Care beyond the bedside: A patient-centered approach

Traditional patient care within a hospital has been centered on what can be accomplished at the bedside. Most of today's solutions – from health monitors to drug infusions to audio/visual tools – are based on what staff can do for patients while treating them in-person.

However, according to an online survey conducted by Jackson Health care, nurses lose three hours of patient care every 12-hour shift to non-direct care responsibilities, such as completing paperwork and performing tasks to comply with regulatory requirements. This poses a challenge for hospital leaders who need to ensure they have enough staff available to safely and effectively provide direct patient care.

These staffing challenges, along with other major industry trends such as value-based care and increased consumerism in health care, are driving the health care industry to transform the way care is delivered by placing more focus on the patient experience. Advancements in technology are allowing a new dynamic to take place in hospitals by enabling nurses to deliver strong patient care without the need to be in the patient's room at all times. The end result? Patient-centered care that isn't solely centered around the bedside.

A Quiet Place to Rest: Moving Technology Away from the Bedside
Rest and relaxation is a major part of the recovery process and is prescribed by doctors for anyone with minor afflictions, such as a common cold, to more serious conditions. However, for most people staying in a hospital, sleeping can be a difficult task. The constant hums and beeps of bedside technology, as well as frequent rounds, tests and other disruptions can make it difficult to get any quality sleep.

The inability to properly rest can have a serious impact on a patient's recovery, often leading to longer hospital stays and increased mortality rates.1 This impact is especially profound in the ICU. Research has shown that ICUs, which are high-noise, very bright units, can contribute to delirium in patients2. ICU delirium is associated with long-term cognitive impairment that has a negative impact on patients and also represents a financial burden for the health care sector, totaling $145 billion annually in additional costs in the United States alone3.

While eliminating all noise and light in ICUs is a tough feat, hospitals need to take steps to reduce the disruptions to support circadian rhythm and patient sleep. By improving alarm management to focus on actionable alarms, and improving the mobility of the information typically provided at the bedside to check on patient status, hospitals can create a more patient-friendly room that is quieter and less stressful. In turn, patients will achieve better sleep, which will pave a quicker road to recovery for the patient while cutting down on long-term costs for the hospital.

Keeping Tabs on Patients, Even From Afar
Particularly with high-risk, fragile patients in the ICU or NICU, clinicians traditionally stay directly at the bedside so they can respond within seconds to any change in a patient's condition. However, technology keeps getting smarter and smaller, making it easier for providers to transition care away from the bedside. Information is becoming more mobile, allowing varied clinical access points, thus they don't need to be "chained" to the bedside. It's possible in the future that common items such as bandages or clothing or jewelry will be equipped with sensors to detect vital signs and automatically transmit valuable patient data to monitoring stations or mobile devices to support doctors and staff where they need it.

Alarms, too, are getting smarter, striking a balance between sensitivity and specificity to improve the ongoing work to reduce alarm fatigue. But if more care is to be delivered away from the bedside, the industry will need to do more than just reconfigure alarms. Hospitals will need to take a look at their nursing and clinician policies and assess the workflow within their care environments in order to drive real change management that will aid staff to better interpret and respond to alarms.

Beyond the Bedside for Enhanced Mobility and Patient Engagement
Another key step to the recovery process for many patients is the ability to get mobile again after an illness or surgery. Movement as a recovery regimen can help patients avoid problems such as sepsis (a potentially life threatening condition), infections, bed sores and other conditions that can impede recovery. This is supported by a 2008 Johns Hopkins University study, which found that bed rest in ICU patients may cause unnecessary physical impairment after patients are discharged from the hospital4. Moreover, the ability to get out of the hospital bed can have a strong psychological effect for patients as they view it as taking a more active role in their own recovery.

Understanding this need for mobility, hospitals are beginning to make important culture changes, invest in the right technology and empower patients. Clinicians juggle dozens of patients per day, and may not have the time or appropriate workflow to wrangle a handful of cords and cables to help a patient use the bathroom on their own or go for a walk. Hospital leadership must work in partnership with clinicians, patients and families to ensure that both clinicians and patients have the resources needed to increase mobility.

For example, wireless and other mobile technologies can make it possible for patients to move freely in their room or around the hospital, while still giving clinicians constant updates on patient health status. These new workflows supported by predictive algorithms, could provide peace of mind for both patients and their care team. In addition, reconfiguring patient rooms can encourage patients to get up and move around in a way that's appropriate to their ability while helping to facilitate their recovery. Seemingly small redesigns, like adding patient support bars or marking walls with mobility goals, make it easier and less scary for patients to stand or walk around the room or hospital.

A Patient-Centered Recovery
The road to recovery doesn't end at the hospital doors. The move to value-based care and focus on reducing readmissions means that clinicians and hospital leadership want to be sure that when a patient is discharged from the hospital that they can recover well at home. After all, a hospital discharge is just one blip in a longer patient-centered journey, especially looking at the rising amount of aging patients with chronic diseases. Providers thus look at programs and processes to improve transitions of care and to keep patients healthy, even after they leave the hospital.

As the health care system embraces a patient-centered approach to care and transitions toward population health, providers will need to explore new care delivery methods that go beyond the bedside. These new approaches to care delivery will make it possible to improve clinician workflow and make efficient use of scarce health care resources while improving patient satisfaction and care, ultimately realizing higher value for all.

1 Kamdar, Biren B. et al., Society of Critical Care Medicine, 2013, 41.3 (2013): 800-09
2 Pandharipande P.P. et al., N Engl J Med, 2013, 369(14):1306-16
3 Leslie D.L. et al., Arch Intern Med, 2008, 168(1):27-32

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