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Are quiet alarms, real-time advice and AI the future of intensive care?

As the world population ages and medical staffs shrink, the wise use of technology in intensive care will be critical. Getinge is driving the evolution of smarter, more holistic intensive care units (ICUs). How all of these highly complex systems work together requires re-thinking the way intensive care providers wield technology.

“The biggest challenge in the ICU today is the increased complexity of the patient demographics and the lack of resources to care for them,” says Jennie Haag, director of product management for ventilation for the Swedish medical equipment provider Getinge. “We are being born earlier and we live longer than ever before. This is, of course, wonderful, but it also comes with challenges.”

Haag points out a stubborn fact for intensive care providers. According to the World Health Organization, the population of people over the age of 65 will reach 800 million in five years. That’s about 10% of the world’s population. It’s also the case that patients over 65 account for more than 50% of admissions to ICUs.

Although we think of medicine today as quite advanced, providers of healthcare have had good reason to be cautious in embracing the digital revolution that's transforming the business world. It’s one thing to trust your credit card number to a platform that automates a payment process, and quite another to trust your life to a platform that automates vital sign monitoring. But the transformation is happening, and ICUs stand to benefit greatly as they face the dual challenge of increasingly older patient populations and increasingly smaller staff sizes.

It’s one thing to trust your credit card number to a platform that automates a payment process, and quite another to trust your life to a platform that automates vital sign monitoring. But the transformation is happening, and ICUs stand to benefit greatly as they face the dual challenge of increasingly older patient populations and increasingly smaller staff sizes.

Advanced monitoring techniques, for instance, provide doctors with more moment-by- moment information than they’ve ever had before. Instead of just heart rate and blood pressure, doctors today can assess blood chemistry, the volume of air moving through the lungs, tiny twitches in the diaphragm that signal the urge to breathe, brain activity and organ functionality, among many other things.

This higher level of information allows doctors to diagnose and treat patients with increased specificity. For decades, the advances of evidence-based medicine have allowed doctors to better understand how efficient and effective treatments are at the population level.  But as David A. Kaufman, MD, Pulmonary & Critical Care Medicine at NYU School of Medicine in New York, likes to say, “Ultimately, every patient is his [or her] own universe.”

“We're talking about information that helps doctors and nurses synthesize not just how one organ system is working, but how organ systems are working together,” Kaufman says. “I think advanced patient monitoring holds the potential to allow those of us who are providing bedside care to come up with a higher-level picture of what's going wrong with the patient and how different interventions are interacting. It really allows us to tailor-make a specific patient care and adapt our care in real-time.”

But advanced monitoring contributes to another issue intensive care professionals deal with every day, the information overload. Take all those sensors and monitors and multiply them by the number of patients in an ICU, and knowing what to pay attention to becomes very difficult.

“We deal with thousands and thousands of data points, and we like to think that we know which of those data points are important and which of them are unimportant,” Kaufman says. “But we gather so much information, it's very easy to get distracted. It's very easy to follow blind alleys.”

This, Kaufman says, is true of all monitoring, advanced or basic. Any piece of equipment, used indiscriminately, can create “noise” in the flow of information doctors are trying to assess. Which is why the qualitative improvements in monitoring are more valuable than quantitative one.

“When used judiciously, in the right situation, advanced patient monitors can help cut through that thicket of bad or questionable information that we often get in the ICU,” Kaufman says.

It’s not just clearer monitoring; context and communication are key. Getinge, for instance, is also designing smarter interfaces that allow doctors and nurses to quickly make sense of all the information being presented to them. That way medical professionals can spend less time responding to equipment and more time focusing on the needs of the patient.

There is a lot for caregivers to respond to. Today’s ICU is a forest of blinking and pinging and beeping monitors and alarms, which can be disorienting.

It's like a chorus of crickets in the forest in September. It almost becomes white noise. It's a constant background part of the environment in the ICU.

Noise levels and the number of alarms going off in intensive care units are often found to be beyond acceptable levels and well above international recommendations. The average daytime noise levels have been reported to be around 60-65 decibels with peak levels up to 80-90 decibels, levels similar to close proximity power tool use.

Research shows that intensive care units with lower noise levels could potentially lead to better outcomes for patients and improve the situation for relatives and caregivers. That’s why Getinge, along with partners from other industries, are working side by side with clinicians and researchers to make the vision of a quiet ICU a reality in the near future.

