Positive Outcomes for Hospital Patients, Providers
Remote monitoring of patient hospital rooms using IP network surveillance yields immediate benefits in care, efficiency and safety
- By Paul Baratta
- October 01, 2020
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
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
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.