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A Wearable, Wireless Early Warning System for Enhanced Patient Outcomes Dr Alison Burdett
CTO, Toumaz Group
September 2015
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• Patient Vital Signs Monitoring – the Healthcare Need
• SensiumVitals – a Wearable Wireless Early Warning System
• NHS Deployment – Challenges and Opportunities
- Building the Business Case
- Digital Interoperability
Outline
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Intermittent/Manual Systems
Clinical Patient Monitoring Today
• Vital signs taken during routine observation rounds every 6-8 hours
• Method deployed for the majority of hospital patients in general care
Continuous/Automated Systems
• Patient tethered to the bed/monitor
• Reserved for high-dependency/critical care patients (<10% of population)
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The Healthcare Need
• NICE guidelines for acute patient care (CG50 2007) identified that patients
becoming unwell often receive suboptimal care, primarily due to a delayed
recognition of deterioration and failure to trigger a response from the medical
team.
• The guidance recommended the introduction of a “track and trigger” system for the
frequent monitoring of vital signs
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Sepsis
For every hour’s delay in the treatment of Sepsis, the
patients risk of death increases by 7.6%
Its estimated that 33% of bed days are taken up by
patients with Sepsis in the UK
The average cost of treating a patient with Sepsis is
£10,000
The Deteriorating Patient
11% of patient deaths reported to the NRLS were as a result of deterioration not detected or acted upon
Action taken in the early stages can
prevent deterioration progressing to cardiac arrest
60% of deaths, cardiac arrests and unplanned ICU admissions were preceded
by abnormal physiology
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• Wearable, wireless monitoring as an adjunct to standard NEWS monitoring, will allow earlier detection of deranged physiology in specific patient groups.
• Benefits:
- Less invasive treatment
- Reduced length of stay
- Reduced level II/III care
- Improved patient outcomes
- Reduced treatment costs
• Patient groups most at risk of deterioration
- Post-surgical (colorectal, GI, orthopaedic….)
- HDU step-down
- Neutopenic (chemotherapy, burns)
- Elderly (increased co-morbidities, often non-verbal)
The Benefits of Early Detection
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• Patient Monitoring – the Healthcare Need
• SensiumVitals – a Wearable Wireless Early Warning System
• NHS Deployment – Challenges and Opportunities
- Building the Business Case
- Digital Interoperability
Outline
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SensiumVitals® Monitoring Technology
• Wearable, wireless, continuous monitoring for general ward patients
-‐ heart rate, respiratory rate, axillary temperature
-‐ patient worn monitoring patch
-‐ low cost, single patient use to avoid cross infection risk
-‐ FDA cleared & CE Marked
• Ultra low power device, near real-time vitals every 2 minutes, 5 day battery life
• Lightest, most unobtrusive patient monitor on market
• Clinical evidence for efficacy and cost effectiveness (US study)
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The SensiumVitals® System
EMR
SensiumVitals Patch
SensiumVitals Bridge
Virtual Server Controls bridges Tracks patches
No patient names
Virtual Server Links patient ID to patch
Notifications via email / SMS User interface (using https)
Connects to ADT & EMR
System
Wireless Monitoring Application
Screen
Notifications sent to
handheld devices
Wi-Fi (802.11) or
Ethernet (802.3)
Proprietary 868/915 MHz
HL7 Messaging
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Patient Summary Screen
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Patient Trend Screen
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• Notification generated on sustained period
of deranged vital signs (configurable, but
typically 10 minutes)
• Notification limits can be set on a per ward
or per patient basis
• Default values are aligned with NEWS
limits
• Email notification can be forwarded to
phone, pager, tablet etc. as appropriate for
given clinical setting
Mobile Notifications – Taking Data to the Nurse
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SensiumVitals® – Key Messages
Optimised patient care
• Allows nurses to prioritise patient care
• Provides reassurance to the clinical team and patients
Increased patient mobility
• Patient mobility is key to faster recovery times
• Unique roaming capabilities allow monitoring and mobility
Patient data when and where it is
needed
• Accurate and reliable data every 2 minutes
• Easy integration with hospital information systems saves time and ensures accuracy
Early detection of patient deterioration
• Proactive notification of change in patient status brings the nurse to the deteriorating patient prompting early clinical intervention
• Improves patient outcomes, shortens hospital stay, lowers treatment costs
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• Patient Monitoring – the Healthcare Need
• SensiumVitals – a Wearable Wireless Early Warning System
• NHS Deployment – Challenges and Opportunities
- Building the Business Case
- Digital Interoperability
Outline
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NHS Procurement & Deployment is Complex!
Lead Clinicians Senior Nursing Teams
CFO, CTO, CEO Nurses
Outreach teams Clinical Informatics
Innovation Biomeds
Patient safety teams Hospital IT
Programme Managers Purchasing
Charitable Fund Holders Patients
External Parallel Stakeholders
Pager Companies
Phone Suppliers
IT Services
Government Legislators
Enablers of Automation
Non Local Decision Makers
Innovation Organisations
GPOs
External Fund
Holders
Medical Societies
KOL’s
Patient Organisations
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Clinical Benefits and Cost Savings Must be Demonstrated
Installation time & cost
Ongoing purchase price
Nurse training
Workflow changes
=
*US trial indicated average LOS reduction ~4 days, costs savings $5.5K, for deteriorated patients
Better patient outcomes
Reduced costs through:
• Lower LOS
• Fewer HDU readmits
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Health Economics Trial Data Comparative Data Trial Data
Notifications Received and Resultant Intervention
Deteriorations and interventions in the pre-trial period (typ. 30 days)
Notification reason; notification time; time until next manual obs; intervention given
Length of Stay Average LOS for the patched ward LOS for each patient (on ward & in hospital)
HDU Referrals Number of referrals to HDU in the pre-trial period
HDU referrals from the ward during trial period
Number of Patients put on the Sepsis Pathway
Number of patient put on the sepsis pathway in the pre-trial period
Patients on the sepsis pathway during trial period
Patient Satisfaction Current level of complaints made to PALS about this ward in the pre-trial period
Level of complaints to PALS during trial period; direct patient feedback
Nurse Feedback & Compliance Nurse feedback; # of patched
patients meeting trial criterial
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• Patient Monitoring – the Healthcare Need
• SensiumVitals – a Wearable Wireless Early Warning System
• NHS Deployment – Challenges and Opportunities
- Building the Business Case
- Digital Interoperability
Outline
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Digital Interoperability – Challenges
EPR
PACS
e-Prescribing
e-Obs
SensiumVitals
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• Hospital benefits:
- Single login for users
- Single ‘point of care’ mobile device
- Notification and audit trail incorporated into existing, familiar systems
- Hospital can select ‘best of breed’ for e-Obs, EPR, e-Alerts etc.
• SHC benefits:
- Company can focus efforts on key USP (wearable, wireless, disposable vitals signs monitoring)
- Simpler deployment, as partner manages ADT feed, Active Directory interface, etc.
- Interoperability partners have pre-installed customer base
Digital Interoperability – Opportunities
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– a Secure, Audited Messaging Platform
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Data Available Remotely through Secure Mobile Platform
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Future Interoperability Partnerships
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Interoperability with the Patient?