UHN’s Halo keeps an eye on patients who need constant care

A program to use two-way audio and video to remotely monitor hospital patients requiring constant care at Toronto’s University Health Network (UHN) has expanded to 11 sites in Alberta, Manitoba, Newfoundland and Ontario.

Launched in 2016, the UHN’s Halo service is delivered from a command centre in downtown Toronto by staff who are trained and enabled to each keep an eye on eight patients simultaneously, replacing the need for one-on-one bed sitters.

“We built our first prototype in 2016 and did a pilot in thoracic surgery and respirology at Toronto General,” recalled Marijana Zubrinic, a nurse practitioner and executive clinical lead for the program. Based on the positive impact on patient care, the service was expanded to Princess Margaret, Toronto Western, and eventually to all six UHN sites.

The service is now live in all UHN inpatient units, including surgical and medical specialties, rehab, dementia and behavioural units, complex continuing care and the emergency department. “The only area we’re not live in is intensive care, where they already have one-on-one care,” said Zubrinic.

The expansion of the program to external sites began in November 2021 with Alberta Health Services’ University Hospital site, in Edmonton.

The popularity of the program is directly related to the shortage of staff that healthcare organizations are experiencing and the cost of employing them. Dr. Shawn Young, chief operating officer at Winnipeg’s Health Sciences Centre cites both reasons for beginning a pilot with UHN in January.

“We saw they were having some success with the program, and we were very interested from the get-go because it ticked off all our boxes,” he said. “We have some significant healthcare resource challenges, and this is one way for us to monitor patients without the need for extra people that we don’t have. Hiring constant cares, as we call them, is an added expense and nobody has budgets for them. They’re always deficit funded, so UHN’s telemonitoring service is one way to avoid that expenditure.”

According to Dr. Young, the savings to date are in the six figures.

“Hospitals are spending millions of dollars on constant observers, so it’s a huge savings,” said Zubrinic, who came up with the idea and served as a bed sitter herself as a nursing student. Prior to the launch of the program, UHN was spending $4 million per year on PSWs and healthcare aides who were paid $25/hour pre-COVID. “Now it’s in the range of $40/hour and there aren’t enough of them.”

Predicting the healthcare workforce shortage will only get worse as our population ages, Zubrinic warns, “A lot of the burden will fall on our nursing staff as part of their workload.” Telemonitoring, she said, is one way to ease the pressure on hospital budgets and nursing staff while keeping vulnerable patients safe.

Patients selected for constant monitoring include those at high risk for falls or climbing out of bed when it’s dangerous to do so, as well as patients who get confused and try to pull out invasive lines.

One area of the hospital that is especially suited for telemonitoring is the pre-lung transplant unit, where patients on high-flow oxygen can go into respiratory arrest in the event of a problem with their oxygen supply while sleeping. Early in the rollout of the program, “monitoring techs reported not being able to tell if patients dependent on high-flow oxygen were sleeping or if something else was happening. That prompted us to add oxygen saturation monitoring to the solution,” said Dr. Shaf Keshavjee, UHN’s chief of innovation.

“Typically, in the past, we’d put patients with very high oxygen needs in a very high-resourced environment, like a step-down unit,” noted Dr. Young. “Now we can monitor them just as safely without having to put them in that environment.”

UHN’s Halo telemonitoring system is a mobile device on wheels consisting of two cameras, a speaker, a microphone and a notebook-sized screen that allows patients to see and hear their telemonitoring tech.

Having another human being in their room even if only on a screen was appreciated by patients who were in isolation during COVID.

To avoid disturbing patients at night while sleeping, the screen goes dark. There’s also a privacy hood that a nurse can flip over the camera during private care.

The meticulously engineered program, developed by UHN’s in-house Techna Institute health technology team and delivered by Altum Health Medical Solutions, includes integrated data-recording software that documents interventions by telemonitoring staff and attention detection functionality that alerts telemonitoring techs if they are distracted and not watching the screen.

To talk to patients, they simply touch the screen, and if a patient is trying to get out of bed or is in distress, they reach out to a nurse in the unit by telephone. If the battery on the phone dies or if the nurse doesn’t pick up because the phone has been misplaced, the system automatically cascades to the main desk at the nursing station, and if needed, to the manager on the inpatient unit.

Bed sitters are still required for some especially vulnerable patients, but telemonitoring suffices for 50 to 60 percent of patients requiring constant observation.

UHN has 90 camera systems across its six sites and was using up to 50 at a time during COVID.

Currently, said Zubrinic, an average of 30 UHN patients are monitored daily. Including external sites, the service provides constant monitoring for an average of 45 patients at any one time. Since inception, UHN has monitored 4,200 patients for a total of 600,000 remote patient monitoring hours.

Winnipeg’s Health Sciences Centre has seven camera systems for the pilot in its medical and neurosurgery units and generally monitors two to four patients at any one time. Once a patient is selected for telemonitoring, a camera system is simply wheeled to the patient’s bedside and plugged in. As of mid-August, the service has monitored 45 patients for a total of 8,800 hours.

UHN has 15 permanent telemonitoring techs on staff and another 12 part-time and casual employees, including PSWs, healthcare aides and internationally trained nurses who aren’t licensed to work as nurses in Canada.

They work in a Command Centre located in the Krembil Discovery Tower at Toronto Western Hospital and sit at workstations equipped with a large screen monitor, computer and headset. Each telemonitoring tech goes through a training program that instructs them how to intervene in each situation.

Feedback from clinical staff and patients has been positive, and families are relieved, said Zubrinic. “In the past, they would be reluctant to go home and leave their loved ones alone because they knew there were fewer staff scheduled at night.” That’s not the case anymore.

The reluctance of hospitals across the country to develop their own telemonitoring programs isn’t surprising given the sophistication of the UHN technology.

“Initially, some of the hospitals started off with the idea of doing it themselves,” said Zubrinic, “but they quickly realized that it’s a lot to take on. It’s a total solution and, often, they don’t even have the people to do the monitoring locally.”

The expansion of the program to other sites is a good example of the power and potential of telehealth technology to deliver best-in-class solutions to other hospitals across Canada, but there is also the possibility of going global.

As a result of a recent expression of interest from Australia, Zubrinic and Dr. Keshavjee see the potential to also offer the service to healthcare institutions in other English-speaking countries, including the U.S., the U.K., Ireland and New Zealand.