Challenge
COVID-19 placed more stress on an already stressed nursing staff
During the peak of COVID-19, nurses had to gown-, glove-, and mask-up before entering a patient’s room to provide needed care. However, as total positive COVID-19 cases climbed, patients’ morbidity and mortality escalated, and workforce demands for personal protective equipment (PPE) and high-acuity staffing exponentially increased, leaders at every admitting hospital quickly realized the impact on an already stressed nursing workforce.
This was when many turned to patient-engaged video surveillance (PEVS) for continuous patient observation in hospitals. PEVS is an interactive form of video surveillance whereby trained staff can monitor multiple patients simultaneously.
In order to gain insight into medical-surgical nurses’ use of PEVS to meet care demands of high-acuity patients, Quigley, et al, set out to answer the following 4 questions:
- What are the enrollment and duration of monitoring trends of PEVS into patient care for COVID-19 across hospitals?
- What is the relationship among patient gender identity, age, and duration of PEVS?
- How is patient engagement (verbal interventions, alarm rate, timeliness of alarm response) different for patients with COVID-19 compared to patients without COVID-19 patients on PEVS?
- What are the frequencies and types of adverse events experienced by patients with COVID-19?
What the Answers Revealed
- This study included a national sample of 97 participating hospitals throughout the US
- Over 2 months, 1625 patients with COVID-19 were monitored for 98,918 hours (4121.58 days)
- Admissions due to COVID-19 accelerated the need for monitoring, peaking on April 9, 2020, with 72 patients added in a single day
- Over time, admissions decreased, but with no fewer than 19 patients added each day
- Of total monitored patients:
- 52% (n=852) were male and 48% female (n=773)
- Length of stay (LOS) of monitoring was 67.8 hours for males and 63.5 hours for females
- Most participating hospitals had implemented PEVS before the pandemic for patient safety, with safety attendants continuously monitoring patients at risk of adverse events, such as falls, suicide, elopement, or safety of medical devices
Nurses quickly expanded their ability to observe, interact with, and engage patients, confirming the value of remote patient monitoring
- Registered nurses nationally admitted 4.8% of patients (n=1625/32,130) to PEVS due to COVID-19, totaling 98,918 hours—about 4121.58 days—of observation
- Safety attendants verbally engaged with COVID-19 patients on average 17 times in 24 hours, which is higher than in patients without COVID-19 (10.6 times in 24 hours). This may suggest that verbal interventions were effective and that activating nursing staff was not needed
- Fewer alarms were activated—1 alarm/patient-day for COVID-19 vs 1.8 alarms/patient-day for non–COVID-19
It should be noted that the average timeliness of alarm response to the COVID-19 patients was 35.4 seconds, which is 16.4 seconds longer than for patients who were not in isolation. This time difference can be attributed to the time it took staff to apply personal protective equipment before entering the patient room.
Conclusions
With the COVID-19 pandemic, remote safety monitoring enabled nursing staff to quickly expand their ability to observe, interact with, and engage with patients. The impact of monitoring further confirms the value of investing in proven technology at the point of care. As such, the safety net provided by the integration of remote safety monitoring must be expanded. As experts and leaders in patient care management, nurses deserve hospital administrators who invest in proven technology that is value-added and effective.
