Team at UH Using “Guardian Angel” Monitoring with COVID-19 Patients Wins OHA Award

Masimo SafetyNet technology shown to preserve vital hospital capacity and encourage connections between caregivers and patients

UH Clinical Update | May/June 2021

The Department of Emergency Medicine at University Hospitals began using a remote home-monitoring technology for certain COVID-19 patients early in the pandemic, preserving hospital beds when they were most needed and allowing some COVID-19 patients to recover at home with the support of their family – while always being monitored by a UH nurse. The system, known as Masimo SafetyNet, relays data on a patient’s oxygen level, heart rate, perfusion index and respiration rate from a watch-like device worn on the patient’s wrist and an oxygen monitor worn on one fingertip. Originally used with COVID-19 patients in the ED at UH Cleveland Medical Center, the system was ultimately implemented at all EDs across the UH system in just a matter of months.

“I always tell patients when I deploy the unit was that this is your guardian angel,” says Robert Hughes, DO, Associate Medical Director of Emergency Medicine at UH Cleveland Medical Center. “In a very real way, this little wrist piece and the pulse oximeter on the finger with that little red light lets you know that someone was watching over you the whole time.”

Now, the Department of Emergency Medicine here has won a patient safety award from the Ohio Hospital Association (OHA) for this work. The Dr. Frank Dono Best Practice Award, issued by OHA’s Ohio Patient Safety Institute Board of Trustees, recognizes outstanding efforts to improve patient safety in Ohio. Specifically, it recognizes the individual or organization that has designed and implemented the most innovative, evidence-based patient safety practice in Ohio.

One thing that stands out, Dr. Hughes says, was how rapidly UH was able to develop the program and then scale it. He worked with Emergency Medicine colleagues Riley Grosso, MD, and Marlea Miano, MD, to develop clinical practice guidelines for using the Masimo SafetyNet technology and train ED providers across the system. Dr. Grosso is Director of Peer Review & Quality Improvement, and Dr. Miano is former Director of Clinical Operations, both at the Center for Emergency Medicine at UH Cleveland Medical Center; Dr. Miano is now Chief Medical Officer at UH Geauga Medical Center, a campus of UH Regional Hospitals The project also had the enthusiastic support of Peter Pronovost, MD, PhD, UH’s Chief Quality and Clinical Transformation Officer.

“This technology is transformative,” Dr. Pronovost says. “It allows people to be safely monitored at home, surrounded by loved ones, sleeping in their own bed, eating their own food, rather than healing in hospital. It ultimately improves value, providing higher quality and patient experience at a lower cost. No doubt this will expand to other types of patients.”

Dr. Hughes says he’s gratified that both UH patients and physicians have embraced the technology.

“Emergency medicine physicians are not a risk-averse bunch by design,” he says. “We needed to ensure patient safety, especially in the setting of a new diagnosis that we all weren’t super-familiar with. But patients became comfortable with it, and physicians became comfortable with it. It’s just an excellent example of what our hospital system can do when we are innovative and put our minds to it. We were able to not only take a novel technology, but also take a novel practice paradigm, educate and scale across the entire hospital system within a couple of months.”

Preliminary results show that the Masimo SafetyNet program has made a significant difference in preserving hospital capacity at UH. Over one representative period from March 26, 2020 to April 23, 2020, 83 COVID-19 patients were enrolled in the program, with average monitoring duration of 10.1 days. Just 17 patients returned to the ED, an average of nine days after beginning remote monitoring. Return visits were typically due to symptom progression, with approximately 50 percent of those returning requiring oxygen.

“Of 83 individuals, the program allowed 66 patients to be re-targeted to home as opposed to a hospitalization,” Dr. Hughes says. “Accounting for an average length of stay for a COVID-19 patient in our hospital system of 6.6 - 11.2 days, this spared a total of 435.6 - 739.2 hospital days. Over a single month, the capacity savings are staggering. Although data is limited, this process extrapolated over time has allowed elective procedures to continue, to the benefit of all patients with in our hospital system. Some COVID-19 patients have also avoided some of the known risks of hospitalization, such as potential exposure to hospital-acquired disease and the development of delirium.”

One unexpected benefit of using technology for remote monitoring of COVID-19 patients, Dr. Hughes says, is the personal connections that it has created between patients, family members and UH caregivers – as well as the confidence it gives patients.

“It actually strengthened the patient/family-healthcare bond,” he says.

For example, in training/coaching sessions with UH caregivers when receiving the remote monitoring device, patients and families learn together how to correctly set up and use the system – especially how to “escalate” a concern and request help.

“This inspires a sense of confidence for our patients and their loved ones, as well as our bedside caregivers, further strengthening the patient/family – provider/healthcare bond,” Dr. Hughes says. “Patients and their family members are also empowered. They’re integral partners in planning decisions about where they will receive care, working in tandem with healthcare, rather than let healthcare happen to them. There’s also a regular cadence of communication with health workers, patients, and their families. These continuous touch points with live healthcare personnel are vital to the program success.”

“While one may assume that technology is depersonalized and mechanical, using remote monitoring technology has actually increased patient and healthcare touchpoints, and in an environment where the patient and their family were vital team members in the patient care,” Dr. Hughes adds. “This linkage has actually deepened the patient-healthcare bond. Through distance, we found we grew closer.

Congratulations to the Department of Emergency Medicine at UH on this important work and well-deserved award.