In this blog, we frequently talk about remote monitoring, and specifically how networked sensors can be used to continuously collect data on critical environmental and process parameters. In this article, we’ll focus on the applications for this type of centralized monitoring system for hospitals and other healthcare settings.

In the past, nurses, nurse assistants, and other onsite clinical staff have generally been responsible for responding to monitoring alarms, particularly in small facilities. However, the industry is undergoing a paradigm shift, to a model where data is remotely monitored from a central location. In this approach, a combination of software-driven automation and specially trained technicians continuously process monitoring data and immediately alert on-site staff when a critical problem is detected. 

The applications for this type of centralized monitoring include:

• Facility environmental monitoring, to ensure the temperature, humidity, and differential pressure of critical areas are maintained in safe ranges
• Monitoring the conditions inside equipment like refrigerators, freezers, or autoclaves
• Patient care, where it is more commonly known as telemetry, for tracking physiological information 

The case supporting a centralized monitoring system for hospitals can be broken down into two factors: patient safety and efficiency. These systems contribute to patient safety mainly by adding a supplementary layer of data processing, and removing unnecessary burdens from onsite clinical staff. In a typical shift, a nurse will walk about 3-5 miles, and experience interruptions six times per hour. In the course of this demanding work, they’re inundated with audible and visual signals, and a variety of monitoring data. A centralized model shifts the workload of monitoring away from clinical staff, allowing them to focus on more critical, urgent tasks.  

Furthermore, dealing with a high proportion of false alarms can cause burnout and alarm fatigue, a dangerous condition that can lead to certain alarms being ignored or silenced. Numerous studies have shown a direct connection between the frequency of nuisance alarms and delays in response time to real emergencies. Remote, centralized monitoring reduces alarm fatigue by ensuring that alarms are only raised in true emergency situations. 

A hub-and-spoke model also provides efficiency gains and reduces the risk of liability. For example, a network of remote sensors can be used to monitor facilities and equipment across multiple facilities or even multiple cities, which is particularly beneficial in times of staffing shortages and social distancing measures. This type of monitoring technology is also adaptable to dynamic business conditions, making it easy to scale up operations or standardize between multiple locations.  

It’s important to note that a remote monitoring system isn’t just a new set of hardware and software. Implementation involves policy and process changes, including well-defined, risk-based criteria for what types of data to monitor, where to place sensors, where to set alarm triggers, and guidelines for collaboration between remote monitoring technicians and onsite staff. We’ll talk more about those issues later in this article. 

How Centralized Monitoring Can Help Drive Up Efficiency and Improve Patient Outcomes

First, let’s take a closer look at the potential applications related to centralized monitoring systems for hospitals. One common application is tracking the temperature and humidity in critical spaces like ICUs and operating rooms. For example, in areas where sensitive electronics are used, humidity must be kept within a certain range to prevent static discharge. A helpful reference for proper temperature and humidity ranges in healthcare settings is the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 170. 

Another important environmental parameter in hospitals is differential pressure, which is used to prevent the spread of airborne microorganisms into and out of controlled rooms. Like temperature and humidity, this can also be monitored using specialized sensors.

Equipment used to store high value or safety-critical materials like medicines, vaccines, or tissue specimens represents a second use case. Vaccines, for example, must be stored within specific temperature ranges to maintain effectiveness. The consequences of a vaccine refrigerator temperature excursion can range from loss of a batch of vaccine vials, to re-administration or even more significant risks to patient and community health if they are inadvertently administered. 

Cold storage of tissue samples are another notable example. Here, robust monitoring systems are critical to protect often irreplaceable materials. 

A third area is the use of remote monitoring for patient physiological data. This began in ICU’s and specialized telemetry units, but is expanding in scope to include other hospital areas such as medical-surgical wards and other areas with less critically ill patients, enabled by advances in wireless sensor technology.

