A. Cipriano1, C. Roscher2, A. Carmona2, J. Rowbotham3, S. P. Stawicki1 1St. Luke’s University Health Network,Department Of Surgery,Bethlehem, PA, USA 2St. Luke’s University Health Network,Department Of Anesthesiology,Bethlehem, PA, USA 3St. Luke’s University Health Network,Quality Resource Department,Bethlehem, PA, USA
Introduction: Effective detection of clinical patient deterioration (CPD) on medical-surgical units (MSU) continues to pose a significant challenge. Inefficient utilization of hospital resources negatively affects institutional quality, safety, and finances. The goal of this study is to evaluate a pilot implementation of pulse oximetry-based SafetyNet monitoring system (SNMS) as a method of resource-efficient CPD detection on MSU at a tertiary referral center. We hypothesized that the deployment of SNMS will be associated with improved detection of CPD and fewer intensive care unit (ICU) transfers.
Methods: This is a post-hoc, IRB exempt analysis of a quality improvement initiative’s designed to increase CPD detection and to prevent unplanned ICU transfers on our orthopedic MSU through the use of SNMS (Masimo, Irvine, CA). Concurrently, we sought to reduce telemetry overutilization. Primary outcome was the ICU transfer rate, with telemetry utilization and non-clinical alarm burden (NCAB) as secondary outcomes. We compared study outcomes on two adjacent MSUs (P8 + P9). The P8 unit served as “control” both during pre- and post-SNMS implementation periods (e.g., the SNMS was only deployed on the P9). Quality reporting methods, Fisher’s Exact and Mann-Whitney U-test were used to compare pre-/post-SNMS periods, with significance set at α=0.05.
Results: Study duration was 30 months (Jan-Dec 2015 "pre-implementation" and Jan 2016-Jun 2017 "post-implementation" period). We examined 21,189 patient-days on the P9 MSU (11,702 and 9,487 pre/post-intervention, respectively) and 23,388 patient-days on the P8 MSU (13,616 and 9,772 pre/post-intervention). Median case-mix index (CMI) was higher for P9 than P8 during the duration of the study (2.08 [IQR 1.98-2.17] vs 1.67 [IQR 1.64-1.76], respectively). SNMS implementation was associated with significant reduction of ICU transfers form P9. Median ICU transfers per 1000 pt-days declined from 11.7 pre-SNMS to 8.8 post-SNMS (Fig 1, p<0.03). Median telemetry utilization per 1,000 pt-days declined from 20.8 pre-SNMS to 16.5 post-SNMS (p<0.01). Targeted staff training and “sensor off” delay implementation resulted in significant reduction in NCAB, from 72.3 to 36.5 pages/device (p<0.01).
Conclusion: Implementation of SNMS was associated with 25% reduction in ICU transfers per 1,000 pt-days on our P9 MSU. At the same time, median telemetry utilization on P9 MSU was reduced by 21%. In addition, we were able to reduce the number of non-clinical nursing notifications by 50% through the combination of staff education and “sensor off” delay implementation. Due to its success, this pilot program is undergoing active expansion.
