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Globally it has been recognized that where there is continuous monitoring of patients post-surgery, there is reduced mortality and fewer complications due to timely clinical interventions. However, the primary dependency of continuous monitoring is on nurses who can at most monitor a patient every couple of hours to compute Early Warning Scores (EWS) that determine the type of clinical intervention required. In India, we struggle with a shortage of nursing staff and stretched hospital ICUs. For instance, we have a population of over 1.5 billion and is estimated to have just around 1.25 lakh ICU beds with a shortage of 4.3 million nurses. This is where continuous Remote Patient Monitoring (RPM) technology, where patients are monitored every minute can improve patient outcomes as well as significantly reduce the financial burden of the healthcare system in India.
Continuous ward monitoring for better patient outcomes, improved patient safety and ICU stay reduction
Continuous RPM systems which can record patient vital signs and calculate EWS automatically can ease the time burden on healthcare staff during postoperative monitoring, and help combat the challenges of intermittent data capture, thus allowing the nurses and doctors to work more efficiently in providing early intervention for high-risk patients. A meta review that looked at the effectiveness of contactless monitoring of patient vitals postoperatively, found an overall reduction of 39 per cent in risk of mortality, around 3.32 days reduction of stay in the ICU, as well as a reduced risk of general patient health deterioration postoperatively. In public hospitals in India, where the nurse to patient ratio in wards is generally suboptimal, continuous ward monitoring systems can significantly reduce the time that they have to spend on collecting, and manually entering data for each patient, allowing them to provide better care.
Significant cost-saving for hospitals, improved affordability for patients
There are several ways in which remote monitoring and improved data driven clinical decisions via automation of early warning systems can increase profitability, but primarily it reduces the Average Length Of Stay (ALOS) in the ICU per patient, thereby reducing the ICU cost for hospitals. One study investigated the economic impact of the implementation of a continuous monitoring system in the medical–surgical ward of a US community hospital. Savings were estimated to range between $224 and $710 per patient, with the hospital breaking even on the investment after 6-9 months. Such savings in the Indian context can not only make it economical for the hospital but can also make the treatment cost more affordable for the patient.
Current challenges and navigating the future
While there is a lot to benefit from adopting continuous remote monitoring systems in the Indian healthcare system, there is a certain scepticism that goes hand in hand. The human interface for any technology requires an understanding the system and then manoeuvring it accordingly to derive the best results. The speed breaker in this journey is in integrating legacy protocols in a hospital with these newer and more efficient monitoring systems. Seamless integration with legacy protocols and existing manual processes in public as well as private hospitals will create value for the entire Indian healthcare ecosystem.