Patent Application
20180314801
The present disclosure relates generally to systems and methods for tracking resources in a healthcare environment, and more specifically, to systems and methods for tracking clinician time usage related to spontaneous events, such as alarm and nurse call events.
In the field of medicine physicians often desire to continuously monitor multiple physiological characteristics of their patients. Oftentimes, such monitoring of multiple physiological characteristics involves the use of several monitoring devices simultaneously, such as a pulse oximeter, a blood pressure monitor, a heart monitor, a temperature monitor, etc. These monitoring devices may be separate devices or elements within a larger multifunction patient monitoring device. Additional monitoring, treatment, and/or support devices and systems may further be connected to or associated with the patient, such as for delivering fluids, medication, anesthesia, respiration assistance, patient requested assistance, lab/imaging results, EMR/EHR notifications/alerts, etc. or analyzing various patient-related data to determine and alert a clinician to a condition or patient state (e.g., sepsis protocols, APACHE scores, early warning scores). Each of these devices and systems may generate one or more alarms to alert a clinician of a problem, which may be a problem with the patient's physiology or health status, or may be a technical problem with the monitoring and/or care delivery device. Thus, at any given time, one or more devices may be generating alarms/alerts requiring the attention of a clinician. Furthermore, alarms may require various amounts of resources in order to alleviate the alarm condition, which may include clinician time by one or more clinicians.
This Summary is provided to introduce a selection of concepts that are further described below in the Detailed Description. This Summary is not intended to identify key or essential features of the claimed subject matter, nor is it intended to be used as an aid in limiting the scope of the claimed subject matter.
In one embodiment a healthcare resource tracking system includes an incident analysis module executable on a processor to receive alarm events detected by one or more patient monitoring systems or devices, wherein each patient monitoring system or device obtains physiological signals from a different patient over a time period. The alarm events for each patient are then divided into alarm incidents, wherein each alarm incident is either a single alarm event or is an incident group of two or more related alarm events for the patient. A clinician time usage is determined for each alarm incident, wherein the clinician time usage is an amount of time required of one or more clinicians to attend to the one or more alarm events in the alarm incident. A total time usage is calculated over the time period based on the clinician time usage.
A method of tracking resources in a healthcare environment includes receiving alarm events for one or more patients and dividing the alarm events into alarm incidents, wherein each alarm incident is either a single alarm event or an incident group of two or more related alarm events for the respective patient. The method further includes determining a clinician time usage for each alarm incident, wherein the clinician time usage is an amount of time required of one or more clinicians to attend to the one or more alarm events in the alarm incident, and calculating a total time usage over the time period based on the clinician time usage.
Various other features, objects, and advantages of the invention will be made apparent from the following description taken together with the drawings.
The present disclosure is described with reference to the following Figures.
Currently available patient monitoring and alarm analytics assess alarm events as discreet events and do not assess their relation to one another. The present inventor has recognized that, in reality, groups of two or more alarms may occur within a time period that are so related to one another that they may be considered together as a single “incident.” The present inventor further recognized that failure to account for the relations between alarm events and to group them accordingly provides incomplete or even inaccurate information regarding the progression of the patient's physiological condition and regarding the amount of care and resources utilized in treating the patient. Thus, current systems fail to provide context to the individual alarm events and their relationships.
Upon recognition of the foregoing challenges and problems in the relevant art, the inventor developed the presently disclosed patient monitoring systems and methods that recognize when one or more alarm events are related and group them together as a single incident that can be analyzed as a whole and in context of the longitudinal view of all incidents and events in that time period. Thus, in addition to assessing the individual alarm events as provided in current systems, the alarm incident group can be assessed to provide further information and context, or “metadata,” regarding the alarm events and the overall patient treatment requirements. Further, this generated “metadata” describing the event-driven incidents can be utilized to provide a longitudinal picture describing the relationships of alerts and/or alarm events occurring over a period of time and/or for multiple patients within a defined care environment. For example, a severity value of the incident group can be determined based on one or more of a duration of the incident group, a number of alarm events in the incident group, an alarm type and/or alarm level of the alarm events in the incident group, the number of clinicians and/or amount of clinician time spent tending to the incident group, or the like.
