Balancing high-tech with humanity – digitization in the Intensive Care Unit

No other hospital area features as much high-tech equipment as the intensive care unit. Each acute care hospital bed has four to ten devices that continuously monitor all patient vital signs and can replace nearly any organ. This creates big data that is often not used effectively. Yet it also holds promise and huge potential.

Germany's intensive care units provide critical care to over two million people each year. Patients are usually admitted to the intensive care unit if their disease or condition requires intensive monitoring or critical care, such as mechanical ventilation. The most common reason for being admitted to an ICU is an acute heart attack. This is followed by blood infections and severe injuries following an accident. Patient monitors measure vital signs including heart rate, pulse rate, and blood pressure, which are usually sent to a central monitoring station for observation and analysis purposes. The medical devices sound the alarm if they detect abnormal activities. This allows critical care physicians to quickly assess the situation and start prompt intervention in critical events.

Given its high-tech and sophisticated environment, the intensive care unit provides the ideal setting for the digitization of processes. For example, so-called patient data management systems can automate document-related healthcare processes and digitize patient data to facilitate broader access. This can save the medical staff a tremendous amount of valuable time, which ultimately benefits the patient. "I believe that digitalization in the intensive care unit can improve conditions for humanity because it can help eliminate some fatiguing tasks for nurses and doctors," attests Professor Emanuela Keller from the Neurocritical Care Unit at the University Hospital in Zurich, Switzerland. "This allows us to focus more on the individual patients, freeing up time to engage with them and their family members."

Keller and her team are committed to using big data that is generated daily in the ICU more effectively. The team of researchers aims to use artificial intelligence to analyze the data and develop early warning systems. "We can improve patient safety by automatically identifying and eliminating artifacts – inaccurate measurements – in the biosignals. The early detection of risk constellations and critical complications also supports an earlier therapeutic intervention, which can improve patient care in the future," explains Keller.

Another example of digitization in the intensive care unit is telemedicine. IntelliSpace Consultative Critical Care by Philips is a solution that monitors intensive care patients remotely using telemedicine. The information system transmits all relevant patient data from the hospital to a centralized tele-ICU center. This allows intensive care physicians and other specialists to continuously monitor the patients in multiple, geographically distributed ICUs, supporting local medical staff. While the patients remain in familiar surroundings, they benefit from the care provided by an interdisciplinary team of experts. Studies have shown that patients who receive telemedicine care exhibit lower mortality rates and the average length of ICU stay is shorter.

Professor Keller also confirms the great potential of telemedicine in critical care: "Digital technologies such as telemedicine also make it possible to transfer patients out of the ICU into general wards much sooner. Another benefit is that critical care patients could also be monitored remotely."

That being said, many clinical facilities still don't have the necessary information and communication structures. It only adds to the burden of medical personnel, which is already challenged by staff shortages. This pertains to cumbersome activities such as medical record documentation, data analysis, and the more than 10,000 steps the average nurse walks per shift every day. One reason for this is the multitude of alarms triggered by the patient's call button alert or sounded by the various medical devices. Quite often, this alerts multiple nurses at the same time, who then must decide who responds. That's why the St. Martinus Hospital in Olpe, Germany, has introduced the Ascom Myco 2 smartphone that's purpose built for healthcare. It is linked to the nurse call system, displays color-coded alerts on the touchscreen, and shows all mobile staff the status of the response. The Myco2 sends alerts directly to the responsible doctors and nurses – an important step towards creating a quiet intensive care unit as the constant alarms lead to dangerous alarm fatigue issues in staff, and are also a source of stress for patients.

Sleep and rest, especially at night, are vital for the recovery of critical care patients. "A continuous night's uninterrupted sleep is the prerequisite for delirium prevention. It is such an important aspect because people who develop delirium have a much higher 1-year mortality rate. Each day an ICU patient spends in delirium is associated with a 10 percent increased risk of death," explains Dr. Marc Achilles in an interview with MEDICA-tradefair.com. He is the Head of the Department of Anesthesiology and Intensive Care Medicine at the Marien Hospital in Wesel, Germany, which has equipped seven ICU beds with the VitalSky light therapy system by Philips. "The patient lies under an artificial sky that measures 4 meters in length and 2 meters in width. The ceiling installation has 13,000 LEDs. During the 24-hour cycle, the artificial light mimics the sunlight outside," Achilles explains how the system works. The light is lowered at night, allowing just enough low light intensity in the room for physicians and nurses to monitor the patient. Alarms are directed away from the patient. Both aspects safeguard undisturbed sleep through the night, prevent ICU delirium, and improve the intensive care experience.

However, the use of new technologies is only successful "if everyone – chief physician, senior physician, chief nursing officer, and intensive care staff – embraces this paradigm shift,” underscores Dr. Achilles.

Digital technologies can make a big and vital contribution to the future of intensive care unit design. They can reduce the burden on physicians and nursing staff and eliminate repetitive and cumbersome tasks. They also make it possible to consult experts, facilitate remote patient monitoring and treatment, and support intelligent alarm management. All of this can help reduce anxiety and stress on the part of medical staff and patients. "They can help improve patient safety and the quality of care. Ultimately, this reduces cost and saves money," adds Professor Keller.