GE says monitoring technology and analytics will change healthcare

Patient safety and wellbeing is a core focus of the healthcare industry and providers – and an area in which GE Healthcare has a strong history as an innovative contributor.

From an economic standpoint, healthcare spending and reimbursement policies are struggling to offset the increased demand of quality healthcare; many institutions have begun to investigate new solutions for resource optimisation, while simultaneously seeking to provide better quality care that meets increasing levels of patient safety requirements. Rapid advancements in the world’s IT and wireless capabilities have made it possible to offer intelligent monitoring solutions that can support caregivers in their efforts to drive quality and efficient care in challenging environments. GE Healthcare believes combining miniaturised monitoring technology with powerful analytics will be the game-changer, and this is what the business hopes to achieve through its Digital Health programme.

Respiratory depression is detectable and, in many incidents, preventable through appropriate and continuous monitoring of a patient’s respiratory function

Extending the reach of monitoring

Each month, news reports around the world tell the story of patients who were seen and deemed stable by a nurse only to be found in a critical condition or dead a short time later. In the vast majority of these incidents, this is not a consequence of bad or neglectful care: it is, in fact, often caused by traditional care practices and workflows in the ward environment, whereby a nurse visits their patients every few hours to take their vital signs measurements on the spot. For the hours in between visits, patients aren’t usually connected to any technology that supports continuous collection of patient data and alerts staff to developing adverse trends or sudden events. Several institutions have already taken steps to mitigate these risks and, through dedicated research, have established the value of continuous monitoring in helping increase patient care.

One clinical challenge faced by healthcare providers as the number of people with chronic diseases and critical illnesses rises is that more and more patients will go through surgeries and, as a result, require pain relief medication afterwards. These opiates, either administered by the medical staff, or by the patient themselves using specially designed analgesia devices, can, in a handful of cases, affect a person’s respiratory function and possibly lead to respiratory depression (a serious and in some cases fatal side effect where breathing can cease entirely). However, respiratory depression is detectable and, in many incidences, preventable through appropriate and continuous monitoring of a patient’s respiratory function.

In light of this, GE Healthcare set to work to make available a surveillance monitoring solution that is capable of monitoring patients’ respiration and heart rates wirelessly. The wireless element of the technology is worn by the patient and transmits information to the equipment’s central monitoring hub; this allows hospital staff to set smart alarms and alerts to inform them of patient deterioration. The solution utilises existing Wi-Fi infrastructure in the hospital to enable straightforward installation and flow of information to the electronic medical record and alarm notification solutions. In addition to strengthening patient care, it is expected the introduction of continuous and wireless patient monitoring will help decrease patient re-admission to intensive care units (ICUs) from standard wards, and it may likely decrease the length of patient stays too¹.

The Goldilocks zone

While in ICU, a patient in a critical condition can be hooked up to as many as 15 different machines, including monitors, ventilators and infusion pumps. Powerful sedative drugs are routinely administered, potentially leading to respiratory depression.

To manage this risk, doctors aim to give as small a dose of sedatives as possible to make sure patients can tolerate their critical care treatment and mechanical ventilation. But no two patients are the same; figuring out the minimum dose each individual needs is both challenging and can significantly affect the patient. Both under-sedation and over-sedation carry serious risks: under-dose, and the patient could become agitated, show fear and anxiety, try to get out of the bed, pull out vital IV-lines and tubes, and cause harm to themselves; overdose, and the sedatives could suppress spontaneous breathing, delay ventilator weaning, and put the patient at risk of a ventilator-acquired infection. All this may cause a longer ICU stay and could increase the risk of death.

Effectively dosing patients with the right amount of sedatives – keeping them in a ‘Goldilocks zone’ of sedation – is an area of ICU care where clinicians could benefit from extra support for their decisions. A recent study conducted at the University of Edinburgh indicated there could be a technology that offers such support on the horizon. Itís called Responsiveness Index, developed through collaboration between GE Healthcare and the University of Edinburgh, and at present only used for research purposes. It continuously monitors the status of ICU patients based on facial electromyography activity. Facial electromyography measures muscle activity in the face by detecting and amplifying tiny electrical impulses generated by muscle contractions in the forehead. By measuring these electrical impulses through electrodes stuck to the forehead, Responsiveness Index assesses the frequency and intensity of a patient’s alertness during treatment.

Through two recent studies (IMPROVE and DESIST) it was suggested the combination of a comprehensive web-based education programme and responsiveness monitoring can improve sedation quality, and that Responsiveness Index monitoring can support nurse decision-making at the bedside. As a proof of concept, the technology is promising and worthy of further study to demonstrate statistical significance too. It’s about innovation to advance patient safety and drive quality care in the ever-changing, cost-constrained world of healthcare.

REFERENCES

¹ Brown, Harvey et al. “Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial”. The American Journal of Medicine 127.3 (2014): 226-232