So it is not a surprise to see that hospitals that fail to apply a defibrillator shock to a cardiac arrest victim quickly while in the hospital fare worse than those who receive it early. And it was surprising to see that in-hospital deaths from cardiac arrest were higher than out-of-hospital arrest survival in areas with available AED technology.
But what was most shocking to me (pun intended) was not these findings of the study, but the accompanying editorial by Leslie Saxon, MD who advocates for centralized monitoring stations "insensitive" to staffing needs in hospitals:
The automated detection system offers advantages in that it is insensitive to staffing issues and, if centralized, can track patients anywhere in the hospital. The system also allows for quicker notification of key personnel.Who are we kidding?
I've seen such centralized stations in action, and it was scary. First, how many monitors must one person staffing these centralized station watch? 10? 20? 100? How attentive are they? (How attentive would you be after doing this for a week or a month or a year?) Then, there's notifying the staff that there's a problem: what if no one's at the nurses station to answer the "code" phone? Also, who will check to be sure the electrodes stay applied to patients or replace the monitor's batteries when they go dead?
Can we really expect that being "insensitive" to staffing needs will save lives? If no one is there competent to execute the necessary steps for successful resuscitation (including defibrillation), then few will survive.
More effective will be the hospitalist movement, where physician staff are available in-house 24 hours per day. Additionally, simple steps, like placing every patient who undergoes any surgery, especially with conscious sedation or general anesthesia, on telemetry (and perhaps pulse oximetry). After all, not all arrests are cardiac - many are respiratory first, and then become cardiac as hypoxia ensues.
Monitoring of patients in hospitals takes people. Especially people sensitive to patients' needs. Centralized monitoring stations that remain "insensitive" to staffing issues can only spell ultimate disaster to our patients.