Incessant alarms affect both the patients trying to rest and the medical staff trying to care for them. “Alarm fatigue” at the end of a long shift may cause doctors and nurses to normalize alarms and to not react to them. Several equipment makers are turning to smarter alarms. Some trigger visually or with haptic signals similar to a vibrating phone. Other alarms are becoming remote, so that the alarm occurs at the nurse’s station or on a hand-held device beyond the patient’s hearing range.

The growing industry trend of remote control and display devices will bring further advantages. Remote data displays, for instance, allow highly trained consultants who may not even be in the same city or state to offer real-time input on a patient’s case. Controlling machines remotely allows doctors and nurses to reduce their exposure to highly infectious situations. In such cases, the more they can do from outside the room, the better.. Remote control also allows a doctor or nurse to respond to Patient A’s immediate needs even if they are standing bedside with Patient B.

All of these technologies can make the ICU quieter, but only if there is a high level of integration between devices. Few hospitals are interested in becoming locked into one equipment vendor— administrators want the future-proof freedom to adapt as new and improved technologies become available from myriad vendors. For ICUs, that means finding ways to make varied machines produced by different vendors talk to each other to contextualize data and streamline workflows.

That will be important in the future, because another ominous shift is occurring in the demographics of health care. Even as the needs of care become more complex, the number of nurses available to help provide it is shrinking. Researchers project that one million RNs will retire by 2030, even as the need for more help in the ICU grows. Some studies have shown that adding just one additional patient to an ICU nurse’s workload increases the likelihood of death among those patients by seven percent. [1]

In order for hospitals to treat more patients with fewer nurses, critical care providers are turning to intelligent technology to streamline workflows. Devices must be connected and communicating to make sense of all the different data streams generated by a sick patient. All critical and pertinent data should be easily read and quickly understood. Studies have shown that devices can reduce the cognitive workload of intensive care providers simply by displaying all the data on a single platform, preventing doctors and nurses from wasting time and attention looking around the room at different displays. [2]

“Clinicians are telling us they are seeing an increase in patients and less personnel to treat them. They have to do more with less,” says Getinge’s Jennie Haag. “We strive to help them improve their workflow and provide more useful information. Automating services really helps doctors focus on the patient, rather on the equipment that they're using.”

Digital information is also evolving to not just show doctors what’s happening, but to help them decide what should happen next. Artificial intelligence can help with alarm management, for example, by evaluating the state of the patient five, fifteen or sixty minutes before an alarm was triggered and “understanding” what the response to an alarm should be—more oxygen, less air medication, an increase of fluids. AI also provides the potential for decision support for doctors. By collecting all of the information generated from sensors on or in the patient, AI can create decision trees that make suggestions to doctors about what to do next.

“In the future, I believe that digitalization and especially artificial intelligence will play a big role in giving decision support in many clinical treatment situations”,” says Jens Viebke, president of Acute Care Therapies for Getinge. ”Clinicians will be helped by suggestions from artificial intelligence for how to treat a certain patient”

Data streaming from sensors monitoring ventilation status, heart rate and blood pressure, blood chemistry and many other signals can be synthesized and processed by a computer much faster than the human mind.

“We should be able to give real time analysis and advice on how to change a treatment course of that particular patient,” says Viebke. “I believe we at Getinge can really improve clinicians’ workload with more decision support tools and automatic functions to make the complex procedures easier.”

Individually, these details may be small contributions at first, but the ICU of the future will likely feature heavier demand as our population ages and caseloads overburden tight staffing resources. At the same time, our ability to gather information about critically ill patients will continue to expand. We will have to make sense of it all to keep our most critically ill patients alive

“I think we have only started the journey towards what digitalization really can offer to health care,” says Viebke.

NAVA. The ventilation technology for premature babies that is also groundbreaking for adult intensive care

Born 12 weeks too early with 50/50 chance at survival, Sabina Checketts grew up to become a neonatal doctor herself, using new therapies and sophisticated technology to improve outcomes for premature babies. One such technique, invented by Getinge, utilizes sensors to help babies on ventilators breathe more easily and naturally—and it's increasingly being used on adults. It's just one part of a quiet revolution in intensive care.

All references

  1. Aiken LH, Sloane DM, Bruyneel L, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014;383(9931):1824-1830. doi:10.1016/S0140-6736(13)62631-8

  2. Lin YL, Trbovich P, Kolodzey L, Nickel C, Guerguerian AM. Association of Data Integration Technologies With Intensive Care Clinician Performance: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(5):e194392. Published 2019 May 3. doi:10.1001/jamanetworkopen.2019.4392