Additionally, the inventor further recognized a need for systems and methods for tracking clinician time, skillset, resource, etc. usage, especially clinician resource usage pertaining to alert, alarm event response, nurse call response, and/or to other event-driven patient care alerts/requirements (e.g., lab and imaging/radiology result notifications, admit/discharge/transfer activities, patient procedures or testing, EMR/EHR notifications/alerts, patient condition or patient state analysis system notifications/alerts such as sepsis protocols, APACHE scores, early warning scores, etc.). As multiple events may occur at one time, the determination of the amount of clinician resources utilized by each alarm event is difficult to determine, and may be less important than determining the overall tax on a clinician as a result of caring for the patient and responding to all alarm events associated with that patient. Upon recognition of the forgoing problems and challenges, the inventor developed the system and method disclosed herein that groups alarm events into separate alarm incidents and then tracks the clinician time usage in responding to the alarm incident or other event. Thereby, clinician resource, including clinician time, usage related to certain spontaneous events can be accurately tracked and totaled. Various types of events may be included in the analysis, which may include any of various types of alarm events, nurse call events (or other requests for patient care), lab and imaging/radiology result notifications, admit/discharge/transfer activities, patient procedure and testing, EMR/EHR notifications/alerts, patient condition or patient state analysis system notifications/alerts such as sepsis protocols, APACHE scores, early warning scores, etc.
In one embodiment, information regarding time usage for each alarm incident and/or other included events is used to calculate a total time usage over a time period. The total time usage may be for any patient, group of patients, clinician, group of clinicians, unit or section of a healthcare facility, etc., and may be over any time period. For example, a per-patient total clinician time used by the patient may be calculated, such as the amount of resources utilized by a patient per day or over their entire stay in a healthcare facility (or a particular unit thereof). Alternatively or additionally, the total time usage may be a per-clinician total time expended by a clinician in responding to events generated by all of the patients in their care, such as for the time period of that clinician's shift (or a portion thereof). The inventor has recognized that such information can be highly valuable in load distribution and resource planning. For example, such total time usage calculations can be used to assess workloads on a per-clinician basis, a per-unit basis, a per-shift basis, a per-day basis, or the like. In another example, the total time usage calculations may aggregate information regarding group averages of time usage for particular patient groups, such as patients sharing a common diagnosis, or a common admission reason—e.g., a chief complaint or presenting complaint upon admission, or other problem documented in the patient's health record upon admission. Likewise, the group of patients may be formed based on a physiological condition, such as a diagnosed condition or shared qualitative or quantitative physiological parameter data. The total time usage data for each of the group of patients can be averaged or statistically analyzed in order to provide statistically relevant information regarding the amount of resources patients in that group consume, and thus the amount of resources that future patients meeting the group criteria are likely to consume. This can assist healthcare facilities in resource planning and management, such as for clinician staffing and staff allocation.
As exemplified in
Each sensing device 3a-3c contains one or more sensors 9a-9c for measuring physiological parameter data from a patient, and also includes a data acquisition device 10a-10c that receives the physiological parameter measurements from the sensors 9a-9c and transmits a parameter dataset based on those measurements to the hub 15 via communication link 11a-11c. The sensors 9a-9c may be connected to the respective data acquisition device 10a-10c by wired or wireless means. The sensors 9a-9c may be any sensors, leads, or other devices available in the art for sensing or detecting physiological information from a patient, which may include but are not limited to electrodes, lead wires, or available physiological measurement devices such as pressure sensors, flow sensors, temperature sensors, blood pressure cuffs, pulse oximetry sensors, or the like. In the depicted embodiment, a first sensing device 3a is an ECG sensing device having sensors 9a that are ECG electrodes. A second sensing device 3b is a non-invasive blood pressure (NIBP) sensing device with a sensor 9b that is a blood pressure cuff including pressure sensors. A third sensing device 3c is a peripheral oxygen saturation (SpO2) monitor having sensor 9c that is a pulse oximetry sensor, such as a standard pulse oximetry sensor configured for placement on a patient's fingertip. It should be understood that the patient monitoring system 1 is not limited to the examples of sensing devices provided, but may be configured and employed to sense and monitor any physiological parameter of the patient. The examples provided herein are for the purposes of demonstrating the invention and should not be considered limiting.
The data acquisition device 10a-10c of each exemplary sensing device 3a-3c may include an analog-to-digital (A/D) converter, which may be any device or logic set capable of digitizing analog physiological signals recorded by the associated sensor 9a-9c. For example, the A/D converter may be Analog Front End (AFE) devices. Each data acquisition device 10a-10c may further include a processing unit 12a-12c that receives the digital physiological data from the A/D converter and creates physiological parameter data for transmission to the hub 15 and/or to the host network 30. Each data acquisition device 10a-10c may be configured differently depending on the type and function of sensing device, and may be configured to perform various signal processing functions and/or sensor control functions. To provide just a few examples, the processing unit 12a in the ECG sensing device 3a may be configured to filter the digital signal from the ECG sensors 9a to remove artifact and/or to perform various calculations and determinations based on the recorded cardiac data, such as heart rate, QRS interval, ST segment/interval, or the like. The processing unit 12b in the NIBP monitor 3b may be configured, for example, to process the physiological data recorded by the sensors 9b in a blood pressure cuff to calculate systolic, diastolic, and mean blood pressure values for the patient. The processing unit 12c of the SpO2 sensing device 3c may be configured to determine a blood oxygenation value for the patient based on the digitized signal received from the pulse oximetry sensor 9c.
