How to Use Wearables Inside the Hospital

While wearable devices have gained attention for their use in remote patient monitoring programs, hospitals are finding more value in inpatient programs

Healthcare leaders are going wireless to monitor patients in the hospital, using new technology that can track a wide variety of vital signs and give providers new insights into improving clinical outcomes.

For many health systems, the initial thought is to use wearables to monitor patients who are discharged from the hospital and into a remote patient monitoring program. But Sarah Pletcher, MD, MDHCS, Houston Methodist’s vice president and executive medical director for strategic innovation, says the inpatient setting gives hospitals an opportunity to improve a key element of care management.

“We wanted to use it in the inpatient setting because we've seen the value of continuous algorithm-based monitoring by a dedicated and highly skilled remote clinical team in the virtula ICU space,” she says. “And the idea that we could hack the way vital signs are taken in the hospital setting, which hasn't really been innovated much in the last hundred of years, was a key opportunity area.”

Houston Methodist selected BioIntelliSense's BioButton roughly one year ago, after an exhaustive process during which Pletcher even slept and showered with multiple wearables to make sure they had the form, features, and would function as intended. Pletcher says she wanted an unobtrusive, durable, medical-grade device that would track several vital signs and be scalable.

Houston Methodist is using the wearable to supplement and replace manual collection of vital signs, pushing data hourly into the EMR and continuously to a central team, who respond to algorithm alerts and then alert bedside nurses when their review data suggests something concerning.

“As we began to advance the technology across the system, we also began to redesign how we did routine vitals,” Pletcher says. “We went from every four hours for routine vitals first to every six then to every eight. And we will look for opportunities to stretch it to every 12, especially at night and for stable patients so that the patient gets more rest. The bedside teams get a bunch more time back while at the same time there's a peace of mind that even when they're not in the room with the patient doing a spot check, the technology is there gathering data every minute and flowing it to a central monitoring team that's keeping an extra eye on things.”

While the wearable detects a wide variety of vital signs, Pletcher says she’s most impressed with the value of objective, high-frequency respiratory rate.

“It turns out that changes in respiratory rate are one of the earliest things you start to see in a patient,” she says. “By the time they get to the point where their blood pressure is tanking, you're late in the game, they've likely been deteriorating for a while.”

And that’s where wearables might prove their ROI in clinical outcomes. The ability to track vital signs in real time means clinicians can identify patients in distress much earlier, rather than waiting for a nurse or doctor to come to the bedside. In many cases clinicians can intervene even before a patient shows any outward signs of distress—and with AI tools on the horizon, the opportunity to collect and analyze data in the blink of an eye offers more potential for early detection.

Pletcher sees a more immediate ROI in workflow improvements, especially for nurses.

“The ROI is solid just based on the workforce savings,” she says. "Not having to send staff wheeling that vitals cart in there for every patient every four hours no matter what, can offset the cost of using the technology. And that doesn't factor in quality/safety catches, patient experience and nursing and physician satisfaction that there's more in place helping to look after their patients. Every day there are moments where we're catching patients earlier and hopefully avoiding them needing more intensive intervention.”

She’s also noticed the ability for wearables to pick up on heart rate arrythmias, giving hospital officials new insight into whether the wearables can reduce the demand for telemetry. And she’s looking forward to the ability to monitor pulse oximetry, blood pressure, and heart function and to differentiate between surface and core body temperature.

“Sometimes it's a case of we already are getting the data,” she says. “We've never had it before, not at this frequency and scope, so we're still learning how to use it.”

Aside from teaching clinicians how to be comfortable with the wearables and understand the data coming in—a common element of change management that comes with almost any new technology—Pletcher says one the biggest issues they’re having with wearables is remembering to collect them when a patient goes home. Sometimes, she says, the small devices are forgotten and thrown away or accidentally go home with the patient.

Using Wearables to Address One Specific Care Concern

While some hospitals see wearables as a means of improving inpatient monitoring, others are starting with one use case, such as monitoring cardiac care patients or trying to reduce sepsis cases.

