Effect of Monitoring System Design on Response Time to Cardiac Arrhythmias
Effect of Monitoring System Design on Response Time to Cardiac Arrhythmias
To increase the potential for timely detection and treatment of cardiac events, hospitals
 have implemented a number of different cardio-respiratory monitoring methods for at-risk
 patients. The goal of this study is to compare different monitoring methods to determine the
 most efficient method to monitor hospitalized patients - the method that will lead to the
 quickest response to critical heart rhythms. The investigators will then test the efficiency
 of this monitoring method by implementing it in a new patient care unit.
Most patients in the hospital who are at lower risk for developing abnormal heart rhythms
 have their vitals signs (e.g., heart rate, blood pressure) measured intermittently, such as
 every 8 hours. In contrast, hospitalized patients who are at risk for cardiac arrest and
 other arrhythmias are put on telemetry to continuously monitor their heart rhythm. A
 telemetry monitor is a portable box that is attached to the patient's ECG leads and displays
 his or her heart rate and rhythm at a central station. The monitor sends an alarm when it
 detects an abnormal rhythm, notifying the person monitoring the patient to check on the
 patient. Monitor watchers are dedicated nurses or technicians who monitor a bank of displays
 . The watcher-to-patient ratio varies among hospitals, with a single watcher monitoring
 between 16 and 72 patients at one time. There are also variations in the additional tasks
 assigned to watchers, communication modalities between watchers and nurses (e.g., pagers,
 overhead speakers, landline and cell phones, or bi-directional voice communication badges),
 and alarm presentation to nurses (e.g., via bedside monitors, centrally located monitors,
 automated phone notifications, or none at all, relying on telemetry watchers for
 notifications).

 A quick and efficient response to cardiac arrest is critical in order to increase the
 patient's chance of survival. There is a need for a better understanding of the impact on
 monitoring efficiency of factors such as the workload of monitor watchers, communication
 methods, and supportive technologies including alarms and automated notification systems. The
 objective of the proposed research is to identify and test determinants of efficient cardiac
 monitoring methods. There are 3 phases to the study:

 1. Characterize candidate monitoring methods (Phase 1). The investigators will study usual
 care for monitored patients in 6 hospital units. As part of their usual care these units
 have different monitoring methods. These methods vary in terms of 1) the location of the
 monitor watchers, 2) the means of communicating routine and life-threatening events
 (e.g., via pagers), and 3) monitor watchers' patient load and workload. For each of
 these 6 units, the investigators will collect data through interviews, observations, and
 20 cardiac arrest simulations.

 2. Determine which monitoring method leads to consistently rapid response times to lethal
 arrhythmias (Phase 2). Using interview, observation, and simulation data collected in
 Phase 1, the investigators will develop a computer simulation model of each of the 6
 monitoring methods that will allow them to identify the most efficient method.

 3. Test a new monitoring method (Phase 3). In one of the units we had previously conducted
 arrhythmia simulations, we will conduct 20 additional simulations after a change from
 remote telemetry monitoring to local nurse-based monitoring. We will evaluate whether
 response times decrease with the new monitoring method.
Inclusion Criteria:

 -  Care providers including the individuals responsible for monitoring patients
 (monitoring technicians and nurses), individuals communicating life threatening events
 (monitoring technicians, health unit coordinators, and nurses) and the individuals
 responsible for the initial check on a patient in the event of life-threatening
 cardiac arrhythmias (generally the patient's nurse).

 -  Patients for whom cardiac monitoring was ordered by their physician.

 Exclusion Criteria:

 -  NA