Accordingly, each processing unit 12a-12c may develop physiologic parameter data that, in addition to the recorded physiological data, also includes values measured and/or calculated from the recorded physiological data. The respective processing units 12a-12c may then control a receiver/transmitter 5a-5c in the relevant sensing device 3a-3c to transmit the physiological parameter data to the hub 15 via communication link 11a-11c. The physiological parameter data transmitted from the respective sensing devices 3a-3c may include the raw digitized physiological data, filtered digitized physiological data, and/or processed data indicating information about the respective physiological parameter measured from the patient. Additionally, one or more of the data acquisition devices 10a-10c may be configured to compare the physiological parameter data to one or more alarm thresholds to determine the presence of an alarm condition—i.e., detect an alarm event based on the physiological parameter data.
Upon detection of an alarm event by the respective sensing device 3a-3c, an alarm may be generated either by the sensing device 3a-3c (e.g., an auditory alarm via a speaker and/or visual alarm via a display) or the hub 15 (e.g., via speaker 18 and/or display 16), at a central monitoring station 50 (e.g., via speaker 53 and/or user interface display 52), and/or a clinician device 70 (e.g., via a speaker and/or display 72). Notice of the alarm may be transmitted from the respective sensing device 3a-3c to the hub 15, or may be detected at the hub 15 in the first instance as explained above. Further, the system may be configured in various ways for a clinician to silence the respective alarm, which may be provided via the respective sensing device 3a-3c, at the hub 15, or at some other location, such as via the user interface 72 on the clinician device 70.
The alarm events may be triggered by analysis of the physiological parameter data, such as if alarm limits for the respective parameter data are exceeded (e.g., heart rate low), a parameter message alarm (e.g., apnea), or one or more particular data patterns are detected (e.g., indicating an arrhythmia such as tachy or asystole). Additionally, other alarm types may be generated, such as a technical alarm type or an alarm generated regarding treatment delivery to the patient. A technical alarm type is generated based on and/or as a result of a function of the sensing device 3a-3c, the hub 15, the treatment delivery device/system 36, or the like, and/or some component thereof. Examples of technical alarm types are low battery alerts, sensor off alerts (e.g., sensor(s) 9a-9c are not properly connected to the patient), sensor malfunction alerts (e.g., sensor(s) 9a-9c is not functioning properly), device malfunction alerts (e.g., sensing device 3a-3c or the treatment delivery device/system 36 is not functioning properly), data transmission malfunction alert (e.g., there is a problem with one or more communication links 11a-11c, 28, 38), or a technical problem regarding the function of a treatment delivery device/system 36 delivering therapy, medication, or the like to the patient.
In other embodiments, the processing units 12a-12c may not perform any signal processing tasks and may simply be configured to perform necessary control functions for the respective sensing device 3a-3c. In such an embodiment, the parameter data set transmitted by the respective processing unit 12a-12c may simply be the digitized raw data or digitized filtered data from the various sensors 9a-9c, and all alarm event detection may occur at the hub 15 or at the host network 30.
