Today's vital signs monitors are lightweight, portable and communicate directly with electronic health records, making them essential tools for anesthesia providers who want to keep pace with high-volume centers. Here's a sampling of the latest design improvements that demand your attention.

• Improved interconnectivity. Spurred by the federal government's push for patients to have electronic health records by 2014, the entire perioperative process is becoming digitized. When your facility transitions completely to electronic health records, if it hasn't already, you'll need monitors that can send captured vital signs data to the digital files in an anesthesia information management system. Slowly, AIMS have been working their way into smaller surgical facilities; some independent anesthesia groups are even purchasing the systems (see "Anesthesia Recordkeeping Enters the Digital Age" on page 27).

Vital signs information that's captured electronically can be added to the patient's electronic medical record, used for electronic anesthesia billing and compiled for reporting as Surgical Care Improvement Project measures and pay-for-performance targets. Because the AIMS captures data in real time, vital signs information is immediately added to the patient's record. This saves the anesthesia provider from having to manually enter the patient's blood pressure, heart rate and temperature at various times during the perioperative period.

For the AIMS to capture the data, however, the vital signs monitor must be able to send the information to the system by way of a USB, Ethernet or serial port. The ports can also be used for updating the monitor's software. The newest monitors are able to export patient data in ASCII or Health Level 7 (HL7) formats. HL7 is the worldwide standard communication format between electronic healthcare devices. Some monitors allow bi-directional communication between the AIMS and the monitor. With this feature, the anesthesia provider can scan the patient's ID bar code, which loads all the patient's information into the monitor.

There is, however, a caveat. In most cases, exporting data is not a plug-and-play scenario, unless you buy a monitor manufactured by the company that makes your EMR or AIMS software. As a result, you'll need to work with an expert who can write software that lets your vital signs monitor talk with your EMR system. In some cases, the EMR software company will write the required program. In others, the monitor company will write it.

• Intelligent alarms. Clinical alarms are important safeguards when a patient's status is deteriorating. Alarms can also be bothersome if they're not set to parameters relevant to the patient. When parameters are inappropriate to the patient or clinical situation, alarms go off needlessly, causing alarm fatigue. This can become a dangerous situation if anesthesia pro-viders disregard alarms, believing that the monitor is "crying wolf." In other situations, an anesthesia provider may turn down the alarm volume. This can lead to serious untoward events. As a result, one of the Joint Commission's National Patient Safety Goals is to improve the effectiveness of clinical alarm systems.

Manufacturers of vital signs monitors have begun to address these issues by creating more intelligent alarm systems that let providers react sooner to a combination of parameters that more accurately reflect the patient's situation. They've also worked to reduce the number of false alarms that occur during a procedure. These newer machines adjust an alarm's parameters to baseline readings taken when patients arrive in the OR. The devices then calibrate the alarms to individual patients.

For example, a young athletic adult may have a heart rate of 55 beats per minute, which could be dangerously slow for an overweight 65-year-old. Thanks to settings on newer monitors, the anesthesia provider can program the monitor's alarm to sound when the athlete's rate dips to 45 beats per minute or the senior citizen's to 55 beats per minute.

Manufacturers are also adding more parameters for tracking trends, which give the anesthesia provider an early indication that the patient's status may be deteriorating before the situation actually reaches a critical juncture. The trending features in some monitors let the provider see more than one trend at the same time and compare the patterns to real-time values.

• Greater portability. Vital signs monitors are becoming smaller and lighter. In some models the screens are becoming simpler to read and understand. Smaller monitors are well-suited for such volume-focused specialties as cataract surgery, during which monitors stay on stretchers with patients as they flow through the perioperative process. The batteries included in newer, more portable monitors are also improved. They keep their charge longer, recharge quicker and some even recondition themselves while charging, which adds to their lifespan.

Wireless technology has been employed in several applications related to patient monitoring. In MRI suites, wireless monitors let providers monitor blood pressure, oxygen, ECG and other parameters. In these systems, wireless radiotranslucent electrodes are affixed to the patient. Although this setup is more expensive than a wired system, you can also use it to monitor patients on the floor and in the OR.

A real trial
When you're shopping for new monitors, it's best to work with a product in the setting where it will be used daily. You may learn that the monitor everyone liked on paper is actually not well-suited for your facility or has expensive features that you don't really need. Conversely, you may discover a feature that your staff suddenly can't live without. You never know until you try.