Abstract
Hospital wards can be hectic with a high turnover of unwell patients. They are regularly faced with inadequate numbers of healthcare staff with poor provider-to-patient ratios. Routine vital sign observations are often delayed or missed; this is repeatedly worse overnight and at the weekend. Measuring a patient’s vital signs is currently labour-intensive with chances of inaccuracies both for vital signs and early warning score calculations. 1 The wave of the latest technology and smart sensors can be utilised to improve care, transparency and efficiency for patients admitted to hospital.
The smart ward will be fully digital. Patients will be wearing wireless wearable sensors which continuously detect multiple vital signs. The latest sensors are lightweight, wireless, waterproof and have a long battery life of up to five days. They can be worn discretely by patients under their clothes with minimal disturbance. There have been several trials and clinical validation studies using continuous wireless monitoring. 2 Subtle changes in vital signs can be easily missed on busy hospital wards with outstretched resources. A measurement of a patient’s vital signs is often the first step in assessing for any acute deterioration in their clinical condition, 3 and the early identification of patients at risk of deterioration is associated with improved outcomes. Any changes in vital signs will be readily available and reviewed with centralised monitoring and real-time alerts sent to health professionals. Any forms of clinical deterioration will be easily identified with earlier escalation to the healthcare team. Ward staff will have more time to spend with patients and perform other tasks. A ‘Tilt towards tech’ releases more time to care. 4 In addition to vitals, the sensors will have in-built motion detectors which can track a patient’s level of activity and help identify any patients who may have fallen. Tools such as activity tracking and step counts can be routinely monitored by clinical teams as an adjunct to care and may predict functional recovery postoperatively. 5
One of the most common causes of patient deterioration is sepsis. Sepsis has a high morbidity and mortality; early detection is paramount. Smart sensing may be used to identify potential sepsis sooner. In addition, earlier identification through continuous monitoring of vital signs of other types of sensors may be used. Intelligent catheters with sensors which detect the changes of the electrolytes in the urine, for example, may be used to identify those at risk of developing an infection or sepsis. Any indwelling device should be able to signal and alert clinicians if there are any signs of infection. They should also be able to alert clinicians when they need replacing, thus reducing risks of further potential infection.
Smart wards will have voice-based interactive devices such as Amazon Echo with Alexa which can change room temperature, light settings, play music and call for nurses. This would benefit patients who have difficulty mobilising. Patients will have their own digital dashboard at the bedside where results and vital signs may be reviewed allowing greater empowerment for patients and family members. The dashboard will clearly highlight the team looking after the patient that day (both nursing and doctors). With ever-changing shift patterns, this may cause confusion and uncertainty for patients.
Transparency would be key and patients would have access to their management plans from the ward round. The approximate times for theatre and imaging would be given to clinical staff and nurses and updated in real time. Patients and staff will be able to anticipate and prepare accordingly if they know the porter is coming to receive them. Alerts can be sent when the porter leaves to pick up the patient. The booking systems for theatre and imaging will be digitally linked to both clinical and patient dashboard. This could help ensure efficiency and prevent long waits which happen and also prevent unnecessary delays for theatre or imaging. The patient hospital pathway could easily be mapped. This may be very reassuring for patients and help remove some uncertainty experienced with hospital inpatient admissions.
Patients’ notes shall be digital and easily accessed by the clinical team. The ‘I’ntelligent notes will be interactive with the ability to upload intraoperative photos and surgical videos directly from the time of the operation. Photographs of wounds needing review can be uploaded into the digital notes and reviewed routinely without the need for taking down numerous dressings. Operative videos from highly challenging aspects of an operation can be incorporated into digital notes and reviewed later by the surgical team. These may be used for teaching purposes. All prescription charts will be electronic enabling safer prescribing which prevent inaccurate drug dosages and allergic drugs being prescribed.
Artificial intelligence will be utilised to remove many of the labour-intensive administrative tasks freeing up more time for staff to spend with patients. In addition, machine learning will be applied to large datasets transforming the current emphasis on diagnosing and treatment to one of ‘predict and prevention’ and ultimately to artificial intelligence supported therapeutic decisions. 4 Machine learning may also improve diagnostic accuracy of imaging and pathology.
New healthcare technologies may be met with scepticism as many are unproven and costly. Further outcomes-based quality of life, patient-reported outcome measures and usability research is certainly required prior to their use in routine care. Members of staff should be reassured that this technology is merely an adjunct to care and should not reduce interactions with the healthcare team. For successful uptake of new technologies, usability and acceptability is required by healthcare staff. All staff using any new technologies should be provided with dedicated and appropriate educational programmes. The economic costings for the technologies as well as the potential benefits from potential cost savings need to be reviewed before widespread use. It is likely that as with other digital technologies they will be scalable. Data security is paramount and all processes to ensure this should be followed. While some patients may welcome the monitoring others may feel it to be too intrusive. The opinions of patients must be reviewed and those unwilling to be such closely monitored should have the opportunity to be excluded.
Sensors have been used in other industries such as sports, aerospace and defence. They are now at a stage where they can contribute to clinical efficiency and safety in healthcare and be used on smart wards. Key drivers augmenting widespread sensor growth has been through improvements in accuracy, reduced size and cost. The smart intelligent ward will utilise both sensor technology and other digital solutions. There is strong potential that this combination will ensure transparency, safety, good quality clinical care and patient experience.
Future health systems will adopt smarter wards to harness digital technology for safer and more streamlined care. It can allow healthcare professionals to spend greater time with patients enabling them to do their job safely and efficiently. The technology is arriving, the health needs are increasing so that the time to consider the implementation of this technology is now.