Whether detected at each respective sensing device 3a-3c, at the hub 15, or by logic executed at the host network 30, the detected alarm events are received and analyzed by one or more incident analysis modules 24, or portions thereof (e.g., 24a or 24b), to determine whether each respective alarm event is part of an incident group 63. In various embodiments, the incident analysis module 24 may be stored and executed on the patient sensing device 3a-3c or one the hub 15 (e.g., 24a), and the resulting incident group information may be transmitted to a host network 30, such as the network where patient monitoring data and/or patient medical records are stored. In other embodiments, the incident analysis module 24 may be contained on and executed on a computing system of the host network 30 (e.g., 24b). In still other embodiments, the incident analysis module 24 may be divided between the patient monitoring device and the host network 30, where certain aspects of the incident group analysis are carried out at each location (i.e., the embodiment of
The incident analysis module 24 may further be configured to divide alarm events for each patient into alarm incidents, wherein each alarm incident is either a single alarm event 57 or an incident group 63 (
Alternatively or additionally, the total time usage 85 may be a per-clinician total time usage calculated based on the clinician time usage 84 for each alarm incident to which the respective clinician has responded and/or for each alarm incident occurring for a patient in that clinician's care or assigned to that clinician. Where the per-clinician total time usage is calculated, the incident analysis module may further perform an assessment of whether the clinician workload is maintained within a threshold. For example, the per-clinician total time usage may be compared to a threshold clinician time value 78 which sets a maximum expected or permitted value for the per-clinician total time usage over a predefined period. Thus, the per-clinician total time usage may be continually assessed over a rolling predefined time period to make sure that the threshold clinician time value 78 is not exceeded and that the clinician is not being overworked and/or unable to respond to all presented alarm events 58, 59 and/or nurse call events 65. If the per clinician total time usage does exceed the threshold clinician time value 78, then the incident analysis module 24 may generate an overload alert 89, such as to provide information to other clinicians, managers, schedulers, etc. that a particular clinician is being overworked and/or is unable to handle a current event load.
In an exemplary process of dividing alarm events into incident groups, the incident analysis module 24 may receive a first alarm event 58 and a second alarm event 59a, and then determine whether the second alarm event 59a is part of an incident group 63 with the first alarm event 58 (
In certain embodiments, depending on the configuration setup, the system may pick and choose the types of alarm events that may be groupable together in an incident group. In such an embodiment, the determination of whether the second alarm events 59a and subsequent alarm events 59b are part of an incident group 63 with the first alarm event 58 is determined, at least in part, on the alarm type of the alarm event. For example, the incident analysis module 24 may be configured to disallow grouping alarm events of the technical alarm type with alarm events of the physiological alarm type based on the physiological parameter data—e.g., where the physiological parameter data exceeds one or more alarm thresholds. In many monitoring arrangements and applications (though not in all cases), the technical alarm type alarm event is not generally going to be substantially related to such physiological alarm types. Further, in certain healthcare environments different clinicians or staff respond to technical alarm types as opposed to physiological alarm types. In certain embodiments, the incident analysis module 24 may include instructions executable to determine one or more permitted alarm types based on particular grouping rules applied to the alarm type of the first alarm event 58. For example, if the first alarm event is a technical alarm type, then the permitted alarm type for the incident group 63 may be confined to only technical alarm types. Similarly, if the first alarm event is a physiological alarm type, then the permitted alarm type may be only other physiological alarm types, or may be devised to allow multiple different alarm types but exclude technical alarm types (or other alarm types depending on the particular grouping rules).
Such alarm grouping can provide useful information regarding the patient's overall condition, as well as providing a basis for determining the amount of resources utilized to care for a patient. The usefulness of such incident grouping is highlighted and explained with respect to
In general, alarm events for a particular patient are divided into alarm incidents, which can either be comprised of just a single alarm event 57 or can be an incident group 63. An incident group 63 is comprised of two or more alarm events, including a first alarm event 58 and one or more subsequent alarm events 59. In the depicted example, Patient 1 had three separate alarm incidents, each being an incident group 63 of two or more distinct alarm events. Namely, a first incident group 63a was identified for Patient 1 consisting of 5 separate alarm events, a second incident group 63b was identified that includes two separate alarm events, and a third incident group 63c was identified to include four separate alarm events. Patient 2, on the other hand, had six distinct alarm incidents, with only one being an incident group 63 and the remaining five alarm incidents being single alarm events 57. The incident group 63d contains two distinct alarm events (and a nurse call event, as explained below). Similarly, for Patient 3, the eight total alarm events are separable into four total alarm incidents, where the first two incidents each comprise a single alarm event 57, five of the alarm events are grouped into incident group 63e, and a single alarm event 57 alarm incident occurs during the incident group 63e based on a technical alarm event that, in this embodiment, could not be grouped together with alarm events in the incident group 63e.
Alarm events of four different exemplary, non-limiting, alarm types are represented in
In certain embodiments, one or more treatment delivery devices/systems 36 may also communicate with one or more of the host network 30 and/or the patient monitoring device, such as with the hub 15. A treatment delivery device/system 36 delivers treatment to the patient, such as medication or respiration therapy. Non-limiting examples of treatment delivery devices/systems 36 include anesthesia delivery devices, infusion pumps of various sorts, ventilators, respirators, blood glucose monitors, CO2 monitors, cardiac output monitors, etc.
