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REAL-LIFE PATIENT STORIES

In the Operating Room

Consider a Certified Nurse Anesthetist (CRNA) who is monitoring vital signs and medications for a sedated patient in the operating room.

This patient, like many, would be intubated and sedated, and pain and neuromuscular blockades would be administered while the patient’s airway and breathing are supported through the anesthesia machine. The CRNA monitors blood pressure, heart rate and electrocardiogram (ECG) as well as level of sedation and other signs for changes.

Medication doses of the sedatives and pain medication must be governed properly to ensure adequate sedation, and medication administration timing is key to proper care management. Medical devices need to be synchronized with hospital system clocks, or the time stamps associated with various vital signs may not indicate the accurate time at which they were obtained. Vital-signs time stamps must be accurately coordinated with drug administration to correctly determine adequate sedation relative to indications of pain expressed by the patient, particularly through changes in heart rate and blood pressure. Device connectivity can coordinate and assign common time stamps to all automatically collected values, ensuring that precise time stamps of findings are associated properly with the medication administration record. Here, the CRNA experiences the benefit of accurate measurement timing which ultimately results in better patient care management.

In the Catheterization Lab

Across the hospital in the catheterization lab, a patient is brought in for an emergency percutaneous intervention (PCI), including stent placement, after experiencing an anterior myocardial infarction (an AMI). The emergency room attending physician reads the 12-lead ECG from the cardiac monitor obtained in the pre-hospital setting of the ambulance in preparation for emergency department arrival, and confirms the finding of ST segment elevations and reciprocal changes. The catheterization lab is activated in preparation for the patient’s imminent arrival, to ensure the patient goes to the lab immediately and the surgical team is ready.

Thanks to medical device connectivity, ECG waveforms and vital signs are shared with the emergency care physician and the catheterization lab team. Furthermore, hospital staff can optimize patient treatment and management by accessing time stamps of medications administered outside the hospital.

In Surgical Intensive Care

At the same time, another patient is being weaned from postoperative mechanical ventilation in the Surgical Intensive Care Unit (SICU). Connected medical devices communicate the mechanical ventilator settings and patient’s spontaneous parameters, together with cardiac monitoring data, so that attending physician and respiratory therapy clinicians can evaluate whether the patient is being managed adequately during spontaneous breathing trials.

Clinicians review the ventilation trends and lab findings, such as arterial blood gases, and determine the patient is ready to begin weaning trials. Earlier extubation means transfer from the intensive care unit to a step-down unit can occur sooner, reducing mechanical ventilation time and freeing an ICU bed as well as facilitating earlier discharge to the patient’s home.

In the Dialysis Suite

On the dialysis floor, a patient with end-stage kidney disease is receiving dialysis treatment. This patient comes into the hospital for outpatient dialysis three times per week. Device connectivity supports the dialysis staff by monitoring and reporting dialysate pressures and patient vital signs. These values are then communicated to nursing and attending physicians who determine whether pressures are in the normal range or whether the patient is experiencing distress that requires earlier intervention.

Dialysate patients must be monitored frequently to determine if their blood pressure is adequate or if they are decompensating. Monitoring for adverse events, such as fistula occlusions, is also critical to ensuring the patient is properly managed.  Here, the same device connectivity solution provides the critical link in communicating vital data to remote-care personnel who can ensure continuous oversight of these patients, who may be on dialysis treatment for several hours at a time.

In the Medical-Surgical Unit

In the Medical-Surgical Unit (MSU), a patient is brought up from post-op recovery. The patient, an elderly woman, has had a bariatric procedure and will be in MSU under observation for several days. At home, she had been on oxygen (nasal cannula, three liters per minute) and used a continuous positive airway pressure (CPAP) mask for obstructive sleep apnea (OSA).

The patient is administered an oral dose of an opioid pain medication (e.g., hydromorphone) for postoperative pain. She is monitored on continuous pulse oximetry with a cardiac monitor to assess her heart and breathing. In this situation, device connectivity provides continuous post-operative monitoring for changes in breathing and low oxygenation levels that can be associated with post-operative respiratory depression. The integrated data provides a continuous update so caregivers can monitor for trends such as a decline of oxygen saturation or breathing to determine whether the patient requires an intervention or perhaps rapid response.

Medical device connectivity means vital signs can be sent anywhere necessary for observation, such as a remote monitoring station or a clinician’s handheld device.