Education, standardized interventions and accountability: How continual electronic monitoring improves patient outcomes - June 5, 2017

Courtesy of Becker’s Hospital Review • June 5, 2017

Written by Tamara Rosin

As hospital reimbursement becomes more closely linked to quality outcomes, clinical and administrative leaders are looking for the right tools to standardize training and intervention protocols to prevent adverse events and improve outcomes.

Although most hospitals recognize the need for better training and intervention protocols, few are equipped to adequately educate staff on how to use patient monitoring systems, hold clinicians accountable to adhere to standardized protocols and track outcomes data, Cori Johnson Maegley, director of clinical and portfolio sales and Outcomes Pledge Program director of Medtronic, said during a webinar sponsored by Medtronic and hosted by Becker’s Hospital Review.

Medtronic, a medical technology, service and solutions provider headquartered in Dublin, Ireland, created the Medtronic Outcomes Pledge Program to support its hospital customers improve outcomes after implementing two types of patient monitoring technologies. Under the program, Medtronic shares risk with hospitals. Medtronic pledges to improve specific patient outcomes; if agreed-upon goals are not achieved, the company offers a 50 percent rebate on the cost of the technology.

One option includes the implementation of Medtronic’s Microstream Capnography, which aims to reduce the rate of events related to respiratory compromise on the medical surgical floor. The second option involves the implementation of Medtronic’s INVOS Regional Oximetry system, which aims to reduce the rate of cardiac surgical complications associated with major morbidity and operative mortality. Both involve education of staff, implementation of technology and the development of standardized protocols for patient monitoring and intervention.

“The Outcomes Pledge Programs are specifically tied to the implementation of continuous monitoring technologies,” said Ms. Maegley, “and our aim with these solutions is to support caregivers across the care continuum with solutions that facilitate earlier identification and intervention, increase the effectiveness of treatment, prevent complications and ultimately accelerate patient recovery.”

Option 1: Preventing respiratory compromise with Microstream Capnography

Respiratory compromise encompasses respiratory insufficiency, arrest and failure. This broad condition is a serious problem for hospitals, as it affects nearly one-third of post-operative patients and 7 percent of all Medicare patients. Additionally, patients who contract respiratory compromise on the medical surgical floor are 29 times more likely to die compared to the rest of the patient population, according to Ms. Maegley.

In addition to its frequency and morbidity, the condition is also costly and a significant burden on the healthcare system. By 2019, respiratory compromise is projected to cost the U.S. health system more than $37 billion.

“Adverse events are often preceded by observable deterioration, which leads us to the conclusion that many in-hospital adverse events may be preventable,” said Ms. Maegley. “This means better strategies for preventing respiratory compromise may have the potential to improve patient outcomes and reduce the overall cost of care.”

In Option 1 of the Medtronic Outcomes Pledge Program, participating hospitals implement the Microstream Capnography for continuous electronic monitoring of all patients receiving sedatives or opioids to help improve timely recognition of opioid depression or clinical deterioration.

Medtronic’s pledge is to help its partners achieve a 20 percent reduction in a combination of four specific metrics related to respiratory compromise, including code blues, nalaxone administration, unplanned intubation and unplanned transfer to the intensive care unit from the general care floor. If the hospital doesn’t maintain improvements in these metrics after the first 12 months of implementation, Medtronic will provide a 50 percent rebate on the customer’s spend on consumables, namely the Microstream Capnography sampling lines.

Option 2: Preventing major morbidity and operative mortality with INVOS Regional Oximetry

Cerebral desaturation is quite common, affecting between two-thirds and three-quarters of high-risk cardiac patients, according to Ms. Maegley. It is also quite costly: coronary artery bypass graft patients that experience prolonged cerebral desaturation have higher rates of MMOM and three times greater risk of prolonged length of stay, which incurs additional costs for hospitals.

Medtronic’s INVOS system is designed to reduce rates of MMOM by providing real-time monitoring of changes in regional oxygen saturation of the blood in the brain and other body tissues. INVOS allows clinicians to noninvasively monitor site-specific adequacy of profusion. It can also be used to detect site-specific ischemic complications, even when parameters on lab tests are within normal limits.

Option 2 of Medtronic’s Outcomes Pledge Program targets all adult cardiac surgery patients. The company’s pledge is to help all of its partners achieve a 20 percent decline in the number of patients that experience one or more events included in the MMOM definition. Like Option 1, if any improvements gained in the first 12 months of implementing the INVOS system are not sustained, Medtronic will provide a 50 percent rebate on the cost of the technology.

Hospitals see initial success with the Outcomes Pledge Program

While the first two hospitals to adopt Options 1 and 2 in the Outcomes Pledge Program have not yet completed the first 12 month performance period, both have found the program beneficial so far.

Mary Jo Valentine, MSN, RN, OCN, director of nursing professional development at Methodist Hospitals in Gary and Merrillville, Ind., said the hospitals were introduced to Option 1 of the pledge program in the beginning of 2016.

“There was a large percentage of patients that had respiratory issues when coding or having a [rapid response team] event, so we knew there was something going on,” said Ms. Valentine. “But like any other organization, we were already stretched thin at the bedside. We began looking for ways to support nursing staff to make sound clinical decisions and identify patients who are at risk.”

Ms. Valentine emphasized the education and training component of the pledge program, saying comprehensive education ahead of implementation was integral. The hospital and Medtronic set up classroom training for nurses, as well as online learning. From there, clinical leaders created a policy and procedures for identifying patients who were at risk for a respiratory event.

It has not been a full 12 months since Methodist Hospitals implemented the Microstream Capnography system, but “we anticipate the information we receive back from Medtronic will make an impact at the bedside,” said Ms. Valentine.

Parkwest Medical Center in Knoxville, Tenn. — where Jeff Ollis, MD, works as a cardiac anesthesiologist — was attracted to Medtronic’s quality pledge program and the INVOS system because it seemed to offer a “financial guarantee” for improved outcomes.

The program is “kind of a win-win,” Dr. Ollis said during the webinar. “The team already believed the technology would help us improve the quality of care, but now we would have a way to track whether this was truly the case, and our hospital would have a financial guarantee in their investment.”

Standardized training and intervention protocol for staff is a central benefit of the pledge program. This provides a launch pad for hospitals and health systems to support the standardization and actionable results they need to thrive under value-based reimbursement.

“In reality, we probably could have done all of these things without the pledge program, but practically speaking I doubt we would have,” said Dr. Ollis. “The monitors would have been available for use, but the education probably wouldn’t have been as rigorous and there wouldn’t have been an official protocol adopted by the hospital. The Outcomes Pledge Program brought our whole team on board with the process to ensure we will get the most possible benefit from the investment.”