At Sutter Health, hospital leaders are using a wearable that attaches to the neck and takes an ultrasound of the patient’s carotid artery and jugular vein. The Flopatch Doppler ultrasound patch, developed by Flosonics Medical, enables care teams to identify signs of sepsis, hypertension/shock, and renal failure earlier and take action.

“We’re losing a lot of people [to sepsis] every year,” Kristina Kury, MD, medical director of critical care at Sutter Health’s Eden Medical Center, says of the deadly infection, which is the primary cause of death in hospitals, killing almost 40% of the 1.7 million patients each year who get sepsis.

Kury says the patch focuses on carotid artery flow time, creating a waveform that’s similar to an echocardiograph. That measurement changes when IV fluids are administered—too much fluid causes heart failure and respiratory distress, while too little fluid takes out the kidneys and other organs.

“it's extraordinarily easy and practical, and that device can stay with the patient for a week while they're in the hospital because we know things are dynamic,” she says of the patch, which is now being integrated into care pathways in four hospitals. “It's another tool that you can use to incorporate into that clinical scenario, and it's a much more accurate vital sign than heart rate.”

Kury says Sutter Health has reduced its sepsis rate to 20% through other improvements, but seems to have hit a plateau. One option was a non-invasive cardiac output monitor, which consists of a console that has to be wheeled into each patient room and electrode patches that have to be applied to the patient and which isn’t ideal for patients with structural heart disease and vascular replacements.  Other options were cardiac catheters and central venous pressure monitors, both invasive and imperfect.

A wearable, Kury says, addresses a specific care gap but won’t make the patient any more uncomfortable.

“We have people at the outset who are going to be sensitive to giving any kind of intravenous volume because the heart muscle is not healthy [through] heart failure or their kidneys have failed, and they’re on dialysis,” she notes. “They have no way of intrinsically removing fluid from their body, so they quickly could get into trouble. That’s a vexing population to our clinicians, especially in the ER, where they're coming in with an undifferentiated person in shock.”

The Bluetooth-enabled platform, which isn’t yet integrated into the EHR, enables clinicians to monitor six patients through one dashboard in real time.

As a doctor, Kury says, “I would want to see the data myself, the curve, the waveform, the spikes, and I would want to see that myself and then have the interpretation.”

The Rise of Connected Care

Influenced by consumer-facing technology like activity bands, smartwatches and sensor-embedded clothing and jewelry, healthcare organizations have long studied the use of wearables in RPM programs outside the hospital setting. But with more sophisticated medical-grade devices on the market and a desire to create a “hospital room of the future” that places a premium on wireless technology, healthcare executives are now interested in bringing wearables inside the hospital.

Julia Strandberg, chief business leader of connected care and monitoring for Philips, says the next three to five years will see a fundamental shift in how health systems and hospitals view patient monitoring.

 “Scalable, integrated and optimized patient monitoring and management system for the hospital” will become more popular, she says, as decision-makers see the value in keeping a continuous eye on patients rather than relying on spot checks or scheduled vital signs monitoring.

The benefits are numerous. Many hospitals struggled with patient monitoring during the pandemic, when infected patients were isolated and staff and clinicians had to step into bulky PPE to see them. In addition, hospitals have long struggled with the number of wires, leads and other devices attached to the patient, hindering patient movement (a key metric for clinical improvement) and prone to tangles and trips. Add to that the stress and burnout rate for clinicians and staff and the propensity to use loud sounds to demonstrate a monitor’s effectiveness or an emergency health concern.

“Beeps and dings and alarms and alerts and are very burdensome, not only on the patient but also the care [team],” says Strandberg, who notes that wireless technology is now being developed to send data and alerts into the EHR or onto dashboards. Philips is also working on an avatar that can give clinicians a whole-patient view, using cues like a blue color to indicate the patient is cold.

The key to success for health systems and hospitals is what Strandberg calls the pitcher-catcher relationship. Healthcare leaders need to make sure the EHR is catching all the data being transmitted and connecting that information to the right providers.

“How do you synthesize all that data that we brought in and stratify it such that we can help enable more rapid clinical decision making and intervention if it's required?” she asks.