DÜSSELDORF, Germany — In the operating room (OR), a surgeon typically is surrounded by 11 different medical devices, "and they all keep beeping at us," complained Martin Schuster, MD, from Charité University Hospital (Berlin).

"Which one of these alarms is important," he asked, adding that blood pressure, oxygen saturation and ventillator alerts can sound between 10 and 12 times during each case.

"We need smart alarms, and I know that some manufacturers are sensitive to this problem, but it is really a work-in-progress," he said.

For example, loud alarms are effective, but only for being turned off more quickly, not because the information is more important. Adding a rising tone for an alarm according to the severity of the patient condition would be smarter, he said.

As for visual alarms, a blinking light is difficult to notice these days when everyting is flashing, but a more useful visual is a graphic display showing a clinician the critical state in relation to the past few minutes.

Responsible for five ORs at Charité Hospital, Schuster led a presentation on "Patient Monitoring : Friend or Foe of OR Workflow."

The English-language sessions in the program for Medica 2009 were a first, a token acknowledgement of the heavy international influence on the world's largest trade fair, which celebrates its 40th anniversary this year.

Schuster's key theme was the challenge that complexity in the OR presents for productivity, and ultimately for patient safety.

"We counted 81 different types of medical devices in the Charité OR," he said, including 15 anesthesia machines, nine respirators, 16 infusion pumps and 13 cardiovascular monitoring devices, all from different manufacturers.

"We are required, of course, to train OR personnel on all of this equipment, which takes a considerable amount of time," he said.

Yet for any given type of device, the downtime in OR was found to be an average of 40%.

Devices dedicated to a single location and redundancy are two areas where this problems needs to be addressed, he said.

Schuster asked why a patient can not be continually monitored, for example, by the same device throughout the perioperative pathway, a device that is as transportable as the patient.

Integration of devices with hospital information systems would also help answer the most frequently asked question in the OR, "Where is the next patient?"

"Just over 14% of OR time is unused, and half of this is because we do not know where the patient is located, at what state the patient is in preparation," he said.

"Since the patient is connected to a patient monitor in these spaces, why can we not know from this monitor the location and the patient's status?" asked Schuster.

"Sometimes such information conveniently displayed would allow us to improve workflow, or sometimes it simply would let us know that we can take a break for 15 minutes," he said.

As POC testing grows, so does risk of errors

Today testing of patients at the point of care (POC) accounts for 25% of all testing, and these portable assays are increasing their penetration into medical practice at a rapid rate of 12% each year.

Yet along with the growth comes an increasing risk of errors that adversely affects quality of clinical decision-making and patient safety.

"Already healthcare is not as safe as it should be," said Christian Falk, MD, from Zurich University Hospital (Zurich, Switzerland), citing a death rate due to medical errors that places hospitals among the top 10 leading causes of death.

"If a Boeing 747 crashed each week, this would be the equivalent of deaths in the healthcare system due to errors in either the United States or Europe alone," he said, adding, "not many people would want to fly."

POC testing brings great benefit to healthcare with rapid results for glucose levels, cardiovascular monitoring, or even simple pregnancy tests, he said.

Yet these tests are increasingly performed by non-laboratory personnel and subject to errors such as inappropriate testing, excessive testing, inconsistent specimen collection, mistimed tests or critical results that are either not recognized or not documented.

An especially wide area for simple error with serious consequences is misidentification at any of the stages in a process that includes pre-analysis, analysis and then post-analytic results.

At his hospital in Zurich, Falk has studied the variations in patient identifications that are alternately taken from a bed number, a patient medical record, or a patient wrist band, which is rare in Zurich.

The workflow error potential is great, he said, at a large medical center when it turns to "rush hour" at the blood analyzer with unreadable bar codes and syringes stacked on paper toweling marked with bed numbers.

Falk, who made a career transition in 2004 from the hospital's lab to its info systems, believes POC testing should follow a similar path.

He has conducted a pilot program in Zurich that integrates POC test results with the patient medical record through the health information system.

A test profile is created by zapping the bar codes on the ID badge of the healthcare worker performing the test, on the POC test device being used, and then on a patient identification badge.

This profile is bundled in a central process analyzer with the test results and simultaneously sent to the patient medical record and the POC test result device.

He said the system is not completely stable at the moment, nor is it scalable, meaning it is not yet ready to be deployed across the entire university hospital campus.

Yet it is an essential first step, he said, in approaching POC testing the same as other critical healthcare functions, such as the medical device supply chain, or medication tracking with single unit doses.

He also said that increasingly, the manufacturers of POC tests need to support embedded data transfers in their applications to integrate with web-based reporting portals at hospitals.