Outcomes and Response Times for Patients in Critical Care Settings

Abstract

Hospitals are stressful environments where injured and diseased persons receive healing or palliative care. Machine devices are used to monitor individual's health status and often deliver treatment. Treatment may be delivered with a goal of allowing the individual to live a relatively normal life outside the hospital, but treatments may be delivered with a goal of increasing an individual's comfort including reduction of hospital induced stress. Hospitals generally have specialized units, e.g., trauma, maternity, neonatal, pediatric, intensive car, surgery, medical, rehabilitation, neurologic, oncologic, etc. Many units may be sub-specialized, e.g., pediatric oncology, gynecologic surgery, orthopedic surgery, etc. Many units will have associated intensive care units where the more seriously ill individuals receive specialized care including intensive monitoring and varying degrees of pharmacologic and/or mechanical life or organ support.

Claims

1. A communications system comprising: i) a central processor; ii) at least one patient station unit; said patient station unit comprising: a support for a patient; a border surrounding said patient support; at least one sensor capable of monitoring a characteristic of a patient; an identification account identifying said patient station to said central processor; a receiver capable of receiving signal from said central processor; a sender capable of sending signal to said central processor; and iii) a receiver unit configured for a responder; said receiver unit comprising: an identifier identifying said responder to said central processing unit; said receiver unit programmable to correspond to at least one said patient station unit said central processor comprising: a receiver portion configured to receive input of signal from at least one said patient station unit; a processing portion configured to process input from said at least one patient station station unit; said processing portion configured to process input from said at least one patient station station unit capable of accessing data to correlate said at least one patient station unit with a list matching at least one said responder to said at least one patient station unit; a transmitter unit; said processing portion configured to instruct said transmitter unit to transmit a call signal to said at least one responder, said call signal identifying to said at least one responder the patient station matched to said at least one responder.

2. The communication system of claim 1 further comprising a transmitter unit configured to identify said responder to said central processor and configured to transmit to said central processor arrival at a patient station unit.

3. The communication system of claim 2 wherein said transmission to said central processor is interfaced through said patient station unit.

4. The communication system of claim 1 wherein said call signal produces an audible sound.

5. The communication system of claim 1 wherein said call signal produces a visible light.

6. The communication system of claim 1 further comprising a tally board whereupon active station units are displayed and identified with corresponding station identifiers.

7. The communication system of claim 6 wherein said station identifiers are associated with a status indicator.

8. The communication system of claim 7 wherein said status indicator indicates one or more unanswered call signals.

9. The communication system of claim 7 wherein said status indicator indicates that no action is desired in the absence of at least one unanswered call signal.

10. The communication system of claim 5 wherein said visible light is visible at or above said patient station unit associated with said call signal.

11. The communication system of claim 6 wherein said status indicator comprises at least one light.

12. The communication system of claim 11 wherein said at least one light indicates one or more unanswered call signal.

13. The communication system of claim 11 wherein said at least one light indicates that no action is desired in the absence of at least one unanswered call signal.

14. The communication system of claim 2 further comprising a position location device associated with a staff, said position location device associating the staff location with the patient station unit and is programmable to notify the central processor that the staff has arrived at said patient station unit.

15. The communication system of claim 1 wherein said sensor is capable of monitoring presence of a patient.

16. The communication system of claim 1 wherein said sensor is capable of monitoring at least one characteristic selected from the group consisting of: heart rate, blood oxygenation, EKG, EEG, temperature, torso volume, breathing rate, perspiration, urine output, catheter flow, salinity, food delivery, PICC flow, patient mass, patient movement, volatile organic compounds (VOCs) emitted from the patient, and emitted sound.

17. The communication system of claim 1 wherein said at least one responder is selected from the group consisting of: nurse, charge nurse, technician, aide, fellow, resident, and therapist.

18. Use of the communication system of claim 1 wherein a patient in at least patient station exhibits less stress than said patient wherein said communication system of claim 1 is not in active use.

19. Use of the communication system of claim 1 wherein a responder assigned to at least patient station exhibits less stress than said responder wherein said communication system of claim 1 is not in active use.

20. The communication system of claim 1 further comprising sensors for volatile organic compounds in communication with said central processor.

21. The communication system of claim 20 further comprising a database of available aromas available for aromatherapy to said patient and an output from said central processor identifying at least one aroma suggested as beneficial to said patient.

22. The communication system of claim 1 wherein said sensors for volatile organic compounds in communication with said central processor apply an algorithm to data from said sensors to indicate a stress level in said patient.

