Positive Outcomes for Hospital Patients, Providers

Remote monitoring of patient hospital rooms using IP network surveillance yields immediate benefits in care, efficiency and safety

There is a movement underway in healthcare services to utilize technology that acts as a force-multiplier in patient care. The movement is called remote patient monitoring, and it involves the use of IP network-based video surveillance technology. Remote monitoring has been demonstrated to improve patient care and lower costs. Such solutions also play a critical role today in the care of patients being treated for COVID-19, contributing several benefits for both patient and hospital.

Video systems for general surveillance of lobbies, corridors, perimeters and parking garages have been employed in the healthcare sector for decades. Further, it’s not uncommon for hospitals to have cameras in triage areas, operating rooms and the like, to ensure that healthcare workers are complying with personal hygiene protocols and room preparedness. The shift to using IP video systems in patient rooms, however, happened about five years ago — the impetus being to enhance patient care by providing response to critical conditions more quickly.

Success stories in remote patient monitoring are abundant. Today, these solutions involve thousands of cameras used in hundreds of hospitals across the United States.

A Typical Remote Patient Monitoring Solution

Whether it’s installed in Emergency Rooms (ERs), Intensive Care Units (ICUs), or other types of patient rooms, a remote monitoring solution usually consists of video- streaming capabilities provided by an IP network camera; audio capabilities such as a microphone built-in to the camera or two-way audio with a speaker; and analytics often included on the camera (called “edge-based analytics”).

Visual-based analytics include conditions such as patient movement beyond the hospital bed (going past a virtual “fence”). Audible analytics are tuned to the specific frequencies of various sounds, such as aggressive voices, coughing, breaking glass, and even gun shots. Dome cameras and cube cameras are popular, or in some cases PTZ cameras may be installed. Wide dynamic range is advised, to compensate for either brightly lit or poorly lit rooms.

Always at the receiving end of the system are healthcare professionals who remotely monitor the patients through these high-resolution “clinical” cameras. While the implementations vary from hospital to hospital, the goal of the system is the same: to serve as additional eyes and ears for the nurses and doctors, and to reduce alarm response time from minutes to just seconds. At Nemours Children’s Hospital in Orlando, Fla., the cameras are monitored by a rotating team of paramedics in a Tactical Logistics Center (TLC). The paramedics check patients’ vital signs, lab work, patient history and clinical reports. In addition to the data, the TLC integrates live streaming video and audio from the network cameras in each patient’s room through the medical records software.

The TLC covers 100 beds at Nemours and 150 beds at a sister hospital in Wilmington, Del., proving that the system really is structured to operate remotely. Because the system is SIP-standard, doctors can use their cell phones to also see the patients. This enables them to have a proactive response even before entering the patient’s room.

Privacy can be concerning for patients’ families not familiar with remote monitoring technology, so providing education in various forms — such as pamphlets, a web page with frequently asked questions, one-on-one discussions, and other methods — can help ease concerns. One of the talking points of privacy is reassuring families that technology does not take the place of people — rather, it complements them and acts as a force multiplier. Nemours describes it as a third layer of care, following in-room care and then floor care.

Another key aspect of privacy is compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a federal law that restricts access to a person’s medical information. In order to comply with HIPAA requirements and other laws, remote patient monitoring systems don’t ever record images or conversations of any patient.

At Nemours the cameras have a red privacy LED that comes on to alert anyone in the room that someone from the TLC has connected to the camera and is streaming live video. At other hospitals, such as Advocate Health Care, a group that operates more than 250 sites of care including 12 hospitals in the Midwest, when cameras are turned off, they face away from the patient toward the wall. When turned on, the cameras adjust to face the patient.

Improving Patient Outcomes

Advocate’s program is called electronic intensive care unit (eICU) and it covers almost 400 patients. According to Advocate, studies have shown that around-the-clock support from an eICU facility is effective in reducing clinical complications; extending intensive-care physician expertise to more patients across the network; improving patient outcomes and reducing length of stay; and collecting useful data that may be analyzed to improve clinical processes.

Although hospitals and medical centers continuously monitor patients’ vital signs, patient health can’t always be assessed by clinical data alone. Seeing the minute changes in a patient’s skin tone or noting increased restlessness can be a sign of a problem that may escalate. In addition, the two-way audio feature in some systems enables healthcare providers to listen for audible indicators of breathing difficulties, as well as to speak remotely with their patients.

