New home monitoring program for infants with congenital heart disease
Technology is opening opportunities for many medical specialties to provide virtual care to patients who otherwise would need extensive in-person care. One particularly meaningful example is a new program that uses high-tech medical devices to monitor ill infants remotely — so they can be at home with their families.
Jodi Zalewski, a certified nurse practitioner in pediatric cardiology at Cleveland Clinic in Ohio, is building such a program. She and her team have designed a strategy that allows babies with certain types of congenital heart disease to be discharged to their homes. Her team then uses advanced medical devices to closely monitor the infants. The program is available to babies up to 12 months old with certain life-threatening heart conditions that involve shunt physiology, or an irregular pattern of blood flow in the heart, such as single ventricle disease and tetralogy of Fallot.
“We know that patients, especially pediatric patients, thrive at home with their families. So, we wanted to come up with a way to keep these kids at home safely but also make sure that the families feel 110% comfortable taking care of their child at home,” she says.
The home monitoring program has been shown to increase weight gain and decrease readmissions, with a 0% mortality rate, she added. “Digital home monitoring helps us catch changes sooner. That way, we can react so that these patients don’t go downhill so quickly, and they can come in before they are already super sick.”
Monitoring shunt murmurs and other data in high-risk newborns
“I became a nurse practitioner because I’ve always loved kids. I spent my whole nursing career in pediatrics, and I knew that being an advanced practice provider would allow me to be even more hands-on with my patients, providing education to families to really care for their child,” she said. “Becoming a CNP has also advanced my career, as I’ve taken on leadership roles to examine and improve the overall care we provide to pediatric cardiology patients.”
She leads the Infant High-Risk Program, designed for some of Cleveland Clinic’s most fragile babies in pediatric cardiology. The program sends families home with a scale to track weight and a pulse oximeter. Families input that data (and other information such as feedings) into the electronic medical record system. This allows cardiologists and nurses to see in real time what is happening with the child. The system also sends an alert to the healthcare team if any parameters are concerning.
The team recently received a grant to improve the program by adding Eko CORE 500™ Digital Stethoscopes. The brand-new stethoscope technology from Eko Health allows families and healthcare providers to collaborate virtually to listen for shunt murmurs.
“If you notice any change in a shunt murmur, you have to bring those patients in relatively quickly to get an echocardiogram or be admitted to the hospital. If any of those shunt murmurs happen to clot off or narrow in any way, those patients can get very, very sick and go downhill very rapidly, even leading to mortality,” she says. “So, adding a stethoscope to the program is essential. But families can’t just go home with a regular stethoscope because they’re not going to know what they’re actually listening to.”
With the Eko CORE 500™, families will have a virtual appointment with the care team. They’ll hold the stethoscope against the child’s chest and look at the stethoscope’s screen to ensure it is capturing the appropriate data. The stethoscope sends the data to the healthcare team through the recording feature on the Eko App. That allows the cardiologists and nurses to listen to recordings of the heart sounds and assess whether the baby is stable or needs to come to the hospital.
The Eko CORE 500™ helps make virtual health monitoring possible
Zalewski first learned about Eko Health’s stethoscopes at a medical conference, where she heard a physician presenting information about a similar home monitoring program in Florida.
“At that point, we were trying to use another digital stethoscope product, but it was not working really well with our patients and families,” she said. After the presentation, the physician encouraged Zalewski to reach out to Eko Health. The Cleveland Clinic team was quickly impressed and took steps to integrate the Eko Health technology into their home monitoring program.
“Positioning and hearing sounds on some of our kiddos can be challenging — some of them are super small, weighing as little as 6 pounds. But you can hear the quality of the shunt murmur very clearly with the CORE 500™,” she says. “We especially like the built-in screen. With other products, you have to look at the stethoscope and your phone at the same time to see if things are working correctly. The CORE 500™ has a built-in screen, and our families can just look right at that screen. It displays the heart rate and a signal indicator so that the family can tell, ‘OK, I’m listening to the right spot. I’m getting a good reading.’”
TrueSound™ technology overcomes challenges of hearing the infant heart
In addition to incorporating the Eko CORE 500™ into the program, Zalewski and other members of her team hope to purchase stethoscopes to use during in-person clinical evaluations of their pediatric cardiology patients.
As she was assessing the product for use in the home monitoring program, she was particularly interested in the stethoscope’s digital amplification and noise cancellation capabilities, which eliminate background noise and amplify heart sounds. Eko Health has created a new audio innovation called TrueSound™, which uses in-ear speakers to reduce artifact and clarify the most important body sounds.
“I’ve tried some other digital stethoscopes, and I could barely hear what I needed to hear. There was a lot of background noise, or I could hear the patient’s breathing and respirations, but not heart sounds,” she said. “It’s especially difficult to hear heart sounds in a baby because babies breathe faster, and their heart rates are typically faster. So, quality of sound is really important.”
The CORE 500™, when connected to the Eko App, also allows practitioners to save recordings of heart and lung sounds, providing a basis of comparison over time. Zalewski said this would be very useful in the patients she sees once every few weeks or months. She also finds particular value in the recording functionality for medical education.
“In cardiology, there are so many different murmurs, and learning them all can be challenging. This technology can help us educate students about what they’re listening for. Healthcare is rapidly changing right now, and with the shortage of healthcare providers, especially in nursing, we have to figure out ways to use digital health more and change our thinking around it.”