Two ways vitals trends help doctors manage patients better
A patient laughs. BEEP. A patient shakes the probe. BEEP BEEP. A patient readjusts in their bed. BEEP BEEP BEEP.
Traditional vitals monitors were designed assuming a medical professional is always at the patient’s bedside. They take the “better safe than sorry” approach and BEEP anytime a vital signs goes out of range, assuming there is a nurse to assess whether it was a true alert that needs a doctor’s attention, or ignore it if it was a false one. While ICUs often have one nurse looks after one patient, this creates chaos in non-ICU scenarios.
Continuously crying wolf leads to physicians & nurses ignoring alarms. This can have the disastrous effect of patient deterioration going unnoticed, even resulting in preventable deaths.
Moving from “Fire-fighting” to Proactive Care
Today’s doctors rely on asking their nurses to manually graph a patient’s vital signs every few hours. This task is labor intensive and provides only a few data points in a full day. In a typical ward, a nurse will look at a typical vitals monitor and manually graph the vitals every few hours on a paper chart. For example, look at these heart rate measurements taken on a patient manually by a nurse over 10 hours.
Its difficult for a doctor to make a decision with so few data points throughout a whole day.
“Is this patient stable enough to go home?”
“Is the heart rate going up?”
“Is the treatment having the intended effect on this patient?”
Compare this to the data from an automatic trending system that documents vitals every few minutes.
Now it is easy to discern a trend and see a pattern. Lets ask the same question:
“Is this patient stable enough to go home?”
Probably not given that it is frequently breaching the upper limit of normal. Rather than relying on the likelihood that the nurse was able to capture the vitals when a patient is showing a deviation from the normal, a trending system provides a complete story of the patient’s condition.
Implementing automatic patient trends outside of the ICU allows for robust patient management even when nurses are managing several patients.
Automatic Trending Systems provide a Second Dimension of Information
Doctors assess multiple vitals signs simultaneously as a method of validating and predicting patient outcomes. Traditional vitals monitors are not geared to aid clinical decision-making. They provide trends of individual vitals, rather than providing a holistic picture of all available vitals signs. They fail to usefully assist doctors to make and amend management protocols outside of the ICU.
Studies have shown that in order to be most effective, vitals monitors must simultaneously provide trends of multiple vitals signs. This is due to the fact that vitals often rise and fall together as the body compensates for the illness.
The heart rate and respiratory rate trends recorded simultaneously are shown for the same patient. Notice how the patient’s heart rate and respiratory rate trend upwards almost simultaneously. This has huge clinical implications as this could suggest a cardiovascular complication that needs a doctors attention.
By failing to represent multiple vitals trends in a manner that allows better interpretation of a patient’s condition, normal monitors prevent doctors from seeing the patterns underlying patient deterioration. A powerful trending system automatically charts all vitals in relation to one another, mimicking what expert clinicians do automatically in their head. When all vitals are charted together, a clinician can treat a patient holistically and quickly know if they are stable or unstable.
The Future of Monitoring is Trend-Based
The cacophony of noise from typical monitors have desensitized physicians and disturbed patient’s experience in the hospital. Noisy monitors can even affect patient recovery due to the anxiety and stress caused by false alarms. While they have their place in ICUs, threshold alerts in non-ICU areas are ineffective and counterproductive.
Proactive trend-based management will allow physicians to better understand a patient’s condition, assess the patient response to their treatment, and detect early deterioration of patients with greater accuracy. Not only does it provide a more accurate representation of the patient’s condition for one vital, but it also provided a more detailed and multi-dimensional picture of all patient vitals.
