Improved Outcomes and Reduced Costs With Continuous Monitoring of Post-Surgical Patients on the General Care Floor
Masimo (2009).
www.masimo.com/pdf/psn/LAB4806C.pdf
Abstract
A significant number of avoidable adverse and sentinel events occur on the general care floor, where nurse-to-patient ratios often preclude continuous direct patient observation. According to CMS data extracted from Medicare patient discharge records between 2005 through 2007, failure to rescue and respiratory failure were two of the three medical errors with the highest incident rates, accounting for 26% of the 97,755 reported deaths and over $1.82B in excess Medicare costs. More than 80% of patients who experience a cardiopulmonary arrest have evidence of deterioration within eight hours preceding the event. If they are on the general care floor, they often exhibit changes in respiratory function. A retrospective multi-center study of 14,720 cardiopulmonary arrest cases showed that 44% were respiratory-related and more than 35% occurred on the general care floor. One of the major contributors to respiratory-related adverse events is the set of complications arising from opioid pain management, especially for patients with Obstructive Sleep Apnea (OSA). Unfortunately, only 21% of patients with OSA have been diagnosed. The effects of opioids on OSA patients are not uniform. In some cases, patients with mild forms of undiagnosed OSA can experience profound episodes of central apnea and be at significant risk when given opioids for pain management. Hospitals have adopted Rapid Response Systems to make clinical expertise available to the bedside when a life-threatening change occurs. These systems rely on early warning indicators, including changes in oxygen saturation, pulse rate and respiratory rate. How often these parameters are measured on the general care floor largely determines how soon an avoidable event can be detected. Delayed activation of a Rapid Response Team is the strongest predictor of patient mortality. Clinical practice organizations now recommend that post-operative patients receiving pain management be continuously monitored with at least SpO2 and that notifications of critical changes in patient condition be sent directly to clinicians who can act on the reported changes.