Smart Beds Show Promise for COVID Patients

Patient deterioration, which refers to the worsening of a patient’s condition during a hospital stay, has become a growing concern and affects as many as one in six inpatient admissions.

This article was originally published August 5, 2020 on PSQH by John Palmer

Editor’s note: The following Q&A resulted from a conversation PSQH had with Nancy Riffel, MSA, BSN, RN, the patient services manager for Covenant HealthCare, a 643-bed hospital in Saginaw, Michigan, that is the largest healthcare provider in the Great Lakes Bay Region. Riffel has been a nurse for more than 40 years.

The hospital recently installed Centrella® smart beds from Chicago-based Hill-Rom with contact-free, continuous monitoring powered by EarlySense in its 24-bed medical pulmonary unit to continuously monitor patients’ respiratory and heart rates, the most common and problematic signs of patient deterioration.

Patient deterioration, which refers to the worsening of a patient’s condition during a hospital stay, has become a growing concern and affects as many as one in six inpatient admissions.

PSQH: Why is it important to identify if a patient is deteriorating, and how can a smart bed help those with COVID-19?

Nancy Riffel: One of the best ways to protect patients from this problem is to recognize changes in their vital signs, which can accurately predict clinical deterioration. One study found that 60% of patients had a documented physiological indication before a cardiac arrest, unplanned ICU admission, and/or death.

Though much about COVID-19 remains a mystery, one thing is certain: It can turn deadly in a heartbeat, and the smart beds turned out to be a lifesaver in many cases where the hospital was able to identify deteriorating cases faster using the beds.

A Reuters story I read reports that “the speed with which patients are declining and dying from the novel coronavirus is shocking even to veteran doctors and nurses.” A recent study shows that early identification systems for COVID patients using triggers based on vital signs to escalate care have resulted in lower mortality rates.

PSQH: What are some of the biggest challenges facing nurses (besides their usual daily duties) when it comes to monitoring the conditions of COVID-19 patients? How can smart beds help them do their jobs more efficiently?

Riffel: One of the biggest challenges for our nurses is identifying the first signs of deterioration, since the virus can overwhelm patients in a matter of minutes. When this was a pulmonary unit, nurses would do hourly rounds. But to protect nurses from infection and preserve our PPE supplies, they now go into COVID patients’ rooms only every four hours or when necessary.

The smart beds with continuous monitoring have become an essential tool in our toolbox. When a patient’s heart or respiratory rate moves higher or lower than preset parameters, the beds alert the nursing staff using nurse call as well as visual and audible alarms outside the room. A nurse who enters the room can glance at the bed monitor to immediately see the abnormal rate. Nurses also can access trending data to guide decisions about initiating a call to action to response teams, which can decide if the patient needs to be transferred to a higher level of care such as the ICU.

This monitoring method gives our staff the reassurance of knowing they can track a patient’s condition without having to put on PPE and step into the room. Also, high respiratory rates are the No. 1 concern for COVID patients, and it’s impossible for nurses to “eyeball” shallow but rapid rate changes as well as the monitors.

We have had about 120 patients on the COVID unit, and five of them were intubated within an hour after their bed alarms went off. Since installing the monitoring system, the unit has not had any code blue alarms, and not one patient has had a cardiac arrest.

PSQH: Are smart beds connected to the internet or other networks that could be susceptible to hackers? Is there a concern that sensitive patient information could be compromised, and how is that mitigated?

Riffel: The smart beds are not connected to the internet or any networks and monitor only respiratory and heart rates, so there is no risk that sensitive patient information could be compromised.

PSQH: While alarms on a bed are important to make sure that nurses are alerted when a patient needs help, a recent trend in healthcare is to reduce the number of alarms in patient care units. How will the smart beds help continue this trend, while improving the outcome of patients with COVID-19?

Riffel: Alarms are absolutely essential, but the problem with them is that too many are false or non-actionable. In fact, The Joint Commission estimates that 85% to 99% of alarm signals do not require clinical intervention.

That’s not the case with our contact-free, continuous monitoring alerts. First of all, we are not concerned with their accuracy because we have not had any false alarms. When the alarms go off, all our nurses know they need to check the patient for signs of distress.

Unlike telemetry device alarms, which can be triggered when the monitoring leads become detached from the patient, the smart bed sensors under the mattress do not touch the patient. When patients lie down, these sensors continuously record their respiratory and heart rates and send alarms only when these rates are outside preset measures. Nurses also can easily change the alarm parameters as needed to make them appropriate for each patient.

The smart beds are a wonderful complement to the telemetry equipment we use for some of our unit’s COVID patients. Being able to continuously monitor patients without attaching anything to them not only eases our staff’s workload, but also improves patient experiences.

PSQH: What kinds of technology do smart beds use to monitor patients? AI and machine learning are both new technologies that are making their way into healthcare. How will these technologies replace the healthcare worker—and in what ways shouldn’t they?

Riffel: The monitoring system uses patented sensing and signal processing technology sensitive enough to detect subtle vibration and motion signals in the chest, hands, legs, or torso as often as twice a second. Based on this information, proprietary analytic software can determine heart pulse and respiratory rate patterns and alert nurses when significant changes occur.

This technology will never replace healthcare workers—it just lets them know that a patient urgently needs their attention. Our nurses have so much to do when caring for COVID patients and have enthusiastically welcomed the smart bed monitoring solutions as a complement to their responsibilities.

PSQH: Are there any dangers to relying on the technology of smart beds too much? While certainly lifesaving and a breakthrough, how can healthcare workers ensure that the information they are getting is accurate? What mitigation factors (such as human monitoring) need to be in place as a safeguard? Is that even possible on a busy COVID-19 unit with so many other things going on?

Riffel: As I have mentioned, we trust the accuracy of this technology in the same way we trust a thermometer to give us a patient’s accurate temperature. But, again, smart beds are only tools. Nurses and managers still need to regularly listen to COVID patients’ lungs, assess their overall health, and provide support that can come only from human contact. We must always remember: COVID patients can deteriorate very quickly, so we can never let our guard down.

For Covenant HealthCare to fulfill our mission of providing extraordinary care for every generation, we need to continue investing in state-of-the-art equipment. I have been a nurse for more than 40 years, and I believe these smart beds are amazing and will save lives. I often tell my staff, “You don’t know how lucky you are to have them.”