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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 in ICUs.

Although we think of medicine today as quite advanced, in fact providers of healthcare have
been cautious to embrace the digital revolution transforming the business world, for a good
reason. 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 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.

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, which is similar to being close to power tools in 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 real in the 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. So equipment makers are turning to smarter alarms. Some
trigger visually or with haptic signals (like a vibrating phone). Other alarms are becoming
remote, so 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 several other
advantages. Remote data displays, for instance, allow highly trained consultants who may not
even be in the same city to have real-time input on a patient’s case. Controlling machines
remotely also allows doctors and nurses to reduce their exposure to highly infectious situations.
The more they can do from outside the room, the better in those cases. 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 freedom to adapt as new and improved technologies become
available from many vendors. For ICUs, that means finding ways to make all of those machines,
made 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: just as care grows 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. Other 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 technology to streamline workflows. Devices must be connected and communicating
to make sense of all the different data streams generated by a sick patient. That 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 one platform, so the
doctors and nurses don’t waste 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
instance, looking at 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.
Taking all 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 ventilators, 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 are small things, 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’ll
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.

Future ICU. (n.d.). Getinge. Retrieved August 28, 2021, from https://www.getinge.com/int/life-

defining-moments/future-icu/
Reflection:

As I read this article, I can really relate to the struggles of health care worker especially
on intensive care unit. The information overload that critical care providers face every day is
increased by improved monitoring. When you multiply all of those sensors and monitors by the
number of patients in an ICU, it's tough to know what to pay attention to. I was also quite
astonished by the fact that Getinge company come up with those devices and equipment to
provide an environment more therapeutic to both patient and health care workers. The
patients who are attempting to sleep as well as the medical professionals who are attempting
to care for them are both affected by the constant alarms. Doctors and nurses may have "alarm
fatigue" at the conclusion of a lengthy shift, causing them to normalize alarms and not react to
them. As a result, equipment manufacturers are developing smarter alarms. Some are activated
by visual or tactile inputs like a vibrating phone. Other alarms are becoming more remote, such
as those that sound at the nurse's station or on a hand-held device that is out of the patient's
hearing range. All of these technologies have the potential to make the ICU quieter, but only if
the gadgets are well-integrated. Few hospitals prefer to be tied to a single equipment vendor;
instead, administrators desire the flexibility to adapt when new and improved technology
become available from a variety of sources.