Title: Early detection of postoperative patient deterioration through wearable wireless monitoring
Abstract:
Perioperative complications are unfortunately common following surgical procedures. Postoperative mortality is the third leading cause of death in the USA [1]. The International Surgical Outcomes Study (ISOS) found that 17% of patients undergoing inpatient surgery developed at least one complication [2]. This figure rose to 27% in patients undergoing major surgery. In addition, 2.8% of patients who developed a postoperative complication died before discharge from hospital. Monitoring patients beyond the operating room is important to allow early detection of clinical deterioration and timely intervention [3]. In high dependency wards such as ICU, patients are connected by wires to continuous vital sign monitors to track any changes in physiology that might suggest patient is deteriorating. However, on the general surgical wards, continuous monitoring is not practical due to the prohibitive cost and implications for patient mobility and recovery.
Patients admitted to general wards following surgery have their vital signs measured manually by nursing staff at a frequency determined by local protocols. In the UK, the National Institute for Health and Care Excellence (NICE) recommends monitoring of these vital signs at least every 12 hours for each patient, or more frequently when the patient is believed to be at increased risk of deterioration. However, there is a limit to the frequency with which manual observations can be taken practically and affordably by nursing staff, and so patients who deteriorate between manual observation rounds may be undetected for several hours, deteriorating to a point where the patient may need rapid escalation to higher acuity care.
SensiumVitals is an end to end system including a disposable, lightweight (15g), ultra-low power, wireless digital patch with a battery life of five days. It is designed to monitor general care patients’ vital signs at two-minute intervals to enable early detection of clinical deterioration. A recent pilot cluster randomized control trial (4) evaluated the use of a wearable wireless patch for patients admitted to two surgical wards. Although the wide confidence intervals (CI) suggest no statistically significant findings, the results were promising; patients in the continuous monitoring group were administered antibiotics sooner after evidence of sepsis, had a shorter average LoS, and were less likely to require readmission to hospital within 30 days of discharge (4).
This talk will outline the user requirements that influenced the design of the current Sensium patch and will highlight further areas for improvement that could potentially be resolved by innovations in large area electronics.
References
Bartels K, Karhausen J, Clambey E, Grenz A, Eltzschig H. Perioperative organ injury. Anesthesiology 2013;(119):474–89. PMID:24126264
The International Surgical Outcomes Study Group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle-, and high-income countries. Br J Anaesth 2016;117:601–9. PMID:27799174
Michard F, Gan T, Kehlet H. Digital innovations and emerging technologies for enhanced recovery programmes. Br J Anaesth 2017;119(1):31–39. PMID:27566472
Downey C, Randell R, Brown J, Jayne DG. Continuous Versus Intermittent Vital Signs Monitoring Using a Wearable, Wireless Patch in Patients Admitted to Surgical Wards: Pilot Cluster Randomized Controlled Trial. J Med Internet Res. 2018;20(12).
Biography:
Alison has over 30 years of experience in electronic engineering and semiconductor design, particularly in the field of ultra-low power wireless communication for medical applications. She is currently Chief Scientific Officer (CSO) at Sensium Healthcare, responsible for engineering and scientific programmes for the company’s digital health products.
Dr. Burdett is a Chartered Engineer, a Fellow of the Institute of Engineering and Technology (FIET) and a Senior Member of the IEEE. She was as a member of the Technical Programme Committee for the IEEE International Solid-State Circuits Conference (ISSCC) from 2009 – 2018, serving as European Regional Chair 2012 – 2014 and Technical Program Chair for ISSCC 2018. She has been an Associate Editor of IEEE Transactions on Biomedical Circuits and Systems (TBioCAS) since 2008 and is Associate Editor in Chief of the IEEE Open Access Journal of Circuits and Systems (OJ-CAS).
Alison is a member of the UK Engineering and Physical Sciences Research Council (EPSRC) Strategic Advisory Network, a member of the Wellcome Trust’s Programme Advisory Group and a Visiting Researcher at the Institute of Biomedical Engineering, Imperial College. She has 75+ peer-reviewed publications and is a named inventor on 15+ patents.