Financial Objections Don’t Add Up in Monitoring Debate

[Editor’s note: This article first appeared on the AAMI Blog.]

By Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety) and Lynn Razzano, RN, MSN, ONCC (Clinical Nurse Consultant , PPAHS)

ECRI Institute, in its report Top Ten Safety Concerns for 2016, again identified a lack of appropriate monitoring of patients receiving opioids as a major issue.

A lack of resources, especially money, is often cited by hospitals as a major obstacle to implementing continuous electronic monitoring.

Although hospitals may have resource limitations, there are increased costs associated with failing to adhere to best practices. An analysis of more than 3,300 closed claims of the American Society of Anesthesiologists (ASA) by Julia I. Metzner, MD, “Risks of Anesthesia at Remote Locations” shows that the median payment per claim can be $210,000 for events that occur in the operating room and $330,000 for those outside the operating room. This analysis concluded that these adverse events were due to substandard care or preventable by improved monitoring.

Additionally, there are hospitals that have identified a significant return on investment with implementing continuous monitoring. For example:

  • St Joseph/Candler Hospitals in Savannah, GA, has experienced more than 10 years of “event free” years monitoring patients receiving opioids. During a five-year period, St Joseph/Candler calculated that it saved $4 million (estimated potential expenses averted, not including potential litigation costs) and had a five-year return on investment of $2.5 million.
  • In research conducted at Boston’s Brigham and Women’s Hospital, Eyal Zimlichman, MD, MSc, and his colleagues determined that implementation of a continuous monitoring system was “associated with a highly positive return on investment. The magnitude and timing of these expected gains to the investment costs may justify the accelerated adoption of this system across remaining inpatient non-ICU wards of the community hospital.” For a podcast with Dr. Zimlichman on this research, please click here.

These resource factors—professional liability associated with failure to monitor and a return on investment—would seem to indicate that continuous electronic monitoring saves hospital significant costs rather than resulting in higher expenditures.

There are clearly patient safety initiatives that can be instituted and implemented that would result in cost savings, effectiveness, and a significant improvement in patient harm events from lack of or inadequate monitoring protocols.

This would suggest that it may not be resources, but resource allocation that may be the obstacle. If so, what really are the key obstacles within institutions that are stopping the implementation of these and other patient safety initiatives?

PPAHS is a member of National Coalition to Promote Continuous Monitoring of Patients on Opioids. For more on this coalition, please click here.

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