"Electronic Nurse" helps homebound patients stay out of hospital

Newswise — Montefiore Medical Center's Home Health Agency is using a new hi-tech interactive disease management system, dubbed the "electronic nurse," to supplement regular nursing visits to the homes of congestive heart failure (CHF) patients to help monitor their vital signs. Evidence already shows that increased proactive management of weight changes and other vital signs can improve patients' quality of life and reduce hospitalizations.

 "If anything is amiss with changes in their weight, blood pressure, pulmonary function, blood sugar rate or heart rate, one of our doctors or nurses contacts the patient and determines any necessary medical interventions," said Sandra Selikson, MD, medical director of the Home Health Agency. "We can repeat taking vital signs electronically any time of the day and monitor disease processes more closely so we can treat problems early, before they become more serious and require hospitalization." An "e-nurse" disease management system is assigned to each CHF patient and attached to a regular push-button phone in their homes.

Every day patients use the system to monitor their vital signs and transmit the data through the phone line to Montefiore, where it is analyzed by the Home Health nursing staff.

An electronic scale measures changes in weight, a key indicator of worsening heart failure; a peak flow meter checks lung capacity, an indicator of worsening asthma or chronic obstruictive pulmonary disease (COPD); a glucometer measures blood sugar levels which are key to managing diabetes; blood pressure levels are monitored for hypertension and a pulse oximeter reads oxygen levels in the blood, key information to determine interventions needed for patients with asthma and COPD.

Each day the interactive system asks the patient a series of self-help medical questions concerning his or her health in English or Spanish.

Other languages are being added to the system for the future.

"This focuses our patients on a self-care strategy and helps with things like medication adherence," said Dr. Selikson. "Since they must interact with the system at least once a day, it makes them more aware of their health and changes in their conditions. It prompts more interaction with our medical team which leads to better outcomes whether the condition is congestive heart failure, diabetes, asthma or hypertension."

"National data shows that using this new hi-tech disease management system as an important tool in cutting-edge preventive medicine will help improve patient outcomes," said Terry Goodwin, vice president of Montefiore's Home Health Agency. "In one study, visits by CHF patients to emergency rooms decreased by 61.7 per cent and readmissions to hospitals decreased by 65.9 percent," Goodwin said. "We are focused on treating sometimes subtle changes in our patients' medical conditions so we can keep them from getting to the point where they need more serious medical interventions."

Goodwin points out that this disease management system is not for everyone. She says a patient must be fifty years or older, have a primary diagnosis of congestive heart failure, have a touch-tone telephone and be able to stand on the system's scale independently. Montefiore Medical Center, The University Hospital and Academic Medical Center for the Albert Einstein College of Medicine, ranks among the top one percent of all US hospitals based on its investments in medical innovation and cutting-edge technology.

Montefiore invests more in order to enable compassionate, personalized care and the most positive outcomes for patients and their families in New York, the tri-state area and beyond. Montefiore's unique combination of 'state-of-the-art' technology with 'state-of-the-heart' medical and nursing care in a teaching and research environment provides patients with access to world-class medical experts, the newest and most innovative treatments and the best medical center experience anywhere.

This 1,062 bed medical center includes the Henry and Lucy Moses Division, the Jack D. Weiler Hospital and The Children's Hospital at Montefiore, a large home healthcare agency and a 21-site medical group practice located throughout the Bronx and nearby Westchester.

Montefiore treats all major illnesses and has distinguished centers of excellence in cardiology and cardiac surgery, cancer care, tissue and organ transplantation, children's health, women's health, surgery and the surgical subspecialties. Montefiore Medical Center focuses on providing family-centered healthcare in a nurturing environment that extends well beyond its hospital and ambulatory settings.