July 19, 2023
Following on from our Synchronous vs Asynchronous blog we thought we’d take the time to make another subtle but important distinction in the world of remote patient monitoring. This time we’re talking about the difference between continuous monitoring and routine monitoring.
Most people who have been at the bedside of someone in hospital will be familiar with continuous monitoring. Patients health vitals are monitored by machines at the bedside and nurses attend when early warning signs give cause for concern. Not everyone in hospital is monitored continuously, typically this level of monitoring is provided to patients that are severely unwell.
As the availability of hospital beds comes under increasing pressure, more patients are being monitored at home, many of them requiring the kind of continuous monitoring they would get in hospital. “Hospital in the Home” is a relatively new model of care, providing an alternative care model to inpatient admission. It enables patients to receive hospital-level care at home, reducing demand for hospital beds.
In NZ, Te Whatu Ora Counties Manakau has been “working across the hospital and community to build awareness of and confidence in the level of care that can be safely provided within the community, and thus continue to build capacity within the model." Almost half the patients admitted to Hospital in the Home have had a primary diagnosis of heart failure. These patients need continuous monitoring due to the severity of their condition and the risk of adverse events.
The term wearables is used in remote patient monitoring to describe sensors that patients “wear”. These can be stickers adhered to the skin, bracelets worn about the wrist, small units strapped onto the body or clipped onto clothing. There are even clothes such as socks or singlets with sensors in them that transmit data about a person’s health. Wearables don’t require the patient to do anything, apart from wear them (and keep them charged/connected). This is called passive monitoring, as the patient isn’t required to input anything themselves. Data can be collected even when the patient is asleep.
For some patients to be safely managed at home this level of monitoring is required. However, it isn’t required for all patients being monitored at home. Just like in the hospital, some patients receive continuous monitoring (e.g., in high dependency units) but others are simply visited routinely by a nurse who checks their vitals periodically and records them on a chart.
Routine monitoring is less intensive than continuous monitoring but it’s just as important for a large number of patients being monitored at home. Models of care that incorporate routine monitoring depend on patients actually entering data about their own health so that clinicians can periodically review it. Making this easy for patients tends to maximise compliance.
People that need help monitoring long term conditions such as hypertension and COPD can benefit from routine monitoring, also people recovering from surgery or adverse events. The length of time and frequency of the monitoring will differ between patients. Telemonitoring programs are usually designed around specific diagnoses and then customised to each patient based on their requirements.
The most common devices for routine monitoring are blood pressure monitors, oximeters, glucometers, thermometers and scales. For certain patient groups, changes in weight can indicate a need for optimised treatment, for some an elevated temperature requires urgent action. Patients might take readings multiple times a day, or just a few times a month depending on the level of monitoring they need.
For routine monitoring to be effective it requires patients to actually take their readings. It’s therefore important for RPM services to make this as easy as possible for every patient. In many cases that might mean lending them everything they need and setting it all up for them.
Different patients will need different kinds of monitoring depending on where they are in their own health journey. If we want to free up space in hospitals then it’s important the health system implements ways of monitoring patients remotely that are fit for purpose and equitable so that anyone referred to remote patient monitoring services can be safely monitored at home.