Telemetry Nursing Station
With increasing demand for monitored beds, the current Telemetry Unit is always an active and dynamic department. This July to accommodate the community's need, they will welcome 24 new private rooms as part of the Tower Project.

Published: Synapse 2013, Vol. 1

If you saw the last issue of Synapse, you learned about the new Patient Tower and all of its patient-centered features -- from private rooms filled with natural light, to more space for visitors, to bathrooms with fall-prevention features. (If you missed the issue, read the "Next Generation of Health Care" article.) Now we want to tell you more about the first unit that will open on the top floor this summer: Telemetry. In addition to being patient-centered, the unit is intentionally designed to meet the needs of clinical staff, whose input was critical to the project.

Over the past decade or so, many healthcare services have shifted from inpatient to outpatient settings, allowing more patients to have surgery and other treatments without entering a hospital. As a result, patients admitted to hospitals tend to be more critically ill than ever before. They also are older and often dealing with chronic conditions such as cardiovascular disease and diabetes. Many of them need more careful monitoring -- not at the level given by an Intensive Care Unit, but more than the typical Medical/ Surgical Unit provides.

Telemetry Nursing Station
Monitor surveillance Technician Mary Alfano-Brown (overhead image) and JoAnne Higgins (profile image) have been with the Hospital since the inception of the Heart Monitoring Program. Monitor techs are responsible for watching the heart rhythms of the patients from Telemetry, the Post-Interventional Unit (PINU) and various beds throughout the Hospital.
Telemetry Nursing Station

In line with this trend, The Chester County Hospital has experienced increasing demand for the beds in its current Telemetry Unit, where patients' electrical heart rhythms and other vital signs are continuously tracked and transmitted to a central monitoring station. There, two trained technicians watch the rhythms and report any unusual changes to the patient's nurse, who is also specially trained to interpret heart rhythms. Right away, these nurses can know what is happening with their patients without being at the bedside. Such close monitoring, along with a 4-to-1 patient-nurse ratio, ensures that these patients get any necessary intervention quickly for heart-related issues.

"It used to be that just those with heart problems or rhythm problems required telemetry, but now we have more patients who require this type of monitoring," says Jeffrey Wahl, M.D., Medical Director of the Telemetry Unit and a cardiologist with Cardiology Consultants of Philadelphia -Chester County Cardiology Associates. "Patients are sicker and the demand has escalated."

"Cardiovascular conditions do remain our leading cause of death and disability, and when patients have a known problem, we must watch their heart rhythms so we can manage the treatment," says Tina Maher, RN, BSN, NE-BC, Director of Telemetry, Post-Interventional Unit, and Critical Care Support. "If we can intervene early at the first sign of a problem, we can prevent a lot of complications, and get our patients home and on their way to recovery.

"There are other patients who are acutely ill with other conditions that could threaten cardiac stability, so they need to be monitored as well," she says.

Heather Iademarco, RN, BSN, MS, a nurse on the Telemetry Unit for six years, cites a range of conditions that she has seen in her own patients, which makes the unit the safest place for them to be.

"There are many conditions that can cause heart rhythms to go awry: Lyme disease, low magnesium or potassium levels, alcohol withdrawal and even the flu in some people, as we've seen with the early winter outbreak," she says. "If a patient is starting a new blood pressure medicine or a beta blocker, they may need to be monitored. In this and many other situations, it's best practice to have them on telemetry because the system is watching them even when I'm not at the bedside, and it can document what is going on with the heart 24/7. We can go back and look at what happened throughout the day or overnight, and share it with the physician."

In 2004, the Hospital also added remote telemetry capability, which enables us to equip patients on any unit with a transmitter that sends their heart rhythms to the central monitoring station near the Telemetry Unit. This allows technicians to keep a watchful eye on up to 38 additional lower-risk patients.

This is why the Medical Staff and clinical team are excited that an additional Telemetry Unit will be the first area to open in the Patient Tower in just a few months. The unit will feature 24 private rooms with two nurses' stations, along with "touchdown" areas between rooms for clinicians to collaborate. Each room is large enough to accommodate family members and other visitors, and it includes a sofa that converts to a bed for a loved one who wishes to stay overnight.

"Our care delivery model is based on the relationships we have with our patients, their family and visitors," says Tina Maher. "The design of the room really reflects that." Maher and several staff members from the current Telemetry Unit played a key role in planning the new spaces to best meet the needs not only of patients and families, but also of nurses, physicians, and other clinical staff. A couple of years ago, the Hospital assembled a committee that included telemetry nurses, nursing assistants, a unit secretary, the charge nurse and clinical manager to work with the architectural firm Ballinger to design the new unit.

"We met with the architects frequently and went over every nuance of the new space," Maher says. "What makes sense in terms of the overall flow and design? How can we best accommodate the patient and caregiver? Throughout the planning process, we would pull in staff from different disciplines -- information technology, environmental services, and so on -- to get their input on what would work best."

Nichole Coleman, RN, BSN, PCCN, the day shift charge nurse on the Telemetry Unit, participated on the committee and appreciated what she calls the ongoing "back and forth" between the group and Ballinger. Especially helpful was a mockup room that Ballinger set up across the street from the main Hospital, where Coleman and her colleagues could go to try out different configurations and other ideas. Coleman was also part of a core group that traveled to Hill-Rom's headquarters in Indiana to look at beds and other medical equipment.

"Working with Ballinger was a great experience," Coleman says. "We know the clinical side of things -- this is what we do every day -- and they have the architectural and design expertise. This was a chance to take what we know and create a space that would foster a better experience for the patients and make our workflow easier. We got the best possible outcome, and I know patients are going to love and also benefit from the private rooms." Dr. Wahl points out that the entire Telemetry Unit also has been designed for the future, which relies heavily on information technology.

"It is very busy in a Telemetry Unit and everyone needs access to a computer," he says. "Everything is done electronically: ordering, review, making notes, preparing the discharge plan. Traditional units weren't built with workspaces large enough for this way of doing medicine, but this new Telemetry Unit is. Clinicians will be able to function much more efficiently." In addition, each room features a bedside computer for clinicians' use.

The Chester County Hospital is now immersed in the process of orchestrating how the two Telemetry Units will work together in terms of staffing and coordination of care. By the time the new unit opens on the fourth floor of the Patient Tower this summer, all of these details will be in place. More importantly, the Hospital will be able to better accommodate area residents who come through our Emergency Department and need continuous cardiac monitoring as part of their care. This new unit will give the clinical team the ability to stabilize them in the Emergency Department and then get them into a bed quickly, starting them on the path to healing.

By Kristine M. Conner
Photos by Rick Davis

Our Generous Community

The vision for the Tower Project was made a reality in part by the support of many donors. Recently, The Chester County Hospital Foundation received a generous pledge of $5 million from Oscar and Vivian Lasko to fit out the two remaining floors of the Hospital's new Patient Tower. Their gift will also support the renovation of the Emergency Department (see p. 16). With their extraordinary support, our Hospital will be transformed into an even more patient-centered facility, which will further improve patient care and the overall experience at the Hospital.

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