A virtual ICU is often the first clinical surveillance system a hospital implements, but it shouldn't be the last: clinical surveillance brings the greatest value when it's deployed across the care continuum.

Appropriately deployed clinical surveillance systems can improve efficiency, decrease variation, and increase the quality of care by providing a nearly real-time view of a patient's status. This streamlines operations and improves care coordination.¹

How Clinical Surveillance Systems Improve Clinical Decision-Making

Clinical surveillance systems can analyze and integrate data from electronic medical records (EMRs), bedside monitors, flowsheets, labs, and other sources, and send data-based alerts to clinicians in near real-time. Integrating these sources gives clinicians a more complete picture of the patient—one that can be used to make clinical predictions and decisions.²

This approach has worked for years. For example, a study in BMJ Quality & Safety concluded that "the use of technology specifically designed to improve the accuracy, reliability and availability of patients' vital signs and early warning scores" is associated with reduced mortality.³

One of the key uses of this data is to create unique informational dashboards relevant to each area of care. These dashboards then integrate data from multiple clinical systems and devices to provide patient context in real-time.

Choose Tools That are Scalable and Flexible to Synchronize Patient Data

The ability to customize a provider's or department's view of patient data is essential.⁴ The needs of labor and delivery won't be the same as those of the ICU, the burn unit, or the oncology ward.

That's why surveillance tools must be flexible enough to adapt to the needs of a particular facility or clinical unit.⁵ Likewise, they must be scaled to appropriately deliver measurable improvements in hospital efficiency and patient safety to those particular clinicians on a specific unit. Only then can providers ensure seamless integration across the care continuum.

Scalable and flexible systems allow clinicians and departments to customize based on not only the department but also the patient population or clinical condition, such as sepsis or opioid-induced respiratory distress. A successful system in the ICU can be extended to various care areas in the hospital, and eventually, mapped across an entire network.

That scale demands interoperability: devices, platforms, and software must communicate and cooperate with each other.⁶ The EMR system and the clinical decision support system, for example, must both be vendor-agnostic and work seamlessly with the IT systems and platforms where relevant clinical data is pulled and delivered.

Integrating Real-Time Surveillance to Help Improve Patient Outcomes

Some hospitals and health systems are already investing in these solutions, implementing them in various care settings.⁷ Unfortunately, most current monitoring solutions lack the necessary level of integration. They may be able to collect patient data from multiple sources, but they lack the ability to share that information with providers in different departments or stages across the care continuum. These solutions may also not allow users to compare data with care protocols.

When data is fragmented and siloed, hospitals struggle to aggregate and visualize patient data in real-time. As such, clinicians end up relying on alert-driven workflows. Such alerts may fail to flag critical changes while sending out unnecessary warnings. For example, in a study cited in BMJ Quality and Safety about existing electronic alerts for sepsis, most physicians felt that the alerts did not mark an important change in their patient's condition.⁸

Without the proper clinical context, the data may fail to provide the full clinical picture of the patient's status. In turn the detection of deterioration and undermining coordination of the patient's journey across the care continuum is delayed. This delay increases the risk for ICU admission and even mortality.⁹

The financial costs are likewise severe. Lack of care coordination could cost between $27.2 billion to $78.2 billion each year, according to a 2019 review in JAMA.¹⁰

Moving away from reactive alerts and toward comprehensive, real-time surveillance, on the other hand, may prevent adverse effects. A case study from the Carilion Clinic in Roanoke, Virginia found that clinical surveillance helped to decrease ICU readmissions.¹¹ The clinic also hypothesized that surveilling COVID-19 patients has allowed providers to perform more controlled respiratory intubations rather than emergency intubations.

Clinical Surveillance Across the Care Continuum

As clinical surveillance tools expand beyond the ICU, hospital leaders must come up with a strategy to ensure the right data reaches the right clinician at the right time. It must allow them to tailor the system to its own protocols and address the unique needs of each unit. This requires scalability, flexibility, and leadership. With the right people, processes, and technology, you can reduce inefficiency and move toward truly value-based care.

References:

1. Activating a Virtual Hospital with Intelligent Clinical Surveillance Solutions. Frost & Sullivan. www.gecarecanvas.com/whitepaper/activating-a-virtual-hospital-with-intelligent-clinical-surveillance-solutions. Last accessed April 2021.

2. Clinical Surveillance, A Concept Analysis: Leveraging Real-Time Data and Advanced Analytics to Anticipate Patient Deterioration. Bringing Theory in Practice. Online Journal of Nursing Informatics. www.himss.org/resources/clinical-surveillance-concept-analysis-leveraging-real-time-data-and-advanced-analytics-anticipate. Last accessed April 2021.

3. Impact of Introducing an Electronic Physiological Surveillance System on Hospital Mortality. BMJ Quality & Safety. pubmed.ncbi.nlm.nih.gov/25249636. Last accessed April 2021.

4. How Clinical Surveillance Is Making Its Mark in Healthcare. MedCity News. medcitynews.com/2018/04/clinical-surveillance. Last accessed April 2021.

5. Activating a Virtual Hospital. Frost & Sullivan.

6. The Future of the ICU? How Clinical Decision Support Is Advancing Care. HIT Consultant. hitconsultant.net/2020/10/19/future-icu-clinical-decision-support-advancing-care. Last accessed April 2021.

7. Trends in Clinical Surveillance & Analytics. Spyglass Consulting Group. https://www.spyglass-consulting.com/wp_CLINICAL_SURVEIL_2018.html. Last accessed April 2021.

8. To Catch a Killer: Electronic Sepsis Alert Tools Reaching a Fever Pitch? BMJ Quality & Safety. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702042. Last accessed April 2021.

9. Identifying Patients with Sepsis on the Hospital Wards. Chest. www.ncbi.nlm.nih.gov/pmc/articles/PMC5472513. Last accessed April 2021.

10. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. https://jamanetwork.com/journals/jama/article-abstract/2752664. Last accessed April 2021.

11. How Real-Time Data Can Change the Patient Safety Game. Journal of AHIMA. https://journal.ahima.org/how-real-time-data-can-change-the-patient-safety-game. Last accessed April 2021.

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Across the Care Continuum: Why Flexible Technology Is Key to Extending Clinical Surveillance Beyond the ICU

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