Medical Device Integration Team Solves Challenge of Monitoring Private ICU Rooms

Posted June 8, 2019

A team of presenters from Houston Methodist Hospital and Medical Informatics Corp. described the challenges they overcame in integrating software and medical device solutions in private intensive care unit (ICU) patient rooms in a newly constructed building. Their solution, which involved aggregated data streams and a single screen displaying patient vital signs, was shared during an education session on Saturday at the AAMI Exchange in Cleveland, OH.

Houston Methodist Hospital’s Paula and Joseph C. “Rusty” Walter III Tower, or Walter Tower for short, is located in the Texas Medical Center. The 21-story, 1-million-square-foot structure features three ICUs, six acute care floors, and a helipad.

As construction of Walter Tower was approaching its final stages, Houston Methodist nurses toured the building and their respective floors. According to Jicelle Ochoa, medical device integration analyst at Houston Methodist, when the ICU nurses walked through their new space, they realized that the transition to a private patient room layout presented substantial risks and challenges.

"First, due to the size of the private patient rooms and the boomerang-shaped layout of the floor plan at Walter Tower, they feared that device alarms would not be easily heard from the hallways or from the nurses’ stations," she explained.

Ochoa and her team therefore performed an experiment: They rolled a ventilator to one of the ICU rooms, set off alarms, stepped into the hallway, and closed the door.

"We were simultaneously impressed by the quality of the sound-isolating construction and horrified that the nurses were indeed correct regarding this concern," she said.

Other challenges that were identified included streaming medical device data not being easily visible, the ICU department layout posing challenges to the traditional "buddy nursing" system, and the belief that closed patient room doors would require additional staff.

The clinicians voiced two key requirements, said Ochoa: the ability to visualize patient status and alarm state outside of patient rooms and the need for alarm communication via audible alerts from the physiological monitors and ventilators outside of patient rooms.

Meanwhile, the device integration team also determined that the solution must include a variety of other attributes, namely that patient data from multiple sources could be handled, that visualization of patient vital signs must be in near real-time, that alarms needed to communicate multiple properties efficiently, and, ultimately, that the solution would not be burdensome for nurses.

Houston Methodist worked with Christian Pesantes, a developer from Medical Informatics Corp. to create the solution, primarily leveraging the two of the vendor's offerings: Sickbay, a Food and Drug Administration-cleared, software-based monitoring and analytics platform, and MultiMon, an app within Sickbay used for monitoring a group of patients.

Pesantes worked with Houston Methodist to achieve optimal alert sounds, with the nurses themselves selecting the final set of sounds. Unique alert sounds were chosen for warning and critical alarms, while a decision was made that no sound would be tied to low-priority alarms.

The alert sounds are integrated into the MultiMon app, which features a color scheme showing whether alarms have been acknowledged.

After noting that it's "easy to visualize once you hear it," Pesantes then demonstrated the alarm sound and visualization attributes of MultiMon, which features color schemes that sync up with the warning or critical alert sounds.

Ultimately, the private patient ICU room solution involved 63 nurse alcoves displaying from six to 10 rooms and nine stations displaying all beds on the nurses' unit. The monitoring solution runs 24/7/365, with each monitor automatically refreshing when a patient is admitted or discharged.

"Even though we are not at the bedside, we are passionate about taking care of patients," said Ochoa. "While we have no intention of forgetting about traditional device integration to the EMR (electronic medical record), because it's a core component, we’ve taken the responsibility of actively seeking out new technology and products in the market that have allowed us to offer advanced integration solutions for data acquisition, data mining, and monitoring and alerts."

She added that "alerts and monitoring don't mean much unless someone knows about them."