In a 2014-2015 study by the Cleveland Clinic, a central monitoring unit staffed by technicians continuously measuring patients’ cardiac rhythms could identify and notify onsite staff of impending serious cardiac events, with 79% of incidents flagged within 1 hour of occurence. Here, one monitoring technician could cover up to 48 patients simultaneously, an efficiency gain enabled by combining telemetry data with the patient’s history to identify a single patient for direct monitoring at any given time.

In the three cases we’ve discussed, centralized monitoring systems have several potential benefits, including:

• Continuous, around the clock monitoring of critical data so that no potentially dangerous excursions are missed. Monitoring data can be accessed in real time, from anywhere, so any stakeholder has easy visibility. 
• The duration and severity of any excursion that takes place is recorded, which can be helpful when making a plan for disposition of affected material.
• The unnecessary burden of routine monitoring is removed from onsite clinical staff.
• Conditions that trigger alarms can be customized. This could mean setting simple high and low limits, or using more sophisticated algorithms based historical information.
• Remote monitoring systems are inherently scalable, meaning that expanding operations, or combining smaller facilities under one monitoring scheme can be done with minimal effort.
• Modern monitoring systems are designed to be compatible with regulations, simplifying record-keeping for audits and inspections.

Hospital Remote Monitoring Drawbacks

Despite the potential for increased safety and efficiency that has been demonstrated through the use of centralized monitoring, additional preparation, training, and organizational changes are often needed when a centralized monitoring system is implemented. 

This has been particularly apparent during the Covid-19 pandemic. Near the beginning of the pandemic, the FDA approved the expanded use of remote monitoring as a strategy to reduce pressure on hospital facilities, and to allow patients at high risk for infection from having to visit hospitals. The use of remote monitoring increased rapidly, which caused strain because hospitals and patients did not have much time to become acclimated to the new systems.  

In the context of environmental monitoring, planning should cover the placement of sensors, frequency of data collection and systematic data reviews, the setting of alarm limits, and changes to staff procedures that are needed to ensure there are no gaps in monitoring. 

Centralized monitoring also involves changes to how staff respond to alarms. As we’ve discussed already, custom alarm limits can be set using historical data, to reduce the number of false alarms. In addition, targeted alerts can be sent by phone call, email, or SMS text based on the type of alarm. An alarm related to an equipment failure can be sent to local response personnel, while system-wide issues can be elevated to management. 

The Future of Centralized Monitoring Systems for Hospitals

Patient care is expected to evolve significantly in the next 10-15 years, with greater patient mobility, shorter hospital stays, and an improved user experience on the patient and caregiver side. Remote monitoring will play a central role. 

We’ve already seen how advances in treatment, using new medicines or vaccines, or more complex surgical procedures, have required advances in monitoring technology. Examples include the need for more extreme storage environments for medicines, or the use of surgical robotics, a trend which will also continue in the future. 

The consolidation of smaller healthcare sites into larger systems is also expected to continue. The role of centralized monitoring in these cases will be to maximize efficiency gains and improve patient care through standardization and simplification. Similarly, the growth of existing systems by adding new sites, or updating infrastructure, will require monitoring approaches that are scalable and adaptable to highly dynamic conditions. In addition, new sites will often need updated monitoring technology to protect more sensitive, high value materials.  

The use of data collection and data analytics is also expected to expand, for classifying and escalating alarms in centralized monitoring systems for hospitals. From previous studies, we know that incorrectly set alarm limits are a major source of false alarms, but that this is a difficult issue to solve because optimal alarm limits vary from patient to patient. In the future, AI-based algorithms can be used to address this, using the large body of collected monitoring data and known patient outcomes. 

Conclusions

Centralized monitoring systems for hospitals, based on automated IoT monitoring platforms, are being more widely implemented to improve patient safety and streamline operations. One of the key ways these systems contribute to safety is by reducing unnecessary burdens and alarm fatigue for onsite clinical staff. Remote monitoring for ambient hospital environments, storage and processing of critical materials, and direct patient care is expected to be implemented even more widely in the future.

Anyone with questions about the use of remote monitoring in the hospital setting is encouraged to contact the experts at Dickson.