Marijana Zubrinic and Jimmy Qiu
TeleMonitoring at UHN was the brainchild of Nurse Practitioner Marijana Zubrinic, pictured here with Jimmy Qiu, Manager of Engineering, at Techna. (Photo: UHN)

Looking to reduce the risk of exposure to COVID-19 for patients and staff, Toronto Rehab's Specialized Dementia Unit (SDU) has tapped UHN's remote monitoring services to support patients who might have the coronavirus.

The SDU specializes in assessing and treating older adults who are experiencing behavioural challenges related to dementia. The physical space is designed to allow patients to safely roam freely, and when patients are confused or seeking exit from the locked unit, staff redirect them with a helping hand and gentle touch.

But when patients who were suspected of being COVID-positive had to isolate in their rooms awaiting test results, the team faced the challenge of ensuring these patients stayed put, while maintaining their own physical distance, when possible.

"We needed to find a different way to protect our patients and staff, while still delivering optimum patient care," says Robin Shan, Program Services Manager.

By tapping into UHN's Patient TeleMonitoring Program – a shared service that has become critical to the organization's COVID-19 response – the SDU has been successful in keeping some patients isolated while ensuring continuity of care.

A cost-saving service with increasing impact

The Patient TeleMonitoring Program is the brainchild of Marijana Zubrinic, a Nurse Practitioner at Toronto General Hospital (TGH), who saw an opportunity to replace costly, overnight, bedside sitters, for patients experiencing delirium and confusion.

"We were spending $3.8 million each year on bedside sitters who sat by patients to ensure they didn't engage in harmful behaviour, like trying to climb out of bed before they were ready, pulling on invasive lines or taking their oxygen mask off," says Marijana.

"Bedside sitters are an important service, but the model at the time was not sustainable from a financial perspective."

So four years ago, funded by the Sprott Surgery Innovation Fund, Marijana partnered with the Techna Team to develop a remote monitoring service, comprised of a portable camera and two-way microphone unit, that allows one care provider to see, hear, and talk to up to eight patients at a time, across all sites at UHN, from a monitoring station on the 10th floor of TGH.

Eighty percent of the time, TeleMonitoring can be effective in redirecting patients. When it can't, the technician will call the primary nurse of the patient, who has been equipped with a phone, to help.

The area where it's made the biggest impact is in UHN's Lung Transplant Program, where patients with high oxygen needs were either removing their masks in confusion, or masks were coming off, while they slept, increasing the risk of respiratory arrest.

"We found that by gently prompting patients to put their masks back on, incidences of preventable death for these patients dropped significantly," says Marijana.

monitoring machine
A portable camera and two-way microphone unit allows one care provider to remotely see, hear and talk to patients. (Photo: UHN).

A critical tool to UHN's COVID-19 response

When UHN started treating COVID-positive patients, TeleMonitoring became a solution that would allow staff to provide optimal care, while maintaining safe distance, when possible.

It's also helping to conserve Personal Protective Equipment (PPE) supply.

"If a COVID-positive patient isn't being remotely monitored, a nurse would need to frequently enter the room, to check oxygen saturation levels on the ward," says Marijana.

"That's a lot of PPE to go through, on top of the time spent donning and doffing, when you have a full patient assignment."

Oxygen saturation refers to the balance of oxygen needed in the blood, to support proper organ function. Respiratory diseases, such as COVID-19, can cause saturation to suddenly drop quite quickly.

To monitor oxygen saturation levels remotely, the Techna Team, working with Medical Engineering, designed a second camera attachment to couple with the vital sign monitors.

"By pointing a second camera at a monitor, technicians can alert us when a patient starts to de-saturate, so we can immediately intervene and prevent a code blue, or other serious event," says Marijana.

On the SDU, where patients aren't used to staying in their rooms, the benefits are two-fold.

"We implemented TeleMonitoring to help ensure patients under investigation for COVID-19 remained in isolation," says Robin.

A patient trying to leave the room can be remotely redirected with simple prompts such as: "Where are you going? It's nighttime," or "It looks like you need help – I'll call a nurse for you."

But it's also allowed the team to observe the patients' behaviour from a distance, and document whether their treatment plan is working.

"By feeding the camera to a monitor in our nursing station, as well as the TeleMonitoring station at TGH, we have been able to provide uninterrupted continuity of care," says Robin.

Telemonitoring 2.0

The next generation of tele-monitoring services is being expedited to further enhance COVID-19 care.

Instead of placing two cameras in each COVID-positive room, to monitor both the patient and their oxygen saturation level, the development team at Techna led by Jimmy Qiu, Techna Manager of Engineering, will soon replace that second camera with a probe that attaches to the vital sign monitor, allowing real-time information to feed to the TeleMonitoring station.

"The TeleMonitor Program has been a huge success, largely because of the truly wonderful collaboration between the Department of Surgery and Techna," says Luke Brzozowski, Senior Director, Techna and Diagnostics Innovation.

"I am thrilled that our platform has been so instrumental in protecting patients and UHN staff in this time of need."

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