“In the context of the current health crisis, Patient Connect technology is all the more relevant as it improves the safety of the patient and the healthcare employees, who can now monitor the patient remotely. The Patient Connect interface supports our teams’ work by optimizing their tasks,” said Joanne Guay, the CHUM’s Director of Information Technologies and Telecommunications.
In 2017, the Centre Hospitalier de l’Université de Montréal (CHUM) moved its three hospitals to a single site. This world-class hospital has 772 beds and state-of-the-art technologies to provide quality care to its patients within 57 specialties. The CHUM brings together more than 2500 nurses who represent the driving force of the healthcare community[1]. In the context of the COVID-19 crisis, the CHUM’s technological resources and nursing care departments decided to deploy vital signs capture technology in two units dedicated to monitoring patients with COVID-19. The purpose of this decision was to introduce an innovation which, during a period of stress for nursing teams, was able to free them from activities with low clinical-added value. Knowing that 20% of vital signs transcription from a monitor to an electronic health record can lead to errors[2], the objective was also to improve the clinical monitoring process for both patients and nurses.
This innovation project would not have been possible during this COVID-19 crisis without the CHUM’s leadership and its commitment to innovation in the service of care. Making the decision to introduce a technological innovation in care units subject to strong health pressure was not easy. The main question to be answered was how to introduce a technological innovation into care units occupied by highly-infectious patients and with a supplier whose employees were all teleworking. It would certainly have been easier to do nothing. But the CHUM decided to proceed, convinced that these risks were manageable and that the gains linked to this project were too great for both patients and nurses.
In March 2020, Quebec went on alert when COVID-19 arrived. A crisis unit was created and was active in identifying solutions to reduce the nursing staff’s entry into patient rooms. Connected object technology was identified as a potential solution. It is known that real-time collection of data facilitates patient analysis and follow-up by the healthcare professional[3].
The Biomedical Engineering Department has a pool of vital sign monitors. A patient-focussed solution for the interoperability of these devices while enabling the collection of vital signs and reporting data to the patient record was envisaged. This solution has proven itself at the Montreal Heart Institute (MHI) in an intensive care setting with ventilators and pumps. The MHI has observed a gain in productivity in terms of time.
The project was designed to prevent re-transcribing vital signs data from multiparametric monitors, installed in the rooms of patients suffering from COVID-19, and relaying it into the patient’s electronic health record, was initiated. The objectives were to (1) reduce the double entry associated with vital sign transcription (temperature, blood pressure, pulse, saturation and respiration) from the Welch Allyn™ monitor and (2) to integrate the vital signs entered from Welch Allyn™ monitors into the Oacis™ electronic patient record using “Patient Connect”™ technology.
One of the first steps of the project was to map out the desired clinical process. The project team, including two clinicians, developed it while taking into account clinical and technological issues. Vital signs are collected from the Welch Allyn™ monitor, which is connected to the network port identified by the Biomedical Engineering Department. A bar code reader was used to identify the patient from their wrist bracelet as well as to identify the caregiver from their employee card. For quality control purposes and to ensure that vital signs appear in the windows associated with this information in the electronic patient record at the correct time, it was recommended to use the one-time send mode rather than the automated sending mode. The nurse can also prompt the monitor to send the vital signs at any other time. In order to ensure that we reproduce the desired process taking into account the clinical staff’s satisfaction, we held nearly 10 clinical integration test sessions in which several participants from clinical, IT, biomedical and supplier sectors collaborated.
The deployment took place on June 22 and 23, 2020. Training on the three shifts was carried out during these days, plus an additional period. Support in the field as well as task assistance were provided to the nursing staff. During the first few days, although suggestions to optimize the process were offered, clinical staff provided feedback that the new capture technology was simple and easy to adopt. The feedback obtained from the clinical staff suggests that the choice of a clinical process, oriented towards taking vital signs in one-time send mode rather than in automated mode, helped to facilitate change management. Moreover, it has been observed that in the context of a pandemic, a new clinical process, implemented according to known processes, is a success factor[4].
“In the context of the current health crisis, Patient Connect technology is all the more relevant as it improves the safety of the patient and the healthcare employees, who can now monitor the patient remotely. The Patient Connect interface supports the work of our teams by optimizing their tasks,” said Joanne Guay, the CHUM’s Director of Information Technologies and Telecommunications.
The experience of the CHUM and its teams in terms of innovation and implementing new technologies in the clinical context was largely reflected in this project. It was crucial to its success in a period marked by COVID-19. This project demonstrated the importance for a healthcare organization to establish a culture of innovation in all its sectors. This then becomes the driving force behind action and the continuous improvement of care practices, whatever the context. The CHUM’s commitment to innovation is well-established. The establishment was named in the American magazine Newsweek as one of the most innovative hospitals in the world. It also ranks first in Canada in the 2021 edition of the World’s Best Smart Hospitals.
Lastly, it should be noted that this project’s results provide an interesting perspective for a gradual deployment in other care units as well as in ambulatory sectors. In 2022, the CHUM plans to expand its project to Philips vital signs monitors and to introduce the use of Wi-Fi and mobility in a Patient Connect integration.
[1] Rouleau, G., Gagnon, M.-P., Côté, J., Payne-Gagnon, J., Hudson, E., & Dubois, C. A. (2016). How Do Information and Communication Technologies Influence Nursing care? IMIA IOS Press, Nursing Informatics 2016, 934‑935. https://doi.org/10.3233/978-1-61499-658-3-934
[2] Baeur, J. C., John, E., Wood, C. L., Plass, D., & Richardson, D. (2020). Data Entry Automation Improves Cost, Quality, Performance, and Job Satisfaction in a Hospital Nursing Unit. The Journal of Nursing Administration, 50(1), 34‑39.
[3] Kang, S., Baek, H., Jung, E., Hwang, H., & Yoo, S. (2019). Survey of the demand for adoption of Internet of Things (IoT)-based services in hospitals : Investigation of nurses’ perception in a tertiary university hospital. Applied Nursing Research, 27, 18‑23. https://doi.org/org/10.1016/j.apnr.2019.03.005
[4] Griebenow, L., Timm, J., Senn, M., Stancl, M., & Mayo Clinic. (2013). Case Study : Developing Nursing Partnerships to Support a Successful Electronic Medical Record Implementation. Computers, Informatics, Nursing, January, 1‑6. https://doi.org/10.1097/NXN.0b013e3182806174
