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Study: Real-Time Analytics, Continuous Monitoring Mitigates Threat of Respiratory Depression

Peer-reviewed results of patented surveillance application reveals promise of real-time patient safety initiatives in hospitals and health systems

Milford, CT—May 24, 2017—Bernoulli, the leader in real-time solutions for patient safety, announced the publication of a peer-reviewed study demonstrating the use of patented real-time analytics, medical device connectivity and combinatorial alarms to provide remote centralized continuous monitoring of post-surgical patients at risk for opioid-induced respiratory depression (OIRD).

Continuous Surveillance of Sleep Apnea Patients in a Medical-Surgical Unit1 in the May/June 2017 issue of the Journal of Biomedical Instrumentation & Technology consists of two separate studies on the use of continuous capnography monitoring at a medical-surgical unit at Virtua Health System in New Jersey.

The study’s results suggest that combinatorial alarm signals based on multi-parameter assessment reduced overall load better than individual-parameter sustained alarm signals and appeared to be more effective at identifying at-risk patients.

Using only sustained alarms as the filter for notifications reduced alerts from 22,812 to 13,000. However, passing multiple series of data through a multi-variable rules engine that monitored the values of pulse (HR), oxygen saturation (SpO2), respiratory rate (RR), and end-tidal carbon dioxide (ETCO2) in order to determine which alarms to send to the nurse-call phone system further reduced alerts to just 209—a 99% reduction.

“More importantly, clinical staff was alerted for every patient that experienced an actual respiratory depression episode,” said the study’s co-author, John Zaleski, PhD, CAP, CPHIMS, Chief Analytics Officer of Bernoulli. “The successful implementation of real-time patient safety initiatives have long been a goal of health system CIOs, but recognizing and responding to signs of patient deterioration requires medical devices connectivity as well as clinician’s access to real-time data.”

A Growing Patient Safety Threat
The use of opioids, such as hydromorphone and morphine sulfate, are known to increase risk of respiratory depression in patients who have been diagnosed with or are at risk for obstructive sleep apnea (OSA).

More than half of medication-related deaths and 20,000 incidences of respiratory depression-related interventions annually are attributed to the delivery of opioids in a care setting, at a cost of approximately $2 billion per year to the U.S. healthcare system.

“Data from multiple sources may be required to achieve improvements in patient safety, including the EHR and real-time data from medical devices,” said Zaleski. “Moment-to-moment changes in patient vitals are not usually available in the long-term clinical record, so a hybrid approach involving both real-time and aperiodic and discrete data is required to improve the overall surveillance of these patients.”

Respiratory Depression Safety Surveillance
The solution leveraged in the study, Bernoulli’s Respiratory Depression Safety Surveillance (RDSS), includes patented analytics with multi-variable thresholds—adjustable by the care facility—to identify clinically actionable events while significantly reducing the overall number of alarms communicated to remote and mobile clinicians, mitigating the risk of alarm fatigue.

RDSS is flexible, adaptable and scalable from individual departments to enterprise-wide deployments. Its vendor-neutral architecture leverages the hospital’s existing investments in IT, network, wireless and mobile infrastructure, while its FDA class II clearance includes indications for use to provide remote monitoring and alarm surveillance.

Implications for Real-Time Healthcare
“Combining analysis with real-time data at the point of collection creates a powerful tool for prediction and clinical decision support,” said Zaleski. “The ability to track patients throughout the hospital, continuously add new devices, and distribute real-time patient monitoring to centralized dashboards and mobile devices should be a major consideration for CIOs tasked with achieving real-time healthcare capabilities.”

Beyond high-acuity areas, healthcare systems are creating a foundation for other real-time healthcare innovations, including clinical surveillance modules, medical device integration in an EHR and virtual ICUs.

“This study demonstrates the promise of using real-time data for myriad patient safety initiatives,” said Janet Dillione, CEO of Bernoulli. “In addition, Bernoulli’s RDSS solution sets the stage for a wide range of applications, including medical device integration, precision alarm notifications, and clinical surveillance modules in various care settings.”

Reference
1. Supe D, Baron L, Decker T, Parker K, Venella J, Williams S, Beaton K, Zaleski J. A pilot study in middleware-filtered capnography alarms of continuously monitored obstructive sleep apnea patient in a medical-surgical unit. BI&T. May/June 2017.

Bernoulli One™ is the market’s only real-time, connected healthcare platform that combines comprehensive and vendor-neutral medical device integration with powerful middleware, clinical surveillance, telemedicine/virtual ICU, advanced alarm management, real-time analytics and robust distribution capabilities into ONE solution that empowers clinicians with tools to drive better patient safety, clinical outcomes, patient experience, and provider workflow.

About Bernoulli

Bernoulli is the leader in real-time solutions for patient safety, with more than 1,200 installed, operational systems. Bernoulli One™ is the market’s only real-time, connected healthcare platform that combines comprehensive and vendor-neutral medical device integration with powerful middleware, clinical surveillance, telemedicine/virtual ICU, advanced alarm management, real-time analytics and robust distribution capabilities into ONE solution that empowers clinicians with tools to drive better patient safety, clinical outcomes, patient experience, and provider workflow. For more information about Bernoulli One, visit www.bernoullihealth.com. Follow us on LinkedIn and Twitter . Visit our Resource Center to download case studies, white papers and articles.

