More hospitals, staff look to gain clinical surveillance benefits

Technologies aid decision support and aim to identify early signs of patient deterioration, says Gregg Malkary.

Some medical departments and clinicians may benefit from the use of clinical surveillance technologies in treating at-risk patients whose conditions could unexpectedly decline during hospitalization.

These technologies serve as decision support tools, either in standalone versions or integrated with electronic health records. Epic’s EHR, for example, offers best-practice alerts covering sepsis, fall risk and cardiac monitoring, among other measures, says Gregg Malkary, founder and managing director at Spyglass Consulting Group, which recently conducted a survey involving interviews with 30 clinical informaticists.

Clinical surveillance, according to the World Health Organization, “is the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation and evaluation of public health practice.”

In the past, hospitals had some version of clinical surveillance in the critical care unit, but today it is common to have the technology in multiple departments, including OR, ER, medical-surgical nursing and telemetry, the Spyglass research shows.

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The goal of clinical surveillance is to identify early signs of patient deterioration and improve clinical and business outcomes. “It costs money every time a patient needs to be moved to a higher-cost bed,” Malkary explains.

Clinical surveillance, matched with electronic health records data and advanced algorithms, also can reduce the alarm fatigue that plagues nurses who are overwhelmed by clinically unimportant alarms, and also can detect subtle signs that a patient’s condition may be declining. Increasingly, clinicians want to use these tools, Malkary says.

Historically, nurses have used calculators to do clinical surveillance, but variances in care can result. Now, analytics can identify patients at risk, or detect the presence of a certain condition, or predict the likelihood of a condition.

The challenge for hospitals wanting to improve their clinical surveillance lies in changing physician behavior, particularly doctors who are used to doing the same things for many years. Clinical leadership must become engaged in clinical surveillance and accountable to changing workflows, Malkary contends.

“If departments are using different tools and workflows, you won’t have control in the departments,” he adds. “Subtle changes in patient conditions are not always obvious. You need a strategy to collect and use data in a certain way and decide what metrics are collected.”

Intensivists and informaticists can help an organization develop and calibrate risk-scoring systems and curate data. Internal champions in nursing, biomedical and other departments also can lead the change.

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