In this article, we speak to acute physician and lecturer, Chris Subbe, about the patient pathway efficiencies improved general ward monitoring can bring
A. That is a really interesting question. Pathways have usually got several elements: entry criteria, algorithms for the progress and exit criteria.
Monitoring technology could help to support all three of these elements.
Let's just take an example - patients who have pneumonia or another form of infection.
Patients who have got normal vital signs could be treated in an ambulatory care or outpatient setting. Patients with very-abnormal vital signs will need inpatient support. If trends are improving then decisions could be made to allow patients to leave hospital.
A. There are a lot of new technologies being tested at the moment.
Continuous respiratory rate sensors, such as the ones we are using with the Philips’ Guardian Solution, are probably the most-interesting modality.
If the will is there to improve the quality and safety of care, then technology becomes the tool to help deliver this
But even the existing fitness monitors hold a lot of information that is being used.
In anecdotal reports Fitbits have diagnosed atrial fibrillation and even ventricular tachycardias. This technology needs urgent integration with medical platforms because they allow us diagnose 'normality': they help us to understand what a patient normally looks like and how they behave, and from that we can see if normality is no longer present.
A. This is a difficult question and just yesterday I spoke to a colleague from a technology company about this very subject.
Trusts do obviously want reassurances that the new technology delivers: saves lives, reduces harm such as cardiac arrests, and probably reduces the risk of litigation.
Only very few technologies would be able to present data that would to show that.
That is even true for the blood pressure machine or thermometer. So technology is only worth deploying if the trust is willing to put into place the processes and governance to use the information that technology provides.
If the will is there to improve the quality and safety of care, then technology becomes the tool to help deliver this.
The key improvements will be in several areas: continuous monitoring, data integration, and patient-held records.
At this moment in time clinical records produce cognitive overload in their complexity. Technology will help to isolate the handful of key data items or trends that are needed to make good clinical decisions with patients
Continuous monitoring, such as the respiratory rate sensors that we are using with the Philips Guardian Solution, will give us richer data and the ability to look at trends.
If we think that illness tests the resilience of physiological reserve, then this is a key safety approach.
Data integration will help to understand the meaning of the thousands of items of data that we record already on every patient.
At this moment in time clinical records produce cognitive overload in their complexity. Technology will help to isolate the handful of key data items or trends that are needed to make good clinical decisions with patients.
The ability of patients to use the monitoring technology will potentially become the biggest driver for safer systems. It will change the dynamic of the relationship between carers and patients, I hope for the better.
Patients with good information tend to ask really important questions and this will make systems much safer. This is an important aspiration for some of the work we are doing locally at the moment.
A. Technology needs to be adapted to the need of organisation.
We have certainly been able to show that deployment of the Philips Guardian Solution helped us to support the sickest patients in our hospital and the clinical teams who are looking after them in a better way.
We have showed better outcomes on the wards, a doubling of survivors after unscheduled transfer to intensive care, and a drop of cardiac arrests by more than 80%. And this was in an environment where we had already implemented Early Warning Scores and dropped cardiac arrests and death from sepsis significantly before we added the technology.
Chris Subbe is an acute physician and lecturer at Bangor University. He published the first peer-reviewed paper on Early Warning Scores and his research since has focused on collaborative working to create pragmatic solutions for practicing clinicians. He is also co-founder of safer@home, the first international research collaboration in acute medicine and the Crisis Checklist Collaborative as an international patient safety group.