Remote heart monitoring at St. John's hospitals sparks fears about delays in care

A remote monitoring system being implemented at hospitals in Oxnard and Camarillo means heart rhythms of patients at risk of cardiac arrests and other problems are being tracked by technicians 430 miles away at a site in Phoenix, Arizona.

The off-site monitoring is designed to use technology to protect patients and improve care.

In practice, it increases the chances of delayed response to potentially fatal occurrences, according to the more than 20 onsite cardiac monitoring technicians at St. John’s Regional Medical Center and St. John’s Hospital in Camarillo. They say they’ve been told their jobs will be replaced by the remote system.

“You have to ask yourself, would you want to be monitored 500 miles away?'” said telemetry tech Ernie Magana as he stood outside Oxnard City Council chambers on Tuesday night. Moments earlier, he and other members of the two unions that represent the techs and nurses city leaders the new system has already brought delays at St. John's in Oxnard and other mistakes that, if repeated, could be fatal.

“Just a few seconds or a few minutes can be the difference between life and death,” said Joshua Sharp, a telemetry nurse at St. John’s in Oxnard. The city has no authority over hospital equipment but the union members asked elected officials for support by conveying any concerns to St. John's leaders.

At the hospitals, patients at risk of heart problems are tracked via computerized monitors that measure heart rhythms. Onsite technicians watch the monitors around the clock. When a heart stops or the rhythm changes, they issue alarms that tell nurses and doctors to respond immediately. They are located in the nurse's station and immediately make sure their alerts have been heard.

Nurses providing care for the patients being monitored say the techs are the eyes and ears of the telemetry units.

Techs say their jobs are in jeopardy

The new system went live at St. John's in Oxnard in April and is also planned for the Camarillo hospital. Monitoring is conducted at a centralized site in Phoenix manned by technicians and nurses who supervise them. Bedside nurses are notified of any issues or alarms, like code blues that show the heart has stopped.

The onsite techs currently remain at the hospital and continue to track the monitors, backing up the remote efforts. That presence is temporary, according to the techs who said they were originally told their positions would be eliminated 90 days after the centralized system began. Now, they've been told they will remain longer but will still eventually be moved to other jobs.

St. John's hospital leaders declined interview requests and didn't answer emailed questions about possible job elimination or the timetable of the transition to remote monitoring. Spokesperson Christina Zicklin said the hospitals are meeting with employees to listen to their concerns. In a written statement, she asserted the new system enhances patient safety.

"This new technology reduces the amount of false alarms and provides a clear picture of what is happening with a patient's cardiac rhythm," she said.

It is the new way of care and is being implemented by many hospitals across the country, St. John’s CEO Barry Wolfman told employees Wednesday in an email regarding The Star’s planned story on the system.

“We know this advanced technology will enhance and elevate patient safety,” he said, referring to artificial intelligence technology and other tools. The system detects changes in a patient’s status and produces a rhythm strip containing detailed information that helps doctors provide care.

“By leveraging this new technology, our community now has access to the most advanced and safest cardiac monitoring system available,” Wolfman said.

Telemetry technicians and nurses say the new system has already brought delays and errors that could cost lives if onsite techs weren’t there to catch them.

“We’ve already experienced delays of 2 minutes and even miscommunication of up to 40 minutes,” said Christian Luna, telemetry nurse at St. John’s in Oxnard. “When it comes to the oxygenation of the human body, seconds are life.”

Luna worries that if the onsite techs are replaced, it will mean fewer eyes at the hospital tracking heart rhythms, placing more pressure on nurses.

Each onsite tech monitors no more than 31 patients in a limit they say is aimed at protecting safe care. They said they've been told each person working in the remote unit tracks far more patients. They worry the heavier load increases the chance of mistakes and delays.

"Once you get over 40 patients, the chance of error goes up," said Sharp, the telemetry nurse.

Though the system is designed to produce fewer false alarms about changes in heart rhythms, the opposite has happened, techs and nurses said. More alerts are being issued by the remote system. Nurses are scrambling to respond and are being pulled away from other patients.

Hospital leaders didn't directly address questions about specific patient safety concerns or claims of an increased workload at the remote site. Zicklin, in her statement, said the remote system eliminates potential barriers.

"By operating in a dedicated center, removed from typical hospital distractions, (central monitoring unit) technicians are solely focused on patient monitoring for improved safety," she said.

Fears center on communication gaps

Outside of St. John’s, offsite cardiac monitoring sparks debate.

Dr. Vishva Dev, medical director of cardiology at Los Robles Regional Medical Center in Thousand Oaks, said Los Robles will continue to use onsite monitor techs. He worries that offsite systems could bring communication gaps. But he also understands consolidation, telemedicine and artificial intelligence are ways to reduce manpower and help with medical costs that have skyrocketed.

“That is where the world is going,” he said.

Dr. Andrew Zadeh, cardiac electrophysiologist with Keck Medicine of USC, said one possible gain from advanced technology is it could provide more information about heart rhythms, helping caregivers make the right decision. But he worries about remote systems bringing delayed reaction times.

In his email to employees, St. John's CEO Wolfman asserted the remote system will ultimately improve care and bring better clinical outcomes for patients. Employees and technicians said there have already been multiple mistakes.

Nurse reports two-hour gap

Telemetry nurse Kateryna Manu told the Oxnard City Council the remote system mistakenly stopped monitoring a patient who was still in the hospital and still at risk of heart attack problems. It meant there was no monitoring for 2 hours, 10 minutes, she said.

The patient survived but Manu said the lapse shows what can happen.

“We got lucky,” she said.

Telemetry techs worry about the potential loss of their jobs though they’ve been told they will be transferred to other units. They've held one protest rally and talk of conducting another. Oxnard leaders have said they will talk to St. John's leaders about the employees' concerns regarding patient safety.

Standing at the podium in City Hall on Tuesday, Magana expressed concern about a health care future that appears to revolve around advances in technology.

“This should help us, not replace us,” he said.

Tom Kisken covers health care and other news for the Ventura County Star. Reach him at tom.kisken@vcstar.com.

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This article originally appeared on Ventura County Star: Remote cardiac monitoring at St. John's hospitals sparks concerns