23. The communication system of claim 1 wherein said central processor is configured to process information selected from the group consisting of: staff on duty, identity of staff assigned to each patient, identity of staff responsible for each device, output from a sensing device, schedule of staff assignments, schedule of procedures in the account of each patient, schedule of checks for each patient, an acceptable range of result of a parameter monitored, an acceptable output range for each device, list of contact staff for an out of range test results by patient and/or by device, an alarm or contact feature that alerts the identified assigned staff when one of said schedules indicates a task or response is due, and an app that contacts or alarms identified responsible staff according to information in a schedule, an out of range result, or a device malfunction.

24. The communication system of claim 23 wherein said central processor is equipped with an artificial intelligence function that analyzes the data from each patient, compares said data to historical data from said each patient, ranks responses according to beneficial outcome, and provides a responding staff with recommendation(s) relating to earlier response(s).

25. The communication system of claim 24, wherein said ranking responses according to beneficial outcomes includes information from hospital guidelines, treatment protocols, medical journals, or manuals to provide a responder with a step-by-step checklist.

26. The communication system of claim 23 wherein said central processor is equipped with an artificial intelligence function that analyzes the data from a patient, compares said data from said patient with additional information in hospital guidelines, treatment protocols, medical journals, or manuals to provide a responder with at least one recommendation relating to said patient data and said additional information.

27. The communication system of claim 1 wherein said central processor comprises an interface that communicates with a network of remote servers that operates as a single ecosystem.

28. A patient care unit comprising the communication system of claim 1.

Description

EXAMPLES

Example 1

[0037] A NICU has 24 stations or beds for infant patients. The patients range in size and gestational age. But all patients present with at least one issue mandating intensive care scrutiny. The following roster of patients is merely exemplary and is not intended to be complete or exclusive. The purpose is to illustrate, by example, a complex thematic of interplays that may be required in maintaining needed therapeutics in the NICU. Other Intensive care units will have different, but many similar complexities. Three stations are vacant.

[0038] Fourteen patients require incubation with included diagnostic monitors. Two incubators are applying therapeutic hypothermia. Remaining stations whether fully configured as incubators or more open to the environment include temperature controls. Six of these patients have breathing managed using mechanical ventilation. All stations have an oxygen hood. The hood may or may not augment oxygen concentrations, but is often used to control humidity even when no oxygen is added. CPAPs are available for use at any station. The additional pressure is controlled to assist surfactants in keeping alveoli inflated. CPAPs may be used for delivering enhanced oxygen concentrations. Most patients will require timed procedures, e.g., glucose monitoring every one, two, four or six hours; electrolytes once or twice daily; diaper change set by infant size and rate of iv solution delivery; etc. All patients have PICCs inserted into a (usually leg) vein which requires periodic checking. One patient is awaiting results from a genetic test to assess a possibility of an SLC2A1 mutation

[0039] The following assignments are arbitrary and indicate merely to illustrate that many team configurations, including overlapping configurations may be assigned. Often one or two supervising neonatolgists will be present in or available to the unit. In teaching hospitals at least one neonatal fellow is directly caring for a patient. One or more pediatric residents will be on rotational assignment in the unit. Several nurses and aides will be predominant care givers. A respiratory therapist will direct or assist a technician or aide in configuring, adjusting and maintaining breathing assistance devices and oxygen delivery levels. Additional therapists may include speech, occupational or speech therapists who may have assigned hours of activities (sometimes assigned specific hours to control crowding within the unit). A dietitian will monitor a patient's nutritional needs and nutrition and often will have scheduled consultations with a speech therapist working with individual patients for suckling and other mouth behaviors. The dietitian, and speech therapist may work with a mother and lactation consultant regarding maternal milk supply (pumping and/or nursing). Not all these activities and interactions will require presence in the NICU. A dietitian will analyze blood and other data from a patient and will not need to be in the unit for these types of activities. Likewise a pharmacist and discharge coordinator may serve the patient or patient's parents or guardian from a remote location.

[0040] Patient A is housed in an incubator providing therapeutic hypothermia (controlled cooling and sedatives to maintain body temperature between 33°-34° C.). This patient has scheduled: glucose every 2 hours; arterial gases with lactate every 6 hours; electrolyte panel, CBC, platelets, PT, INR, fibrinogen, PTT, D-dimer every 12 hours; and hepatic function every 24 hours. An audible message to the “responsible nurse” says: “Karoline at station 3 is ready for her [test].” The “responsible nurse” may be specifically assigned to this patient or may be a nurse deemed most available when the system is using Artificial Intelligence. The nurse may respond or signal the system to request a back-up nurse. This request is repeated, for example, every minute for an hourly need or maybe at a 2 minute, 3 minute or longer interval for less frequent scheduled needs, until it is acknowledged as complete. When procedures require an aide or other assistance, such request may be transmitted to all suggested respondents and each may signal necessity for a backup independently. A reminder to take a patient's vitals is transmitted to a first aide according to schedule, with back-up transmissions or transmission to an alternate aide repeated until the vitals data are entered in the system. A charge nurse may see the message at a central station and/or when desired may receive signals directed at any one or more individuals. A supervisor may be alerted by audio or text signal when a certain need is not addressed within a predetermined time.

