DHMC initiative cuts complications
A new patient-monitoring system launched by a Dartmouth-Hitchcock Medical Center team has decreased the likelihood of post-operation complications by almost half and postoperative rescue calls by two-thirds, according to a paper written by DHMC anesthesiologist Andreas Taenzer and his colleagues.
Patients in the study were monitored by oximetry finger probes, which measure blood oxygen levels and notify nurses when a patient's condition deteriorates, according to the paper, "Impact of Pulse Oximetry Surveillance on Rescue Events and Intensive Care Unit Transfers: A Before-and-After Concurrence Study," published in the February issue of Anesthesiology. Emergency rescue calls decreased from 3.4 per 1,000 patient discharges to 1.2 over the two years that the program has been in place, the paper reported. The number of post-operation patients entering the intensive care unit also decreased from 5.6 to 2.9 visits per 1,000 patient days.
Doctors previously knew that recognizing a decline in condition could help prevent cardiac or respiratory arrest, but the paper develops a way to survey patient conditions consistently. The monitoring system also decreases false positive alarms, which are time-consuming for nurses and staff and can desensitize them to the urgency of responding to an actual emergency, the paper states.
"Nurses like the system," Taenzer said. "They feel that it is a benefit and frees up some of their time for other tasks."
DHMC's implementation of a rapid response team inspired the study, which Taenzer said he hopes will help rapid response teams become more efficient in addressing postoperative problems. The post-surgical surveillance system was initially enacted in a 36-bed orthopedic unit consisting mostly of high-risk elderly patients, the study said. Two other surgical units without the monitoring system were used as controls.
Representatives from hospitals in places from Cincinnati to Singapore have visited DHMC to observe the system, Taenzer said. Two more surgical units at DHMC adopted the system last February, and there are plans to implement it through the hospital over time, he said. Although the system is most effective for high-risk populations, which are more likely to suffer from cardiac or respiratory arrest, it will be useful in a variety of units as all patients face some risk, he added.
The system pays for itself after the first year and then becomes profitable for the hospital, Taenzer said. The pulse oximeters reduced the time patients from the postoperative unit under study spent in ICU care by a combined 135 days over a one-year period, he said. Taenzer added that an abstract analyzing the cost-saving aspect of surveillance will be released in March.