3. MONITORING TECHNOLOGY
Telemetry
is the monitoring and analyzing
of data that are received at a distance
from their source. It usually refers to a
certain way of monitoring a hospital
patient's heart activity
6. MONITORING TECHNOLOGY
The ICU environment should focus on
these therapeutic elements:
Windows and art that provide natural
views; views of naturecan reduce
stress, hasten recovery, lower blood
pressure andlower pain medication
needs
7. MONITORING TECHNOLOGY
3. Post cardiothoracic surgery.
4. Drug toxicities limited to potential
arrhythmogenic compounds such as digitalis
and tricyclics.
5. New onset supraventricular arrhythmias
(atrial fibrillation or flutter, PSVT, etc.)
6. Suspected pacemaker malfunction.
7. Observation post pacemaker or defibrillator
placement or post ablation.
8. MONITORING TECHNOLOGY
8. Syncope when an arrhythmia or other cardiac disorder is
a suspected etiology.
9. Suspected defibrillator discharge.
10. Unstable angina of low or intermediate grade (new
onset angina without EKG or enzymatic changes,
crescendo angina in patient with history of coronary
disease).
11. Study drug protocols requiring cardiac monitoring as a
part of the protocol.
9. MONITORING TECHNOLOGY
Prior to discharge from the Telemetry Unit,
patients shall meet the following criteria:
1. Physician shall order the discontinuation of
Telemetry monitoring.
2. Patient shall be free of chest pain for 24 hours
prior to discharge.
3. Patient's vital signs shall be stable
10. MONITORING TECHNOLOGY
4. Patient does not require intravenous
vasoactive medications.
5. Patient shall be able to perform minimal
ADLs without shortness of breath.
6. Patient shall have normal sinus rhythm,
stable rhythm, or controlled arrhythmia for
thepast 24 hours
11. DIAGNOSTIC INFORMATION
SYSTEM
Today's physicians and other
caregivers have access to more than
5,000 different patient tests to help them
evaluate, diagnose, and treat patients.
The problem is that physicians receive
these test results from a wide range of
disparate sources that use vastly
different reporting formats
12. DIAGNOSTIC INFORMATION
SYSTEM
Displaying test results in fragmented,
variable and incomplete formats
prevents physicians fromefficiently
reviewing and analyzing vital patient
information. This can lead to:
Clinicians spending far too much time
(an estimated 30%) gathering and
organizing data
13. DIAGNOSTIC INFORMATION
SYSTEM
Critical information being missed which
can cause medical errors
Redundant testing (an estimated 14%
to 30% of the 30 billion diagnostic tests
done annually in the US are non-
contributory and avoidable)
14. DIAGNOSTIC INFORMATION
SYSTEM
The inability to share or exchange vital
clinical information among providers
Underutilization of EHRs and other
health IT applications and an
unnecessary reliance on paper,
telephones, and fax machines
15. In order to provide cost-
effective, high quality care, physicians
and other caregivers need immediate
access to accurate, timely, and
comprehensive clinical information.
16. THE PATENTED DIS SOLUTION
The patented DIS solution
provides rapid access to cumulative
patient information in an easy to read and
analyze format that increases the accuracy
and efficiency of patient care and improves
the productivity of physicians, nurses and
others at all points of care.
17. THE PATENTED DIS SOLUTION
DIS can aggregate and collate
more than 5,000 different patient test
results and display them all in one place in
the same user-friendly format. Its ease of
access and use adds immediate value to
the health care delivery process:
Converts raw patient test results data into
organized, meaningful information for
easy access,viewing, and analysis
18. THE PATENTED DIS SOLUTION
Provides a standardized reporting
format that unifies test results from all
data sources for usersat all points of
care3.
Integrates test results data on all levels
(data, application, system and network)
increasing efficiency, accuracy and
productivity
19. THE PATENTED DIS SOLUTION
Reduces the number of pages and
screens on which results are displayed
by an average of 80percent5.
Saves time and helps physicians
minimize duplicate and non-
contributory testing
20. THE PATENTED DIS SOLUTION
The DIS technology solution was
specifically designed for immediate use by
all test results data users in physician
offices, hospital inpatient facilities and
outpatient clinics and community health
centers. Its implementation will depend on
collaborative innovation among a number
of interdependent stakeholders.
21. THE PATENTED DIS SOLUTION
These include all the test
results data providers in hospital and
community-based clinical laboratories
and in imaging and other testing
facilities and the vendors of EHRs and
PHRs, as well as the vendors of HIE data
integration and exchange platforms and
the HIOs/HIEs that they serve
22. MECHANICAL VENTILATOR
Is a machine that generates a
controlled flow of gas into a patients
airways. Oxygen and air are received from
cylinders or wall outlets, the gas is
pressure reduced and blended according
to the prescribed inspired oxygen tension
(FiO2), accumulated in a receptacle within
the machine, and delivered to the patient
using one of many available modes of
ventilation.