The treatment delivery device/system 36 may generate its own alarms to alert a clinician to a problem with treatment delivery, which are referred to herein as treatment alarm type alarm events. For example, the treatment alarm type generated by the treatment delivery device/system 36 could include issues relating to an inability to deliver the prescribed treatment (e.g., insufficient anesthesia medication, an issue with an intravenous line, a leak in a respirator, a blockage of an airway). Upon detection of a treatment alarm type alarm event, the treatment delivery device/system 36 may transmit the alarm event to the host network 30 and/or to the hub 15. In the exemplary embodiment of
In certain embodiments, a nurse call system 42 may also transmit or communicate nurse call events 65, which can be accounted for in the resource usage analysis as described later herein. The nurse call system 42 may be any type of system for through which a patient may submit a care request or request a visit from a clinician, and numerous such systems are known and available for hospitals and other healthcare facilities. In the depicted embodiment, the nurse call system 42 communicates with the host network 30 via communication between the receiver/transmitter 43 of the nurse call system 42 and the receiver/transmitter 31 of the host network, which may be via any wireless or wired means and according to any communication protocol.
The treatment delivery device(s)/system(s) 36, patient monitoring device(s) 3a-3c, 15, and nurse call system 42 are described herein for purposes of providing an explanatory example and are not limiting. Further, though the treatment delivery devices/systems 36, patient monitoring devices 3a-3c, 15, and nurse call system 42 are shown as communicating directly with the host network 30 (e.g., through receiver/transmitter 31), a person having ordinary skill in the art will understand in light of this disclosure that one or more of these systems may indirectly communicate with the host network 30, such as via an aggregation system or other middleware solutions. To provide just one example, communications from the patient monitoring devices 3a-3c, 15 may be provided through an alarm management system, such as an alarm management system provided by Ascom Holding AG. In other embodiments, additional alarm/alert generating systems (e.g., an EMR/EHR or an application analyzing various patient-related data to determine a condition or patient state such as a sepsis protocols, APACHE scores, or early warning scores) may interface with and transmit alert/alarm information to hub 15, the host network 30, or an alarm management system and be inputs to the incident analysis module 24.
With reference to the example of Patient 1, incident group 63a is comprised of three arrhythmia alarm types and two limit alarm types, which are considered related based on the fact that they overlapped one another in time such that each subsequent alarm event began while the previous alarm event was still occurring. Thus, each of the alarm events in incident group 63a overlap at least one other alarm event in the group. Specifically, the first arrhythmia alarm event is identified as a first alarm event 58 in the incident group 63a. The permitted alarm types for the incident group 63a are then defined based on the arrhythmia alarm event, which in the depicted embodiment includes arrhythmia alarm types and limit alarm types (both physiological alarm types). The second alarm event 59a is a limit alarm event and it overlaps in time with the first alarm event 58. Then, three subsequent alarm events 59b occur after the second alarm event 59a. Arrhythmia alarm event 59b1 initiates after the first alarm 58 has ended but during the pendency of the second alarm 59a. The limit alarm event 59b2 occurs after the second alarm event 59a has ended but before the end of the arrhythmia alarm event 59b2. Another arrhythmia alarm event 59b3 then initiates before the end of the limit alarm event 59b2. The incident group 63a terminates after the last arrhythmia alarm event 59b3 because no subsequent alarm event occurs during the pendency of that alarm event 59b3 to continue the incident.
Incident group 63b is comprised of two technical alarm type alarm events which overlap in time. However, incident group 63c for Patient 1 is comprised of four distinct alarm events, three of which have some overlap in time and one (the first alarm event 58 in the incident group 63c) is separated from the group and ends prior to the start of the second alarm event 59a, which is an arrhythmia alarm type. In certain embodiments described in more detail below, the incident analysis module 24 may be configured to hold the incident group open for a period of time after a last occurring or persisting alarm event in a group in order to continue detecting alarm events for that additional period that may be incorporated in the same incident group 63.
In embodiments where technical alarm types are not grouped together in the same incident group with physiological alarm types, the occurrence of a subsequent alarm that is determined not to be part of an incident group is treated as a new first alarm event. The new first alarm event can trigger a second incident group analysis that may run in parallel and overlap in time with the first incident group analysis. In
In certain embodiments, alarm events occurring within a predetermined time interval following conclusion of an alarm event may be considered as part of the same incident group 63. This is illustrated in the example of
A duration 77 is determined for each alarm incident 57, 63. The continuous top bar of
The termination time 75 of each alarm event 58, 59a, 59b may be the time when the alarm event was silenced, such as by a clinician providing input at a user interface to silence the alarm. Alternatively, the termination time 75 of a respective alarm event 58, 59 may be when the triggering basis for the respective alarm event 58, 59 is resolved or no longer present. For example, if the respective alarm event 58, 59 is a technical alarm event, elimination of the triggering basis is when the technical issue has been resolved (e.g., the battery has been replaced, the sensor has been placed back on the patient, etc.). Similarly, for a physiological alarm type, resolution of the triggering basis may be when the physiological parameter data no longer exceeds the relevant alarm limit. In certain embodiments, termination of an alarm event 58, 59 may be determined differently for different alarm types.
