Postsurgical Monitoring Approach Shown to Minimize ICU Transfers

A simple yet enormously effective patient surveillance system implemented by anesthesiologists at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, N.H. has proven to dramatically decrease the number of rescue calls and intensive care unit transfers in postsurgical patients, allowing doctors to intervene in more cases before a crisis situation develops.

Andreas H. Taenzer, M.D., F.A.A.P., and his colleagues published the results of their study in the February 2010 issue of Anesthesiology.

The group's study is the first published report of such a surveillance monitoring system, which seeks to detect patient adverse events occurring in the general postoperative care setting when medical staff is immediately available to intervene, but is unaware of the deteriorating condition.

"Our primary finding is that early detection of patient deterioration in important areas such as oxygen saturation and heart rate led to fewer rescue events and a decreased need to escalate care," Taenzer said.

In the study, orthopedic patients were monitored by pulse oximetry finger probes (which measure oxygen in the blood) connected to a computer that notified nurses when physiological abnormalities were detected. These abnormalities are often the first sign that a more serious situation may be developing.

After collecting data for nearly two years, Taenzer found that emergency rescue calls dropped from 3.4 to 1.2 per 1,000 patient discharges, and intensive care unit (ICU) transfers declined from 5.6 to 2.9 per 1,000 patient days.

"With an average length of stay of just over five days for patients transferred to the ICU, this saves our institution 135 ICU days per year in our 36-bed unit alone," Taenzer said. Statistically, this worked out to a 65-percent reduction in rescue events and a 48-percent reduction in transfers to the ICU.

Ninety-eight percent of patients agreed to wear the oximetry probe and to be monitored. According to Taenzer, the nursing staff involved in the study commented that the surveillance system helped to increase their knowledge about the status of the patients under their care.

Although the study was limited to mostly elderly patients who had undergone orthopedic surgery, Taenzer sees a much broader potential for the patient surveillance systems.

"Unrecognized adverse events affect patients in academic medical center settings as well as those in small community hospitals, and they affect patients who’ve had surgery as well as those who have not," he said. "Continuous patient monitoring represents a new area of research in patient safety, and we are optimistic that any patient admitted to a hospital may benefit from this kind of monitor."

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