The handful of wires pasted to a cardiac patient's chest can be lifesavers, setting off an alarm if the person's heart rate or breathing get dangerously fast or slow. Unfortunately, the telemetry alarm also sounds when the patient rolls over, scratches an itch, coughs, or does any number of other things. They go off so often that nurses tend to ignore them, which of course can put the patient at risk.
A company called EarlySense takes a different approach. Instead of attaching the monitors to the patient, their device – about the size of an iPad – lies under the patient's mattress. It's sensitive enough to detect the patients' breathing, pulse rate, and whether he or she is moving around too much or too little.
But because it's not attached to the patient, the false alarms are cut way back – from a few times an hour to roughly once in a nurse's eight-hour shift, says Jessie Munn, associate chief nurse of medical surgical nursing at Newton-Wellesley Hospital near Boston.
After a trial run, Newton-Wellesley put the monitoring system under all 150 of its adult medical surgical beds, not just those in cardiac units, and has detected problems that would previously have gone unnoticed, Munn said. Several patients were found to have undiagnosed atrial fibrillation – an unusually fast or erratic heart beat that can cause many problems.
The EarlySense system can also detect if patients coming out of anesthesia after surgery are headed for trouble, or if their breathing rate doesn't recover properly, says Janet Stinehart, a nurse manager in the post-surgical orthopedic unit at Newton-Wellesley.
By tracking motion, the monitors have also been helping hospital staff identify patients who aren't moving enough, or who may be trying to get out of bed before they're ready, Stinehart says. Giving nurses an early alert could help them to reach the patient's bedside in time to prevent a fall.
The system also offers nurses a continuous record of the patient's breathing, heart rate and movements over the course of a shift – rather than just at a few moments in time – so they will be better able to spot developing signs of trouble, Munn explains.
Despite recent progress in other areas, hospitals are still not very good at catching patients before they start to deteriorate, says Dr. David Bates, director of the Center for Patient Safety Research and Practice at Brigham & Women's Hospital in Boston and a professor of medicine at Harvard Medical School. Technology like EarlySense could make a difference, says Bates, who has done consulting work for the company.
"Lots and lots of patients are at risk," Bates says. "This is a big issue and it is one around which there is very, very substantial opportunity for improvement."
The EarlySense system works well for patients, Munn says, because they are largely unaware of it. They're not tethered to monitors, and nurses don't have to wake them up to check vital signs or roll over patients who are moving enough on their own.
And the nurses like the monitoring system, Munn says, because it allows them to do meaningful work rather than constantly chasing down false alarms.
Families find the system comforting, too, according to EarlySense marketing director Maayan Wenderow, because they know their loved one is being monitored.
EarlySense was founded in Israel in 2004 and has its US headquarters in Waltham, Mass. Worldwide, the EarlySense system is in about 18 facilities, including Hebrew Home for the Aged in the Bronx, Florida Hospital in Tampa, and South Shore and MetroWest hospitals outside of Boston. Newton-Wellesley is the first hospital to use the system in every bed, not just in critical or intensive care units.
The device costs about $7,500 per bed, a price that the company says is justified by reducing patient falls, bed sores, and readmissions, according to Clay Garber, EarlySense director of sales-Northeast region.
Corrected on : Corrected 09/16/13: An earlier version of this article misstated the extent to which Newton-Wellesley hospital used the new monitoring device. The device is used in 150 beds, not 258 beds.