In certain embodiments, a group alarm timer may be activated at the initiation time T0 of the group alarm event. The group alarm timer may continue while any alarm event in the incident group 63 is still active, and may be continued for the predetermined time interval 76 following the termination time 75 of the last remaining active alarm events in the incident group 63. The group alarm timer is then stopped at the termination time Tt based on the termination of all alarm events or after the predetermined time interval 76 following termination of all alarm events in the incident group 63. In such embodiments, the recorded time between the initiation time and the termination time of the group alarm timer can be used to determine the duration 77 of each respective incident group 63.
After identifying an incident group 63, the incident analysis module 24 generates an incident group designator 69 identifying the incident group, such as identifying the alarm events 58, 59a, 59b in the incident group 63 and/or the initiation time T0 and/or termination time Tt of the incident group 63. In certain embodiments, the incident analysis module 24 may generate the incident group designator 69 after conclusion of the respective incident group 63. In other embodiments, the incident analysis module 24 may generate the incident group designator 69 piecewise in real time as the various aspects of the incident group 63 unfold. In certain embodiments, the incident group designator 69 may include additional information about the incident group 63, such as information regarding the alarm types or alarm levels therein, or even the incident severity value 79.
Referring again to
In various embodiments, one or all of the sensing devices 3a-3c may be equipped with a patient identification transmitter 14a-14c that emits a patient identifier 61 that is detected by a location tracking system 40. The location tracking system 40 receives the patient identifier 61 in order to determine the patient's location. Likewise, each clinician may also be equipped with a clinician identification transmitter 71 that emits a clinician identifier 60 detected by the location tracking system 40. The location tracking system 40 may be, for example, a real-time location system (RTLS) that provides immediate or real time tracking of the patients' locations, the clinicians' locations, and also the locations of various other individuals and/or devices within a healthcare facility or area. In the embodiment of
The hub 15 may also include a patient identification transmitter 14x that transmits a location of the hub 15. Such patient identification transmitter 14x in the hub 15 may be in lieu of or in addition to the identification transmitters 14a-14c in the sensing devices. In embodiments where the hub 15 is a small, body-worn device that is attached to the patient, the patient identification transmitter 14x in the hub 15 may be sufficient for patient location tracking purposes. In embodiments where the hub 15 is not a body-worn device, the patient identification transmitter 14x may be unreliable, by itself, for patient location tracking. In such embodiments, the patient identification transmitter 14x may be used for tracking the location of the hub 15 separately from the patient.
The location tracking system 40 may further be configured to track the locations of various other individuals and devices within a care facility. Various individuals occupying a care facility may have identification transmitters transmitting an identifier associated to them, or at least to their role in the care facility. The example of
In the depicted embodiment, a plurality of identification receivers 46a-46n are placed at known locations throughout a care facility. The identifier transmitted by the respective identification transmitter 14a-14c, 14x, 71 is received by one of the identification receivers 46a-46n closest to, or otherwise arranged to receive transmissions from, identification transmitters 14a-14c, 14x, 71 at that particular location of the tracked individual or device. Each identification receiver 46a-46n then communicates the patient identifier 61 or clinician identifier 60, along with its own receiver identification 62, to a location tracking module 22. For example, the identification receiver 46a, 46n may communicate the patient identifier 61 and/or clinician identifier 60 and its own identification with a host network 30 for the care facility via a respective communication link 49a, 49n. The location tracking module 22 then monitors and determines a patient location 68 and/or clinician location 66 for the location tracking system 40 within the care facility.
The location tracking module 22 then determines a patient location 68 or clinician location 66 based on which identification receiver 46a-46n receives the identifier for that individual from one or more of the identification transmitters 14a-14c. For example, the location tracking module 22 may access a map or database of the care facility where each identification receiver 46a-46n is associated with a particular location in the care facility. The map associating each identification receiver 46a-46n with a location in the care facility may be, for example, uploaded and stored in the computing system 235 of the host network 30 as part of the system configuration.
