Efficacy and Safety of Cloud based Continuous Monitoring Systems in Management of Patients in Non-ICU Settings in a Tertiary Care Hospital

Introduction: Continuous monitoring is the most vital aspect in the management of patients in non-ICU settings. Continuous monitoring systems have revolutionized the management of vulnerable patients which alerts the doctors to identify the critical events and intervene timely. In this study, we present our experience of using cloud connected continuous monitoring systems at our hospital. Objectives: To study the efficacy and safety of continuous monitoring systems in the management of patients in a non-ICU setting. Material and methods: A retrospective hospital-based study was conducted in the Acute Medicine ward (AMW) of Ramaiah teaching Hospital, Bangalore. Patients were connected to a cloud based continuous monitoring system for automatic collection and documentation of vital signs. All patients admitted in AMW between September 2017 and January 2018 was included in the study. For comparison, data were collected from September 2016 to January 2017 when the continuous monitoring systems were not implemented. We compared the number of admissions, code blue events. Results: Total of 470 patients in the pre- ICU settings were connected to a continuous monitoring system. There was 88% reduction in the ICU admissions as compared to the previous year. About 11.2% of patients were transferred to ICU and in these patients, continuous monitoring helped the doctors to identify the critical event. There was a significant reduction in code blue events using a continuous monitoring system. There was a significant reduction in medical expenses also. Conclusion: Continuous monitoring reduced the clinical burden on ICU due to the availability of remote monitoring capabilities, and continuous monitoring of reduced medical expenses for patients with improved clinical outcomes.

Rational Mind and Heuristics in Medical Diagnostic Decision Making.

The medical diagnostic label is the most important process in patient management. The decision process involves the thinking process of the caregiver which operates differently in emergencies and outpatient clinic. The heuristics aspect of the mind is more efficient in dealing with emergencies and the slower analyzing mind in outpatient setting. The heuristic approach is useful in rapid decisions and management of emergencies whereas the slower stepwise approach in outpatient treatment will help in reducing investigations, medical errors and cost of care. The article also gives an evidence based template for predicting the disease process based on positive and negative likelihood ratios.