How Real-Time Clinical Surveillance Enhances Infection Prevention Efforts

I spent 20 years practicing emergency medicine, healthcare administration, and as medical director for a large ambulance company. In my capacity at the ambulance company, I helped the management as it instituted a Deming’s-style analytic approach to quality, in pursuit of the Baldrige Award.

As I went through the process and watched various clinical programs throughout my IDN do the same, it occurred to me how mismatched this approach to quality was to clinical care. There are a few areas where tweaking a process upstream improves downstream clinical care, but not many. It struck me that a lot of adverse events, suboptimal outcomes, and even deaths, could have been prevented had we not been focused on using retrospective data to identify quality improvement, but rather had access to real-time intelligence and intelligent systems. I recall once seeing a 60-some-year-old gentleman who presented with a litany of symptoms.

I picked up his five-inch-thick paper medical record (this was the ’90s), and started poring through his last admission, the year prior. Nothing stood out in the medical or nursing summaries. But I then went to his lab results (all paper, of course), and saw that after his discharge, a lab test for hypothyroidism (TSH) posted at very high levels. This had been missed, and this poor gentleman had been suffering profound hypothyroidism since.

This is a case that turned out well, but his year of misery could easily have been prevented with a real-time system. Over my career in practice, I saw many others whose clinical courses were, unfortunately, not as favorable. When the opportunity arose to introduce real-time intelligence into healthcare, I pursued it with vigor. I helped found and now serve as chairman and CEO at VigiLanz, which works with clients’ electronic records systems to collect data and perform healthcare analytics.

As the COVID-19 pandemic evolves and intensifies in many areas of the United States, hospitals continue to ramp up their infection prevention efforts. These efforts include providing additional training to staff on infection prevention protocols, implementing broader use of telemedicine to minimize contact, and modifying contingency plans to include overflow areas and new isolation paths for COVID-19 patients.

The real-time visibility into patient data that clinical surveillance provides, and the real-time alerts that it sends to providers via email, in task lists, or other dedicated notification channels, are extremely beneficial to hospitals’ infection prevention efforts because they increase the speed by which hospitals can respond to infections or potential infections.

For example, clinical surveillance can issue alerts to relevant providers when patients have symptoms consistent with COVID-19 but have not yet been confirmed COVID-positive, when tests are ordered, and when results return. This leads to earlier isolation, earlier contact tracing, and earlier use of proper PPE.

In addition to real-time alerts (that can be customized based on hospitals’ unique needs), effective clinical surveillance technology can assist with:

  • Disease cluster tracking and contact tracing
  • Auditing and compliance monitoring of infection prevention standards
  • Outbreak and exposure investigation tools
  • Automated reporting and submission of HAI and COVID-19 data to relevant agencies
  • Employee, patient, and visitor infection safety initiatives

The value of real-time clinical surveillance alerts is underscored in findings from an early 2020 survey of 100 hospital leaders, physicians, pharmacists, and infection preventionists.

The survey, put forth by healthcare consultancy Sage Growth Partners, found that respondents who said their hospital uses real-time clinical surveillance alerts were much more likely than other respondents to be satisfied or very satisfied with their hospital’s safety performance. They were also more confident that their organization could immediately respond to a viral outbreak.

While the survey found that only one-third of hospitals currently use clinical surveillance, about half of respondents who said their organization isn’t yet using it said they plan to use it by 2022.

COVID-19 is likely to drive even faster adoption of real-time clinical surveillance, as more healthcare providers experience the beneficial outcomes it brings to infection prevention in both the inpatient and outpatient settings.

David Goldsteen, MD, is co-founder, chairman, and CEO of VigiLanz, a provider of clinical surveillance services. He is a founder and former chairman and CEO of Vascular Science Inc., purchased by St. Jude Medical. Goldsteen is a graduate of the University of Minnesota Medical School, performing his residency in internal medicine at Hennepin County Medical Center in Minneapolis.