The clinician device 70 also includes a user interface display 72 that displays information to the clinician and receives input from the clinician. The user interface display 72 includes any type of display device appropriate for a portable, handheld, or wearable device, which may be a touch screen or may include an associated user input means, such as touch and/or voice input means. For example, the user interface display 72 may be utilized to silence or acknowledge an alarm event. Alternatively or additionally, the user interface display 72 may be utilized for a clinician to control an availability mode or clinician availability indicator 64 that indicates that clinician's availability to treat a patient and/or to respond to an alarm condition, or the like.
In certain embodiments, the clinician availability indicator 64 may be used by the incident analysis module 24 alone or in combination with the clinician location 66, to determine whether a subsequent alarm 59b can be part of an incident group 63. For example, the incident analysis module may further determine the termination time Tt of the incident group 63 when the clinician leaves the patient's location 68—e.g., when the clinician location 66 is no longer equal to the patient location 68. Alternatively or additionally, the termination time Tt of the incident group 63 may be based on when the clinician changes their availability indicator 64 to indicate that they are no longer attending to the patient. Likewise, the termination time Tt may be determined based on the last occurring of the aforementioned events relating to the clinician location 66 or clinician availability indicator 64, and/or a predetermined time interval thereafter.
Identification receivers 46 may be provided at fixed locations throughout the care facility, such as at each room, bed, bay, hallway, etc. to enable tracking the patient's location and the clinician's location throughout the care facility. Each patient 4 and their associated wireless monitoring system may be assigned a primary identification receiver 46. For example, the primary identification receiver (e.g., 46a) may be located at the location where the patient is likely to spend the most time, such as the patient's assigned room, bed, bay, etc. For example, each patient room may be equipped with an identification receiver 46 dedicated to that room, which may then be associated to the patient when the patient 4 is assigned to that room. When the respective patient identifier 61 is received by the primary identification receiver 46a, that is indicates that the patient is located in their assigned room. A clinician location 66 can be determined to be equal to the patient's location 68, and thus that the clinician is attending to the patient, when the respective clinician identifier 60 is also received by the primary identification receiver 46a.
In certain embodiments, each patient room may be equipped with multiple identification receivers 46 which may provide detailed information about the patient location 68 and/or clinician location 66 within the room. In such an embodiment, one of the identification receivers 46 may be identified as the primary identification receiver (e.g., 46a) which, for example, may be associated with the patient's bed. In an exemplary scenario, each patient room has two identification receivers 46. The primary identification receiver (e.g., 46a in the example of
For example, each sensing device 3a-3c may have a battery 7a-7c that is charged by the respective charger 44. The battery 7a-7c may be a removable battery that can be removed from the respective sensing device 3a-3c and placed on the charger 44 for charging, and a replacement battery may be inserted into the respective sensing device 3a-3c. For example, all of the sensing devices 3a-3c may utilize identical batteries 7a-7c, and thus the charger 44 may provide a bank of charging slots where batteries can be swapped and charged as each sensing device requires. Alternatively, the charger 44 may be configured to connect to each respective sensing device 3a-3c in order to charge the respective batteries 7a-7c. Likewise, the charger 44 may be configured to charge a battery 27 of the hub 15.
The patient identification transmitters 14a-14c, 14x communicate with one of a plurality of identification receivers 46a, 46n via a respective communication link 41a-41c, 41x. Likewise, each clinician identification transmitter 71 communicates with one of the plurality of identification receivers 46a, 46n via a respective communication link 41e. The communication link 41a-41c, 41x may be by any of various wireless communication protocols and/or platforms, such as Bluetooth, Bluetooth Low Energy (BLE), ZigBee, Wi-Fi, infrared, ultrasound, or by other wireless communication means. In certain embodiments, it is preferable that the transmission range of the patient identifier be limited so that the patient identification transmitters 14a-14c, 14x are only within communication range of one identification receiver 46a-46n at a time. Thus, it may also be beneficial if the system is configured such that the communication signals and protocols do not pass through walls or other structural barriers so that identification receivers 46a, 46n can be placed in adjacent rooms, such as adjacent hospital rooms, without concern of cross-receiving. Accordingly, infrared may provide a good means for the communication links 41a-41c, 41x in other embodiments where line-of-sight limitations are prohibitive, other relatively short-range protocols may be desirable, such as Bluetooth, Bluetooth Low Energy (BLE), or ZigBee, or the like. Alternatively or additionally, communication between the identification receivers 46a, 46n and the identification transmitters 14, 71 may be via a publish-subscribe messaging pattern, or model.
