own homes to provide adequate and safe care which they felt was lacking in nursing facilities.

I have long been a proponent of contact-free continuous monitoring (CFCM), and have worked diligently to educate healthcare providers on the benefits of this approach to care as pat of my mission to create a new standard of care across the healthcare continuum. As COVID-19 has totally transformed how healthcare providers view continuous monitoring, I believe that we are on the cusp of achieving this mission. CFCM provides the flexibility for both providers and patients and is more relevant now than ever before.

As a contact-free solution, it has proved especially useful for healthcare facilities during the current crisis from a hygienic perspective, as there are no leads or other wearable devices to adjust or to touch the patient’s body, limiting the need for staff to gown up and enter isolation areas.

Additionally, at a time when confidence among healthcare providers has been shaken, continuous monitoring is an ideal solution as it gives facilities the much-needed technological support through this challenging time. This is especially true for SNFs who are searching for technology and tools which can help them better care for patients and rebuild their image.

However, it is important to highlight it's not just in the hospitals or in the nursing facilities that patient monitoring has changed. With the introduction of COVID-19, a foreign yet familiar phenomenon took place globally: staying at home. While the next several years will see an adoption of continuous monitoring in both hospitals and non-acute areas, I expect to see tremendous growth in the at-home market for better care for the elderly which keeps them and their caregivers safe.

As we head into the winter, ahead of the looming “second wave,” healthcare providers are taking stock of how to care for high volumes of COVID-19 patients. My conclusion from the many physicians and healthcare providers that I have spoken with who are desperately trying to keep COVID-19 patients out of the hospitals, unless they are very ill and require hospital isolation, is that we will only get through this pandemic by implementing new, easy to use technologies that support isolation and staff protection.

While the dramatic ramifications of COVID-19 will continue to be felt for a long time globally, I have no doubt that COVID-19 has become the impetus for the bright future of telehealth and continuous monitoring, signaling the beginning of a new standard of care moving forward. The light at the end of this unexpectedly long and dark tunnel is bright. The introduction of innovative technology like continuous monitoring in support of a virtual health environment, only stands to benefit both patients and caregivers.

Tim O’Malley is president and chief growth officer of 

, the global leader in contact-free, continuous monitoring solutions for the healthcare continuum.

Articles

Beyond the toll the novel coronavirus has taken on our friends and loved ones, COVID-19 has brought to light how our healthcare system has been challenged in the face of a pandemic and a surging influx of patients. 


How Has Patient Monitoring Changed Since COVID-19?

Doctors, nurses, and all health practitioners alike carry a tremendous burden on their shoulders. They are tasked with the great responsibility of keeping patients healthy and safe. This is an ancient responsibility, dating back to the 5

 century when Hippocrates, a Greek physician, first instituted the 

. While only physicians are expected to say this oath or a similar version of it, its principles have remained a foundation of the medical system from generation to generation. Fortunately for the healthcare ecosystem, medical methods and tools used by our predecessors have progressed and evolved to better suit patient needs.

Today, physicians and care professionals have vast archives of medical knowledge at their fingertips and a multitude of devices at their disposal. Many of these modern devices and technologies have been dubbed “smart” and use AI and machine learning to improve patient care and outcomes. However, there is still one crucial aspect of patient care that has yet to undergo a technological renaissance: patient monitoring.

An estimated 65% of hospital patients and over 90% of post-acute care patients are “spot-checked” today. This means health staff are manually checking patients once every four to eight hours for key vital signs parameters and patient-specific issues.

Population Health Driving Investment in Remote Patient Monitoring

According to the U.S. Code of Federal Regulations clause

, hospitals participating in Medicare are required to "have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed.” However, the lack of a clearly defined ratio further compounds the spot-checking challenge, resulting in health teams relying heavily on intermittent information that can easily translate into increased patient risk.

For the average medical/surgery unit patient, the only time they will be continuously monitored is during and immediately following an emergency admission or surgery. Let’s take a typical knee replacement surgery as an example. An elderly patient gets wheeled into the operating room to be greeted by an orthopedic surgeon, an anesthesiologist, and multiple nurses. The patient to staff ratio is clearly in favor of the patient, an estimated 4:1, at least. Post operation, the patient is then taken to the post-anesthesia care unit (PACU) and put under careful watch by nurses, and even a floating anesthesiologist, for a few hours in a recommended 1:2 (estimated) patient to staff ratio. In both the operating room and PACU, the patient is monitored on a continuous basis.

After that, the patient is taken to the general care unit, where that once strong patient to health staff ratio is significantly reduced to 1:6 patient to staff ratio (estimated). Post-anesthesia, there can be some lingering temporary nerve issues which, for example, decrease a patient’s sensation to urinate. So, if after the surgery the elderly patient decides to get out of bed and head to the restroom and falls, alarmingly, many current fall prevention solutions only notify the caregiver after the patient is already out of bed, which in our scenario would be too late. With lower staff ratios, and potentially unstable patients, having advanced warning of a potential bed exit becomes critical.

This example can be applied to all healthcare environments and is also exacerbated by the encroaching “

 the aging population, which is living longer and facing more complex health situations with each passing year. As more elderly patients seek medical attention, especially in the face of the 

, the patient to staff ratio will continue to widen and take a toll on patient care.

Embracing Continuous Monitoring Technology

For these reasons, it’s time for health facilities to embrace new patient monitoring technologies to support them in caring for patients. Continuous patient monitors specifically allow health teams to track key patient vitals including heart rate, respiratory rate, and movement in real time, providing a complete picture of patient health. Continuous patient data also allows health practitioners to track baseline changes in individual patient care journeys, helping doctors and nurses better analyze and detect new opportunities for effective intervention. In fact, continuous monitoring has been proven to help reduce code blue events by 86%, patient falls by 47%, and hospital readmissions by 19%. Over the last decade, hundreds of health facilities have adopted continuous monitoring, yet many more could benefit greatly from this technology.

A unique example of continuous monitoring at work occurred earlier this year in a U.S. hospital in New York. A woman was recovering from surgery in the general surgical unit when at dinner, she started to choke on mashed potatoes. Luckily, the patient’s bed was equipped with a contact-free continuous monitoring sensor, which picked up on a faltering respiratory rate and immediately alerted the nursing staff. The staff rushed to the patient and were thankfully able to save her.

Similarly, applying this to the previous knee surgery patient example, had they too been connected to a continuous monitor, a nurse could have been automatically alerted to the patient’s movement, and gotten into the room before the patient was out of bed, thus preventing a fall.

 in hospitals every day from preventable adverse events. Many events, including avoidable respiratory and heart failure and patient falls, are within our power to reduce. As the nursing shortage continues to widen and as the baby boomer generation continues to age, healthcare technologies will continue to play a growing role in patient care.

The modern Hippocratic Oath states, “I will apply, for the benefit of the sick, all measures [that] are required.” The time is now to empower our health practitioners with the tools and measures necessary for them to fulfill their oaths.

Tim O’Malley, is president and chief growth officer of 

Physicians and care professionals have vast archives of medical knowledge at their fingertips and a multitude of devices at their disposal such as AI and machine learning to improve patient care and outcomes. However, patient monitoring is still one crucial aspect of patient care that has yet to undergo a technological renaissance.

Author | Tim O’Malley

Articles

How Has Patient Monitoring Changed Since COVID-19?

The Need for Continuous Monitoring in Today’s Healthcare System