23. MECHANICAL VENTILATOR
The mechanics of inspiratory support
are more complex than previously
considered. It has been established that
cyclical inflation and deflation injures
lung parenchyma and worsens outcome:
(1). Large tidal volume ventilation, to
normalize blood gases has been shown
to worsen outcome in lung injury
24. MECHANICAL VENTILATOR
(2), presumably due to excessive
pressure induced stretch injury of the
parenchyma. Modernventilation strategy
involves attempting to achieve an
adequate minute volume with the lowest
possibleairway pressure (as this relates
to the degree of alveolar distension).
The pressure that we areinterested in
minimizing is at the level of the alveolus,
the plateau pressure.
25. MECHANICAL VENTILATOR
Ventilator cycling refers to the
mechanism by which the phase of the
breath switches from inspiration to
expiration. Modes of ventilation are time
cycled, volume cycled or flow cycled. Time
cycling refers to the application of a set
controlled breath rate. In controlled
ventilation a number of mandatory breaths
are delivered to the patient at a
predetermined interval.
26. MECHANICAL VENTILATOR
The respiratory rate may be
controlled by the operator or the patient.
The patient may breathe spontaneously,
and with modern ventilators these
breaths are supported either by
delivering facsimiles of the controlled
breaths synchronously with the patient’s
effort or by allowing the patient more
subjective control.
27. MECHANICAL VENTILATOR
Pressure support is a form of
flow cycled ventilation in which the
patient triggers the ventilator and a
pressure limited flow of gas is delivered.
The patient determines the duration of
the breath and the tidal volume, which
may vary from breath to breath
28. CT SCAN
CT scans are a specialized type
of x-ray. The patient lies down on a
couch which slides into a large circular
opening. The x-ray tube rotates
around the patient and a computer
collects the results. These results are
translated into images that look like a
"slice" of the person.
29. CT SCAN
Sometimes a radiologist will
decide that contrast agents should be
used. Contrast agents are iodine based
and are absorbed by abnormal
tissues. They make it easier for the
doctor to see tumors within the brain
tissue. There are some (rare) risks
associated with contrast agents and you
should make sure that you discuss this
with the doctor before arriving for the
30. CT SCAN
CT is very good for imaging
bone structures. In fact, it's usually the
imaging mode of choice when looking at
the inner ears. It can easily detect
tumors within the auditory canals and
can demonstrate the entire cochlea on
most patients.
31. MRI
MRI is a completely different
animal! Unlike CT it uses magnets and
radio waves to create the images. No x-
rays are used in an MRI scanner.
32. MRI
The patient lies on a couch that
looks very similar the ones used for
CT. They are then placed in a very long
cylinder and asked to remain perfectly
still. The machine will produce a lot of
noise and examinations typically run
about 30 minutes.
33. MRI
The cylinder that you are lying in
is actually a very large magnet. The
computer will send radio waves through
your body and collect the signal that is
emitted from the hydrogen atoms in your
cells. This information is collected by an
antenna and fed into a sophisticated
computer that produces the images. These
images look similar to a CAT scan but they
have much higher detail in the soft tissues.
Unfortunately, MRI does not do a very good
job with bones.
34. MRI
One of the great advantages of
MRI is the ability to change the contrast
of the images. Small changes in the
radio waves and the magnetic fields can
completely change the contrast of the
image. Different contrast settings will
highlight different types of tissue.
35. MRI
Another advantage of MRI is the
ability to change the imaging plane
without moving the patient. If you look at
the images to the left you should notice
that they look very different. The top two
images are what we call axial
images. This is what you would see if
you cut the patient in half and looked at
them from the top.
36. MRI
The image on the bottom is a
coronal image. This slices the patient
from front to back. Most MRI machines
can produce images in any plane. CT
can not do this.
37. MRI
Contrast agents are also used
in MRI but they are not made of iodine.
There are fewer documented cases of
reactions to MRI contrast and it is
considered to be safer than x-ray dye.
Once again, you should discuss
contrast agents with your physician
before you arrive for the examination.
38. ICU
The ICU environment should focus on
the set herapeutic elements:
Windows and art that provide natural
views; views of nature can reduce
stress, hasten recovery, lower blood
pressure and lower pain medication
needs
39. ICU
Family participation, including
facilities for overnight stay and
comfortable waiting rooms
Providing familiarity in the ICU
environment through personalization,
warmer colors, natural materials, and
artwork
40. ICU
Providing a measure of privacy and
personal control through adjustable
lighting, adjustable curtains and blinds,
accessible bed controls, and TV, VCR
and CD players
Noise reduction through computerized
pagers and silent alarms
Medical team continuity that allows one
team to follow the patient through his or
her entire stay
41. ICU
A tele-ICU system involves a
command center with the technological
capability to remotely monitor patients in
off-site intensive care units. The command
center is staffed with intensivist physicians
and critical care nurses who use two-way
audio-visual monitoring systems to provide
support and guidance to the bedside staff
in those ICUs.
42. ICU
And critical care nurses play a
major role in the success of a tele-ICU.
They have a great deal of potential when
it comes to bridging distance barriers,
influencing patient safety and even
mentoring bedside nurses, noted Karen
Harvey, MSN, RN, certification programs
specialist for the corporation
43. LABORATORY TESTING
What are the indicators of test reliability?
