Wearables: simply gadgets or really useful tools for providing health care?

13 January 2016

We use them to count how many steps we take in a day, keep track of our heart rate when we jog and see how well we sleep every night. In recent years, wearables have gained a place in our daily lives. Should professional health care providers be advising their patients to use these consumer electronics with origins in the gadget industry? And if so, how could patients benefit? This blog tells you more about exactly what I’m doing in my doctoral research.

Each of these patients is one too many!

‘The operation was successful but the patient died’. It’s sad but true: patients often successfully undergo an operation but a few days later deteriorate undetected or even die in the hospital or at home after discharge. One patient, for example, develops sepsis (blood poisoning) during the weekend following gastrointestinal surgery. Another is readmitted two days after discharge following major abdominal surgery and then dies of a hemorrhage.

Each of these patients is one too many! We’d much rather anticipate these problems earlier or, even better, prevent them!

Wouldn’t it be great if we could use wearables to do this? This is exactly what my doctoral research is all about: ‘A Safe Path from ICU to Home’.

So what prompted my doctoral research? Actually, two things: 1) these revolutionary developments in wearable and wireless technologies and 2) the possibilities this creates to improve the remote monitoring of patients in order to prevent any or further deterioration.

The deterioration of patients not always identified in time

‘Certain complications could easily be prevented or would result in less harm to the patient if they could be identified and treated sooner' Hospital patients run the risk of developing complications. But certain complications could easily be prevented or would result in less harm to the patient if they could be identified and treated sooner.

A complication is often preceded by a change in a patient’s vital signs. And these can be measured. The problem, however, is that this deterioration is not always identified. The main reasons for this are the frequency of taking these measurements and the number of nurses available to take them. This requires an additional explanation. 

Here is the path from intensive care to home as it stands now:
•    ICU In the Intensive Care Unit, each patient has a dedicated nurse and a monitor next to the bed that continuously takes the patient’s vital signs. 
•    Nursing ward On the nursing ward, however, vital signs are taken by the nurses themselves each time they make their rounds. This is usually only once during their 8-hour shift. Although the nursing staff does their best to keep an eye on their patients between rounds, there are also fewer nursing staff available than in the ICU. Having only two nurses to care for 12 patients during the night shift is not at all unusual. Having to attend to one confused patient can quickly lead to losing track of all the others!
•    Home Once at home after discharge, patients are no longer being monitored at all. Having left the hospital, monitoring simply stops.

As you can see, the risks for undetected deterioration only become greater along ‘The Path from Intensive Care to Home’!

So how can wearables help?

We can introduce the use of wearables – like an adhesive patch that measures heart rate and respiration, or a simple oxygen saturation meter or activity tracker– on this path to keep a more continuous eye on patients even after discharge. It’s not so much an acute change that makes it possible to actually identify and treat deterioration faster, but the trend in measurements taken over several hours or days.

‘This is why I’m convinced there will come a time when we won’t be afraid of discharging patients earlier than we do now' This is why I’m convinced there will come a time – once we’re using remote monitoring technologies – when we won’t be afraid of discharging patients earlier than we do now. Recovering in one’s own surroundings is not only more pleasant for a patient but even leads to a faster and better recovery.

Implementing remote monitoring: not as easy as it might look

Needless to say, the data measured by wearables has to be reliable. But verifying the clinical value of this data is just the beginning. The recording of individual readings doesn’t say much about the patient’s condition right away. It’s only meaningful when you look at all that data for more than one vital sign. A device also has to be designed with a smart algorithm that won’t generate an alarm unless something is really going on.

So the next step is to implement an entire system that does all this, and that means answering several questions. How can you make the data available and manageable for nurses and specialists? How do you minimize the generation of false alarms? 

The system won’t be effective if its alarm goes off when it records the high heart rate and increased respiration of a discharged patient if it turns out later that she was ‘just’ vacuuming the carpet. (Yet this information could also be useful: it might mean that the patient is feeling fine.)

Having patients take their own readings at home 

And this is something patients can easily indicate themselves. But information should really be coming from two sources. Information from a patient (‘I’ve felt out of breath for the last couple of hours’) is at least as important! ‘Information from a patient (“I’ve feel out of breath for the last couple of hours”) is at least as important!’

Moreover, patients themselves (or their caregiver) can take measurements like blood oxygen saturation or blood pressure. Besides the advantage of identifying a possible deterioration, remote monitoring can also give patients the feeling of being more involved in their treatment and more reassured because their condition is being monitored.

All in all, these new innovations hint of wonderful possibilities in the future! There’s so much we still have to discover and achieve. As I see it: ‘It’s not a project, but a journey…’

P.S. Coming soon: the first findings from the field!

As a Product Researcher at FocusCura, I am operating in the world of advanced home care technology and, at the same time, I’m working among the patients and physicians at the University Medical Center Utrecht on my research as a PhD candidate. This blog provides updates about my doctoral research, ‘A Safe Path from ICU to Home’ and the developments involved in research into cVitals