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Patient Care and Monitoring Systems


... significant others, and community. ... El Camino Hospital, Mountain View, CA [Watson, 1977] Alerts and reminders Health Evaluation Logical. – PowerPoint PPT presentation

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Title: Patient Care and Monitoring Systems

Patient Care and Monitoring Systems
Patient care
  • Patient care is the focus of many clinical
  • Various disciplines sometimes overlaps
  • Each has its own primary focus, emphasis, and
    methods of care delivery
  • Each disciplines work is complex
  • Collaboration among disciplines adds complexity.
  • In all disciplines, the quality of clinical
    decisions depends in part on the quality of
    information available to the decision-maker.

Care Process
  • Care begins with collecting data and assessing
    the patients current status
  • Through cognitive processes specific to the
  • diagnostic labels are applied,
  • therapeutic goals are identified with timelines
    for evaluation, and
  • therapeutic interventions are selected and
  • At specified intervals
  • patient is reassessed,
  • effectiveness of care is evaluated, and
  • therapeutic goals and interventions are continued
    or adjusted as needed
  • If the reassessment shows that the patient no
    longer needs care, services are terminated

Discipline in patient care
  • Patient care is a multidisciplinary process
    centered on
  • the care recipient in the context of the
  • family,
  • significant others, and
  • community.

Information to Support Patient Care
  • The information for direct patient care is
    defined in the answers to the following
  • Who is involved in the care of the patient?
  • What information does each professional require
    to make decisions?
  • From where, when, and in what form does the
    information come?
  • What information does each professional generate?
    Where, when, and in what form is it needed?

  • The genesis of patient care systems occurred in
    the mid-1960s.
  • One of the first and most successful systems was
    the Technicon Medical Information System (TMIS),
    begun in 1965 as a collaborative project between
    Lockheed and El Camino Hospital in Mountain View,
  • TMIS designed to simplify documentation through
    the use of standard order sets and care plans.
  • More than three decades later, the technology has
    moved on.

Recent History
  • Part of what changed users expectations for
    patient care systems was
  • Development and evolution of the HELP system at
    LDS Hospital in Salt Lake City, Utah.
  • Decision support to physicians during the process
    of care
  • Managing and storing data
  • Support nursing care decisions
  • Aggregate data for research leading to improved
    patient care.

Patient Care Components
(No Transcript)
HELP System at LDS Hospital
Patient Monitoring
  • Repeated or continuous observations or
    measurements of the patient, his or her
    physiological function, and the function of life
    support equipment, for the purpose of guiding
    management decisions, including when to make
    therapeutic interventions, and assessment of
    those interventions Hudson, 1985, p. 630.
  • A patient monitor may not only alert caregivers
    to potentially life-threatening events many
    provide physiologic input data used to control
    directly connected life-support devices.

History of Physiological data measurements
  • 1625 Santorio-measure body temperature with
    spirit thermomoeter.
  • Santorio was first to apply a numerical scale to
    his thermo scope, which later evolved into the
  • Timing pulse with pendulum. Principles were
    established by Galileo. These results were
  • Claudius Galen, was physician to five Roman
  • He also understood the value of the pulse in
  • John Floyer, 1707, acknowledged Galen's skill in
    identifying various pulse beats, but was appalled
    that even 1500 years later the doctors were still
    not using any standard procedure for measuring
  • He said that the pulse should be counted using a
    watch or a clock and he had a special pulse watch
    made for timing 60 seconds.
  • He published his findings in his works called "
    Physician's Pulse Watch" , but doctors largely
    ignored Floyer's advice for over a hundred years.

  • 1852 Ludwig Taube Course of patients fever
  • At this time Temperature, pulse rate respiratory
    rate had become standard vital signs.
  • Scipione Riva-Rocci introduced the
    sphygmomanometer (blood pressure cuff). (4th
    vital sign).
  • Scipione Riva-Rocci his fundamental contribution
    (1896) was the mercury sphygmomanometer, which is
    easy to use and gives sufficiently reliable
  • This device, the standard instrument for
    measuring blood pressure, led to many new
    developments in the therapy of hypertension
  • Nikolai koroktoff applied the cuff with the
    stethoscope (developed by Renne Lannec-French
    Physician) to measure systolic and diastolic
    blood pressures.

What is blood pressure?
  • Blood is carried from the heart to all parts of
    your body in vessels called arteries.
  • Blood pressure is the force of the blood pushing
    against the walls of the arteries.
  • Each time the heart beats (about 60-70 times a
    minute at rest), it pumps out blood into the
  • Your blood pressure is at its highest when the
    heart beats, pumping the blood.
  • This is called systolic pressure.
  • When the heart is at rest, between beats, your
    blood pressure falls.
  • This is the diastolic pressure.
  • Blood pressure is always given as these two
    numbers, the systolic and diastolic pressures.
  • Both are important.
  • When the two measurements are written down, the
    systolic pressure is the first or top number, and
    the diastolic pressure is the second or bottom
    number (for example, 120/80).

Harvey Cushing
  • 1900s Harvey Cushing introduced an apparatus to
    measure blood pressure during operations.
  • Raised the questions
  • Are we collecting too much data?
  • Are the instruments used in clinical medicine too
  • Would not approximated values be just as good?
  • Cushing answered his own questions by stating
    that vital-sign measurement should be made
    routinely and that accuracy was important
    Cushing, 1903.