Four indicators are most
commonly used to determine the reliability
of a clinical laboratory test. Two of these,
accuracy and precision, reflect how well the
test method performs day to day in a
laboratory. The other two, sensitivity and
specificity, deal with how well the test is
able to distinguish disease from absence of
disease.
44. LABORATORY TESTING
The accuracy and precision of each
test method are established and are
frequently monitored by the professional
laboratory personnel. Sensitivity and
specificity data are determined by
research studies and are generally
found in medical literature.
45. LABORATORY TESTING
Although each test has its own
performance measures and appropriate
uses, laboratory tests are designed to be
as precise, accurate, specific, and
sensitive as possible. These basic
concepts are the corner stonesof
reliability of your test results and
provide the confidence your health care
provider has in using the clinical
laboratory.
46. LABORATORY TESTING
Accuracy and Precision
Statistical measurements
of accuracy and precision reveal a lab
test's basic reliability. These terms,
which describe sources of variability, are
not interchangeable. A test method can
be precise (reliable reproducibility)
without being accurate (measuring what
it is supposed to measure and its true
value) or vice versa.
47. LABORATORY TESTING
Precision (Repeatability)
A test method is said to be precise
when repeated analyses on the same
sample give similar results. When a test
method is precise, the amount of random
variation is small. The test method can be
trusted because results are reliably
reproduced time after time.
48. LABORATORY TESTING
Accuracy (Trueness)
A test method is said to be accurate
when the test value approaches the
absolute ³true´ value of the
substance(analyte) being measured.
Results from every test performed are
compared to known "control specimens"
that have undergone multiple evaluations
and compared to the "gold" standard for
that assay, thus analyzed to the best testing
standards available
49. LABORATORY TESTING
Accuracy (Trueness)
Although a test that is 100% accurate and
100% precise is ideal, in practice, test
methodology, instrumentation, and laboratory
operations all contribute to small but
measurable variations in results. The small
amount of variability that typically occurs does
not usually detract from the test ¶s value and
statistically is insignificant. The level of
precision and accuracy that can be obtained is
specific to each test method but is constantly
monitored for reliability through comprehensive
quality control and quality assurance
procedures.
50. LABORATORY TESTING
Accuracy (Trueness)
Therefore, when your blood is
tested more than once by the same
laboratory, your test results should not
change much unless your condition has
changed. There may be some differences
between laboratories in precision and
accuracy due to different analytical
instrumentation or methodologies,
however, the test results are reported with
standardized reference intervals specific
for that laboratory.
51. LABORATORY TESTING
Sensitivity and Specificity
The tests that a provider chooses
in order to diagnose or monitor a medical
condition are based on their in
herentability to distinguish whether you
have the condition or do not have the
condition. Depending on the symptoms
and medical history, a provider will order
tests to confirm a condition (tests with high
sensitivity) or tests to rule out the
condition (tests with high specificity).
52. LABORATORY TESTING
Sensitivity
Sensitivity is the ability of a test to
correctly identify individuals who have a given
disease or condition.
For example, ascertain test may have proven to
be 90% sensitive. If 100 people are known to
have a certain disease, the test that identifies
that disease will correctly do so for 90 of those
100 cases (90%). The other 10 people (10%)
tested will not show the expected result for this
test.
For that 10%, the finding of a "normal" result can
be misleading and is termed false-negative
53. LABORATORY TESTING
Sensitivity
A test's sensitivity becomes
particularly important when you are
seeking to exclude a dangerous disease,
such astesting for the presence of the
HIV antibody. Screening for HIV antibody
often utilizes an ELISA test method,
whichhas sensitivity over 99%. However,
a person may get a false-negative if
tested too soon after the initial infection
(lessthan 6 weeks).
54. LABORATORY TESTING
Sensitivity
Thus, the result of a false-
negative gives a person the sense of
being disease-free when in fact theyare
not. The more sensitive a test, the fewer
false-negative results will be produced.
55. LABORATORY TESTING
Specificity
Specificity is the ability of a test
to correctly exclude individuals who do
not have a given disease or condition.
For example, a certain test may have
proven to be 90% specific. If 100 healthy
individuals are tested with that
method,only 90 of those 100 healthy
people (90%) will be found "normal"
(disease-free) by the test.
56. LABORATORY TESTING
Specificity
The other 10 people (who do
not have the disease) will appear to be
positive for that test.
For that 10%, their "abnormal" findings
are a misleading false-positive result.
When it is necessary to confirm a
diagnosis that requires dangerous
therapy, a test's specificity is one of the
crucial indicators.
57. LABORATORY TESTING
Specificity
A patient who has been told
that he is positive for a specific test yet
truly does not have that disease may be
subjected to potentially painful or
dangerous treatment, additional expense,
and unwarranted anxiety. The more
specific a test, the fewer false-positive
results it produces.
58. LABORATORY TESTING
The FDA requires that developers
and manufacturers of a new test provide
target values for test results and provide
evidence for the expected ranges as well
as information on test limitations and other
factors that could generate false results.
Thus it is critical for the health care
provider to correlate the laboratory results
with an individual's clinical condition to
determine if repeat testing would be
needed.
