The Hospital: Big Bed Is Watching You

20. August 2015

In the hospital, life-threatening incidents can play themselves out beyond the walls of the ICU as well if a patient's condition deteriorates unexpectedly. New technology promises to create a bridge between and provide safeguards during the time between nurses' checks.

A few weeks ago Google announced that it was developing a new health tracker. It’s not so much that enough apps for measuring the actual state of bodily functions don’t already exist: Google is especially targeting medical clinics and hospitals through much more reliable and accurate measuring. Data on heart rhythm, pulse and body temperature should bring attention to potential problems at an early stage. Initial tests in clinical settings are planned for the coming months.

Post-surgical decompensation due to incorrect sedation

Whereas in the Intensive care unit a sophisticated sensor-arsenal registers the seriously ill patient’s every state change, and raises an alarm in case of deviations, in other stations this is not so. There it is rather a matter of how well caregivers assess those under their care, especially during the initial period after surgery, and how well they watch them. This is especially so when such patients are sedated using opioid analgesics and sedatives; respiratory depression is not an infrequent occurrence. A look at events in America reveals that this affects one in 200 recently operated patients. Oversedation or a delayed response to an analgesics intolerance can then lead to decompensation. The first signs develop after about six hours and are often accompanied by a significant deterioration in physical condition; this deterioration can be life-threatening without intervention.

In order to bridge the long periods between manual checks, in particular those involving at-risk patients, medical technicians have come up with new things. There are devices for instance that measure the vital signs wirelessly and in the instance of critical levels being detected these devices send an alarm signal to the nursing staff, doctors and a data centre. There is a lot happening here though in the area of software as well. Thus complex algorithms calculate the current state of health and the state anticipated to exist over the subsequent few hours by using the available data from the last checks and the existing laboratory parameters.

Less heart alarm thanks to mattress sensor

One Israeli manufacturer therefore offers sensors that lie beneath the mattress yet are still sensitive enough to record breathing and heart rate and to also register the patient’s movements. In the instance of breathing and pulse changes the system can alert nurses via mobile phone, for example via a message. And the motion sensor in the device also sends an alarm if, for example, confused patients get out of bed. Through the registration of movements in the bed, the sensor also helps in the prevention of bedsores.

Some clinics in the US [Paywall], and in Europe as well, have already been using this expansion to the system for some time. A retrospective study [Paywall] of two clinics in Los Angeles and Boston involving more than 7,600 patients (2,300 in the intervention, 5,300 in the control arm) in a surgical ward showed a shorter length of stay in the surgical station and fewer days spent in the ICU for electronically monitored patients, even though the “transfer rate” to the ICU did not change significantly. However, a significant decrease occurred in the number of “Code Blue events” – the number of heart alarms – going from six down to some figure between one and two per 1,000 patients.

Low false alarm rate prevents desensitisation

If one believes the numbers from American clinics, over the course of ten hours of monitoring in telemetry or oximetry 15 to 20 alarms occur. Most of these are simply false alarms which cause the nurses unnecessary stress. With the wireless sensors the respective number is specified by the manufacturer to be around 0.3. This means that nurses and doctors do not become effectively “desensitised”, yet at the same time the device does not replace personal care of the patient.

Following trials in the United States, European clinics are now also testing out “ICU light”. Alongside Antwerp and Rotterdam there are sensors in 28 beds in the inner station at the University Hospital Saarbrücken (Germany). Although the costs are relatively high at around 5,000 Euro per bed, the device is supposed to pay for itself in less than one year. Sepsis for instance was revealed on the basis of changes in heart and respiratory rates earlier than with the usual criteria, as Daniel Grandt from the Klinikum Saarbrücken explains in a television interview.

Algorithm for high-risk patients

The sensor under the mattress is however not the only way to keep the patient in view between visits without having to lay him or her down in the ICU. New programs without innovative software are appearing, such as the “VitalPac” system already found throughout the UK. This system compiles the currently existent measurements within electronic medical records indicating “risk levels”, recommends more frequent checks to the nursing staff and also sends alerts to emergency service in the instance of an acute threat. According to an initial study after the introduction of the system, which can run as a mobile app on smartphones or tablets, mortality dropped significantly.

One algorithm which is especially popular in US hospitals works similarly and ensures a more rapid and current overall clinical picture of the patient. Taking in as many as 26 parameters in the patient’s file, the program calculates an index number between one and a hundred in real-time. Appropriate alarm levels then ensure increased attention and intervention from specialists. About 70 hospitals now use this “Rothman Index”, so named in acknowledgement of its developer. For a 300-bed hospital this comes at a cost of US $150,000. The advantage of the software according to the experience of its users thus far lies in its capability to make measurement comparisons using measurements made in the past and can thus also uncover unnoticed changes in the patient’s condition, while also using the data to make comparison to other patients with similar states of disease.

Tedious control of vital functions

All the devices and programs have the goal not of just making further cost savings in the care sector, according to the statements of developers and clinic managers, but rather are designed to support the work of those in the care sector through technical support. One study from Singapore [Paywall] shows that misjudgements frequently occur at stations where there are just a few highly qualified and experienced nurses. With 614 nurses in general wards almost 50 percent mistakenly believed changes in blood pressure to be the first indicator of deterioration. Only a slightly smaller number regarded the respiratory rate to be the most unimportant indicator. More than a quarter of all nurses therefore checked the respiratory rate only superficially. Between 20 and 35 percent of nursing staff regarded the monitoring of vital signs to be generally time-consuming and stressful.

Programs and sensor data could be potentially integrated. They can facilitate work for nursing staff. Recent studies show that this works in principle. Proof-of-principle has already been demonstrated several times. Data protection dealing with the enormous body of additional sensitive patient data remains an open issue.

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