History (Cont.)
  • 1903 Willem Einthoven devised the string
  • An instrument used to detect, measure, and
    determine the direction of small electric
    currents by means of mechanical effects produced
    by a current-carrying coil in a magnetic field.
  • to measure ECG (Nobel Prize 1924)
  • 1901, Einthoven invented a new galvanometer for
    producing electrocardiograms using a fine quartz
    string coated in silver based on ideas by Deprez
    and d'Arsonval, who used a wire coil. His "string
    galvanometer" weighs 600 pounds. Einthoven
    acknowledged the similar system by Clément Ader
    (1841-1926), but later, in 1909, calculated that
    his galvanometer was in fact many thousands of
    times more sensitive.
  • Improvement over the capillary galvanometer, and
    the original galvanometer invented by Johann
    Salomo Christoph Schweigger (1779-1857) in Halle
    in 1820. Einthoven published the first
    electrocardiogram recorded on a string
    galvanometer in 1902.
  • 1905, Einthoven began transmitting
    electrocardiograms from the hospital to his
    laboratory 1.5 km away via telephone cable.
  • On March 22nd that year the first telecardiogram
    was recorded from a healthy and vigorous man and
    the tall R waves were attributed to his cycling
    from laboratory to hospital for the recording.

  • An instrument used in the detection and diagnosis
    of heart abnormalities that measures electrical
    potentials on the body surface and generates a
    record of the electrical currents associated with
    heart muscle activity. Also called cardiograph.

  • 1950 The ICUs were established to meet
    increasing demand for acute and intensive care
    required by patients with complex disorders.
  • 1963 Day - treatment of postmyocardial-infarctio
    n patients in a coronary-care unit reduced
    mortality by 60 percent.
  • 1968 Maloney - having the nurse record vital
    signs every few hours was only to assure regular
    nursepatient contact.
  • Late 60s and early 70 bedside monitors built
    around bouncing balls or conventional
  • 90 Computer-based patient monitors - Systems
  • database functions,
  • report-generation systems, and
  • some decision-making capabilities.

Myocardial Infarction
  • Heart attack, non-medical term, is "Myocardial
  • Either term is scary.
  • "Myocardial Infarction" (abbreviated as "MI")
    means there is death of some of the muscle cells
    of the heart as a result of a lack of supply of
    oxygen and other nutrients.
  • This lack of supply is caused by closure of the
    artery ("coronary artery") that supplies that
    particular part of the heart muscle with blood.
  • This occurs 98 of the time from the process of
    arteriosclerosis ("hardening of the arteries") in
    coronary vessels.

Patient Monitoring in ICUs
  • Categories of patients who need physiologic
  • Patients with unstable physiologic regulatory
  • Example a patient whose respiratory system is
    suppressed by a drug overdose or anesthesia.
  • Patients with a suspected life-threatening
  • Example a patient who has findings indicating an
    acute myocardial infarction (heart attack).
  • Patients at high risk of developing a
    life-threatening condition
  • Example patients immediately post open-heart
    surgery, or a premature infant whose heart and
    lungs are not fully developed.
  • Patients in a critical physiological state
  • Example patients with multiple trauma or septic

Care of the Critically Ill
  • Requires prompt and accurate decisions.
  • ICUs use computers almost universally
  • acquire physiological data frequently or
    continuously, (e.g. blood pressure)
  • communicate information from data-producing
    systems to remote locations (e.g., laboratory and
    radiology departments)
  • store, organize, and report data
  • integrate and correlate data from multiple
  • provide clinical alerts and advisories based on
    multiple sources of data
  • function as a decision-making tool that health
    professionals may use in planning then care of
    critically ill patients
  • measure the severity of illness for patient
    classification purposes
  • analyze the outcomes of ICU care in terms of
    clinical effectiveness and cost-effectiveness

Intensive care Unit Bed
Use of computers for patient monitoring
Nurse station
WEB connection
Some instruments in mind
Types of Data Used in Patient monitoring in
different ICUs
Patient monitoring
Features Matrix ECG 3 leads ECG 5 leads ECG 10
leads Respiration Invasive BP Dual
Temp/C.O. NIBP SpO2
Understanding ECG - Normal ECG summary
  • Rate range 1 to 200 breaths/min
  • Impedance range 100 to 1000 ohms at 52.6 kHz
  • Detection sensitivity range 0.4 to 10 ohms
    impedance variation
  • Low rate alarm range 1 to 199 breaths/min
  • High rate alarm range 2 to 200 breaths/min
  • Apnea alarm rate 0 to 30 seconds in one-second
  • Cardiac artifact alarm
  • Waveform display bandwidth 0.05 to 2.5 Hz (-3
  • Analog output Selectable
  • Trends 24 hours with 1-minute resolution
  • Invasive Blood pressure
  • Catheter sites Arterial, pulmonary arterial,
    central venous, left atrial,
  • intracranial, right atrial, femoral arterial,
    umbilical venous, umbilical arterial, and
  • Trends 24 hours with 1-minute resolution