Bernoulli’s John Zaleski and Jeanne Venella co-author respiratory depression study in Biomedical Instrumentation & Technology

This report consists of two separate studies on the use of continuous capnography monitoring conducted in an effort to improve patient safety at Virtua Health System. The desire for improved patient safety is motivating continuous monitoring and improved surveillance in clinical areas not traditionally equipped for such monitoring. We explored the use of remote monitoring of capnography, using enterprise middleware, in patients recovering from surgery in a medical-surgical unit. Continuous monitoring traditionally has been used in higher-acuity settings, such as intensive care units. Patients diagnosed or suspected to have obstructive or central sleep apnea may benefit from the increased surveillance afforded by continuous monitoring. Pain management in this cohort of patients, recovering from bariatric, joint replacement, or other major surgery, often involves administration of opioids (e.g., hydromorphone, morphine sulfate), which are known to increase risk of respiratory depression. Continuous monitoring of these patients increases the likelihood of detecting adverse clinical events. Our goal was to implement continuous monitoring in order to identify alarm conditions caused by adverse clinical events requiring intervention (e.g., opioid-induced respiratory depression) and artifacts related to patient movement, suspect measurements, or other medical device–generated alarm signals.

virtua case study detailing Bernoulli One successful medical device integration and connectivity

Bernoulli case study details multi-hospital medical device connectivity

Bernoulli, the real-time leader in patient safety, has published a new case study detailing its successful efforts to bring medical device integration to Virtua, one of New Jersey’s largest non-profit, multi-hospital health systems.

Utilizing Bernoulli’s standards-based, open architecture Bernoulli One™ system enabled Virtua to bring medical device integration and connectivity across a complex healthcare ecosystem with an integrated, scalable, secure, and cost-effective web-based platform.

Virtua’s need for medical device integration and connectivity grew in part to free clinicians from writing out hundreds of patient data numbers from scores of different devices and machines every day in the course of care delivery. The health system wanted a plug-and-play medical connectivity paradigm that was uniform across different departments, could seamlessly interface with their Epic EHR, and could easily scale with the health system’s future growth.

With the conclusion of the Phase I integration in Virtua’s Perioperative Department, which includes Endoscopy, ECT and Interventional Radiology, the health system has realized complete electronic documentation, which has allowed clinicians to devote more of their time facing the patient and meeting their care needs.

Phase II will focus on Virtua’s Critical Care Unit, which includes the ICU and NICU/PICU, and will integrate the units’ physiological monitors, ventilators, anesthesia machines, smart tourniquets, and brain activity monitors.

Bernoulli One, the company’s flagship platform, is the market’s only real-time, end-to-end, connected healthcare platform that combines comprehensive and vendor-agnostic medical device integration with powerful middleware, clinical surveillance, telemedicine/virtual ICU, advanced alarm management, predictive analytics and robust distribution capabilities into one solution.

Bernoulli’s vectored event grid architecture enables true interoperability across disparate devices, networks, and systems by utilizing dynamically programmable intelligent appliances at the network edge. The system’s granular level of patient data detail, in real-time, at the point of care for improved decision support applications while also providing flexibility for user-defined configuration and control for device connectivity, monitoring and management, results in better allocation of personnel resources and reduced support costs.

Read the case study here and learn more about Bernoulli’s medical device integration and connectivity solutions here.

Be sure to also follow Bernoulli on LinkedIn and Twitter for the latest news and updates.

Bernoulli to Attend AAMI Foundation National Coalition for Alarm Management Safety

Bernoulli to Attend AAMI Foundation National Coalition for Alarm Management Safety

Bernoulli will take part in the AAMI Foundation’s National Coalition for Alarm Management Safety meeting July 20-21. Bernoulli CIO John Zaleski will be in attendance, as well as representatives from two of Bernoulli’s customers—the Connecticut-based Hospital for Special Care and New Jersey-based Virtua.

The goals of the meeting include determining the unmet needs in hospitals struggling to improve alarm management that the coalition should address, and what deliverables can be developed to fill those needs. In addition the coalition will continue to:

  • Build a common taxonomy around alarm signals and alarm conditions that industry, clinicians, and nursing orgs agree to adopt so all may communicate more effectively about alarms.
  • Build and populate a cloud-based database to generate improved algorithms for alarms and smart alarms.
  • Build national database to collect device alarm parameters contributed to the database by the participating hospitals.
  • Develop new tools and resources for improving alarm notification to reduce alarm fatigue.

Watch this space for more detail. You can also follow us on Twitter and LinkedIn to engage with our thought leadership, read our latest white papers and case studies, and find links to articles and interviews. You can read our latest white paper on strategies to reduce alarm proliferation click here.

Virtua: Implementing Capnography in Low Acuity Settings

AAMI Foundation  Safety Innovations

Virtua: Implementing Capnography in Low Acuity Settings

virtua hospital implementing capnography in low acuity settingsIn 2013, the Virtua (1,009 beds across three hospitals) prioritized narcotic safety. The hospital system responded by implementing non-invasive capnography monitoring and continuous pulse oximetry monitoring on medical-surgical units. Capnography is used to measure exhaled end-tidal carbon dioxide (EtCO2) and inhaled carbon dioxide (FiCO2) to determine a patient’s respiratory rate and generate waveforms (i.e., capnograms) of exhaled carbon dioxide over time. However, unlike conventional capnography, which requires patients to be intubated to sample a patient’s inhalations and exhalations, thus restricting its use to critical care areas and operating rooms, non-invasive capnography uses nasal or oral-nasal sampling tubing that is worn over the nose (and sometimes mouth) to collect respiratory data, making it practical for use anywhere in a hospital.

This paper details Virtua’s journey of implementation of non-invasive capnography, highlighting how barriers were overcome, sharing key factors for success, and describing the ongoing challenges of effectively monitoring patients receiving intravenous opioids for pain management.

The capnography monitoring implementation experience at Virtua provides a prototype of how a team, through persistent advocacy, can influence their organization to change practice and leverage its best asset—staff across all disciplines—to improve the quality of patient care.

You can download the report here.