[0041] Patient B is receiving augmented oxygen in a hood. This patient has scheduled testing less detailed than patient A. Responsible staff will be signaled in a manner similar to that described above for patient A. Suddenly, a sensor indicates that patient B's breathing is not happening. An alert is sent to a nurse and the respiratory therapist. A technician is also alerted. Fortunately in this circumstance, patient B had managed to turn out of range of the microphone detecting the breathing. The summoned technician adjusted directional sensitivity with approval from the respiratory therapist and nurse.

[0042] Patient C is receiving mechanically assisted respiration. His pulse-ox meter alerts with a pO.sub.2 at 92. A nurse, the respiratory therapist, technician, and fellow are alerted. Each responds reflexively as their earpieces direct them to station 17. The fellow contacts the neonatologist who approves adjusting the pulmonary gas pressure to keep lungs and airways more open and increases tidal volume slightly. Both agree that increasing O.sub.2 concentration may be more risky. The technician performs the adjustments and all summoned staff go on their ways.

[0043] Patient D receives breast milk with supplemental nutrition, but requires pulmonary support. To assist lactation, the mother will allow the infant to suckle briefly with O.sub.2 provided through the nose. Otherwise the infant is tube fed (with augmented oxygen in the bubble) or treated with CPAP. Scheduled summonses are transmitted to an aide every 2 hours for vitals and every 3 hours to position the feeding and nasal tubes and five minutes later to stop the feeding. A sensor in the diaper generally summons an aide for a change before the time scheduled change. Turning off the diaper full signal resets the countdown time to next diaper change. Alerts are sent to relevant staff with every device anomaly or unexpected symptom including, but not limited to: blood pressure, pO.sub.2, urine acidity, blood in urine, heart rate, chest movement, etc. Only staff who may be needed to address the concern are contacted, freeing the others to concentrate on their assignments.

Example 2

[0044] In another environment, needs are primarily indicated using light. Staff may wear a speaker, for example as an earbud, on a collar, or in an isolation mask the may be used as a backup or may function in parallel to the electromagnetic (visible light) signaling protocols.

[0045] Rather than a personalized patient relevant sound being transmitted a light is visible above the station. Preferably the light is transmitted upwards from the station to avoid misidentification of the patient in need (for example, if the patient were to be moved to an unassigned location). Position location is provided by electronic proximity indicators. A lighted cone, bulb or other shape visible from across the room will be lit with one or more colors indicating patient status. For example, a green light may signify that that patient has received all scheduled interactions and no condition requires immediate or imminent attention. An orange and blue alternating light may be a signal for both a nurse and aide to attend the patient. The light may be transmitted upwards from the station and reflected off the ceiling mounted protrusion. The light may originate in the protrusion perhaps signaled wirelessly from the station below. The ceiling unit may additionally or alternatively receive signal instruction from a central server. A board numbered with each station is also useful as an option providing similar information in a centralized location. When a board is available, one option might be to provide a red light over the station that will direct staff assigned that station to look at the board where specific immediate staffing requirements are indicated for that station. Colors may appear as numbers to indicate which specific staff should be attentive to that station. For example, a first aide may be assigned number “X47” personally; X47 would only appear when that aide was present and responsible.

[0046] The alerts, either audio or visual, and scheduled interventions are transmitted to only those in need of responding or who should be aware. Stress levels on patients are reduced with less noise. Concentration of the caregivers is more focused with improved patient outcomes. The background noise in an intensive care unit may be reduced by at least 4 or 5 fold (.sup.˜20 db or greater) in many situations. Where mechanical ventilation, pneumatic cuffs to reduce risk of blood clots, staff movements, patient movements, human voice, etc., are significant, the present invention may reduce stressful background noise in the human audible range generally considered .sup.˜20 Hz to 20 kHz. Sounds in a range from about 500 Hz to 8000 Hz are considered most important for hearing tests because of the high sensitivity of the human ear in this range. Smaller ears, for example those of the average female, child or infant have narrower ear canals with a resultant reduced emphasis on lower frequencies. In accord with the present invention noise reductions of 10 db or more will be beneficial decreasing perceived sound by a factor of 2 within this frequency range or a narrower portion thereof, e.g., higher sensitivity zones of about 1000 to 5000 Hz, about 2000 to 5000 Hz, about 2000 to 4000 Hz, or 3500 Hz+/−about 500 Hz. By eliminating the broadcasts of alarms over a loudspeaker system, noise levels sound levels in the room can be significantly reduced to more generally acceptable levels.