Nobody's Watching

Aiming to cut costs in health care, more and more hospitals are eliminating the position of “monitor watcher” in cardiac telemetry units. A monitor watcher is a Registered Nurse specially trained to keep track of patients by observing the video displays of their heart rhythms. In most hospitals today, the monitors watch the patients but no one watches the monitors. As recently as 1992, 70 percent of the step-down units across the country employed full time monitor watchers. By April, 1995, only 55 percent of the nation’s hospitals still did.

Yale University Professor of Nursing Marjorie Funk, a cardiac technology researcher, set out to discover whether the presence or absence of a pair of human eyes alters the outcome for patients. Her preliminary findings were announced at the Eastern Nursing Research Society’s annual conference in Pittsburgh last week.

The Yale New Haven Hospital study involved 2,400 patients and spanned 18 months. During the first nine months, a trained nurse was designated to observe the central bank of monitors for each shift. Then, for nine months, the monitors were unsupervised.

The good news, Professor Funk discovered, is that there was no significant difference for patients in whether or not a human was monitoring their condition in six out of seven possible scenarios for patients – transfer to another unit of the hospital, bradyarrhythmia slowed heartbeat, asystole irregular heartbeat, supraventricular tachycardia/rapid atrial fibrillation and ventricular fibrillation varieties of rapid heartbeat, or death less than a 1 percent probability.

The bad news, she learned, is that, in the seventh scenario, patients suffered significantly more episodes of sustained ventricular tachycardia excessively rapid heartbeat originating in the ventricle of the heart when no one was watching the telemetry. Sustained ventricular tachycardia is a life-threatening condition, and one that generally results in longer – and therefore more costly – hospital stays, explains the Yale researcher, adding that it can also be highly unpleasant and frightening for the patient.

What do human monitor watchers see that prompts them to intervene before a serious problem arises? Professor Funk suspects that they notice the precursor signs of a problem that are too subtle for existing telemetry to pick up. This permits them to take action to prevent minor dysrhythmias from developing into episodes of sustained tachycardia.

If no one is watching, she surmises, the minor dysrhythmia goes unnoticed until the patient is in so much trouble that alarms begin to ring and lights flash on the monitor. At that point, nurses around the unit respond according to who notices the alarm and who is available, which is not the most efficient way to handle the situation, notes Professor Funk.

Her conclusion: “The efficiency and quality of patient care can be enhanced by the presence of a dedicated monitor watcher.”

The research study was conducted by Professor Funk with cardiac clinical nurse specialist Janet Parkosewich, nurse manager Cynthia Johnson, and graduate nursing student Irene Stukshis, who is a staff nurse on the step-down unit. Funding came from Hewlett-Packard and the American Association of Critical Care Nurses.