Because it would be impossible for medical staff to be in every patient’s room simultaneously, hospitals with in-room cameras allow medical staff who are remotely monitoring patients’ vitals to also visually verify if a patient is in distress and call for immediate medical attention. Medical staff can help clinicians with procedural checklists or remind them when they last administered a certain medication. If they see an emergency developing, they can quickly call for additional support personnel, so the nurse doesn’t have to leave the patient’s bedside.

Sometimes a delay in responding to a critical medical situation can have dire consequences. A study published by medical journal JAMA Pediatrics discovered that alarm fatigue is an industry challenge, as it can take nursing staff more than 10 minutes to respond to less critical physiological alarms. With cameras in every patient room, medical staff doing the remote monitoring can observe sudden changes within seconds and quickly dispatch a code blue or rapid response team to potentially save a patient’s life.

One such episode occurred after the attending nurse had just left the toddler’s room. Suddenly the child’s vital signs indicated he was having a febrile seizure. Based on what the paramedic saw, he triggered an immediate alert to the nurse and to the rapid response team who arrived at the boy’s bedside within seconds, saving him from brain damage.

In another case, the cameras revealed a mother attempting to smother her child. The paramedics instantly alerted the rapid response team at that hospital to intervene. The cameras also helped a medical team stop a sick teen from leaving the hospital without permission during an abduction and elopement alarm. The in-room camera showed that the patient wasn’t in his bed and surveillance cameras throughout the hospital pinned down his location before he was able to leave the building.

More Efficient Response, Lowered Costs

At Lee Health in southwest Florida, which operates 35 medical facilities including two specialty hospitals, IP surveillance cameras not only improve the facilities’ security, but ensure that patients are being provided with high-quality care. Among the focus there are patients who may pose a fall risk.

Falls are a major problem in healthcare settings, especially in hospitals where the risk factors are heightened. Each year, between 700,000 and 1 million people in the United States fall in hospitals, according to The Joint Commission, the nation’s oldest and largest standards-setting and accrediting body in healthcare. Anywhere from 30 to 50 percent of patients who fall sustain an injury, according to Agency for Healthcare Research and Quality.

Lee Health was forced to hire retired healthcare professionals to sit in the rooms of high-risk patients to ensure their safety. Now, however, the group can quickly mount wireless network cameras in rooms to monitor patients at risk of falling. By connecting to a video decoder, the live video feed is immediately displayed on a monitor at the nurse’s station. The technology allows Lee Health to monitor these high-risk patients more efficiently and has a cost-saving benefit, too, since the total annual cost of hiring “sitters” for at-risk patients is $1.6 million to a hospital.

Other efficiencies are delivered through alarm verification. A study published in the Journal of Hospital Medicine showed that more than 90 percent of patient alarms are non-actionable or nuisance alarms. In fact, nuisance alarms are widely recognized to be a leading contributor of alarm fatigue — a sensory overload and de-sensitization to alarms among healthcare workers — resulting in missed alarms and delayed response times. By using video to validate patient telemetry alarms, hospitals can quickly dismiss nuisance alarms and direct their teams where they are most needed.

Remote Monitoring of COVID-19 Patients

Remote monitoring of surveillance cameras used for clinical purposes also provide a level of safety to those on the front lines of the coronavirus pandemic. Because remote monitoring helps reduce direct contact with patients, it minimizes the risk of contagion to healthcare workers, lowers the spread of the virus, and helps to stretch the supply of single-use personal protective equipment (PPE). Overall, remote monitoring can aid hospitals that are experiencing a surge in patients by more efficiently using staff and resources.

Temporary hospitals, the likes of which have been erected during the pandemic, can benefit from video door stations, which include both an IP network camera and a built-in microphone and speaker for two-way audio communication.

This type of unit can easily be strapped to an IV pole as a simple and mobile device. If the patient needs attention, he or she can push the button to send an alert to the nurse’s station allowing the nurse to see the patient and providing them with the ability to talk to one another. Remote monitoring of COVID-19 patients allows medical professionals to be proactive with their response, which again can help with the level of PPE that they may need.

When you consider that there are nearly 1 million hospital beds in the United States alone, the potential use of IP network video, audio and analytics to improve patient care is enormous. Remote monitoring adds an extra layer of patient observation and accelerates the response to emergencies. The concept is scalable and return on investment is in months, not years. The use of IP surveillance technology in healthcare today is not only making hospitals smarter, it’s making them safer, too.

This article originally appeared in the September October 2020 issue of Campus Security & Life Safety.

Digital Edition