The identification receiver 46a, 46n may communicate with the host network via a separate receiver/transmitter (e.g., 48) that communicates with a respective receiver/transmitter 34 associated with the host network 30. Alternatively, one or more of the identification receivers 46a-46n may have a transmitter incorporated therein capable of transmitting the patient identifier and its own receiver identifier to a respective receiver/transmitter 34n associated with the host network 30. The patient identifier is communicated to the host network 30 via a respective communication link 49a-49n, which may be by any wireless or wired means and according to any communication protocol. For example, communication may be via a Wi-Fi network for the care facility, or by a dedicated wireless network for the location tracking system 40. For example, in certain embodiments the location tracking system 40 may employ one or more wireless local area networks (WLANs) situated throughout a care facility. In other embodiments, the devices on the location tracking system 40 may utilize the (WMTS) spectrum. Alternatively or additionally, communication between the identification receivers 46a, 46n and the host network 30 may be via a publish-subscribe messaging pattern, or model. In such an embodiment, the identification receivers 46a, 46n may publish information, and the host network 30 may subscribe to the published “messages” from the identification receivers 46a, 46n, or vice versa. Accordingly, the host network 30 does not need to establish a direct communication link with identification receivers 46a, 46n, and vice versa, and each can continue to operate normally regardless of the other.
In the embodiment depicted in
Returning to the depicted example, the location tracking module 22 is configured to receive the patient identifier 61 associated with the patient and/or the clinician identifier 60 associated with a respective clinician, as well as the identification of the receiver 46a, 46n that received that patient identifier 61 or clinician identifier 60. Based thereon, the location tracking module 22 determines a patient location within a care facility. For example, the location tracking module 22 may be configured with the map of the care facility, where a location of each identification receiver 46a-46n is associated to a location on the map. Thus, when a patient identifier 61 and/or clinician identifier 60 is received at a particular identification receiver 46a, 46n, the location tracking module 22 determines the patient location 68 for the patient associated with the patient identifier 61 and/or the clinician location 66 associated with the clinician identifier 60 to be a given location range on the map of the care facility associated with the identification receiver 46a, 46n that received the patient identifier. For example, the patient location may be determined to be the patient room associated with the identification receiver 46a assigned to or associated with that room.
As a patient or a clinician moves throughout a care facility, the identifier transmitted by the respective identification transmitters 14a-14c, 14x, 71 are received by different identification receivers 46a, 46n, and the location tracking module 22 may update the patient location 68 or the clinician location 66 as a new identification receiver 46a, 46n reports receiving the respective identifier. Further, the location tracking module 22 may store the patient location 68 and the clinician location 66 in order to track and store the respective locations over time.
The hub 15 may further include a display 16 and a speaker 18 that may be used to generate an alert or alarm and/or to display information regarding the patient's location, activity, physiological condition, etc. The display 16 may be any type of digitally-controlled visual display, and may further be a touchscreen controllable by a user to provide input to the hub 15, such as to silence an alert or alarm.
The hub device may further include computing system 135 having processor 139 and storage system 141. The hub 15 may serve to control the sensing devices 3a-3c, and thus may transmit operation commands to the respective sensing devices 3a-3c via the communication link 11a-11c to control their monitoring operations. The hub 15 may contain a monitoring regulation module 23 that is a set of software instructions stored in memory and executable on the processor to assess the physiologic parameter data collected by the sensing devices 3a-3c and determine a patient condition therefrom, such as to detect an alarm event, and to control the respective sensing devices 3a-3c according to the patient condition. For example, the alarm event may be determined by comparing the physiological parameter data collected by one or more of the sensing devices 3a-3c with alarm limits to determine whether the patient condition requires generating an alarm to alert the clinician to the patient's condition.
The incident analysis module 24 may further, in a non-limiting example, determine or calculate an incident severity value 79 (or like factor or factors) for each incident group 63. For example, the severity value 79 may be based on one or more of a duration of the incident group 63 (from the initiation time T0 to the termination time Tt), a number of alarm events 58, 59 in the incident group 63, or an alarm type of each alarm event 58, 59 in the incident group 63. Alternatively or additionally, the example incident severity value 79 may be calculated based on the amount of clinician resources utilized to respond to an incident group 63, such as a total amount of clinician time spent related to the incident group 63 and/or a total number of clinicians that responded to an incident group 63. Accordingly, the severity value 79 can provide information regarding how much work was required to respond to a single alarm event or incident group 63, and/or indicate the amount of resources that were required to respond and alleviate the alarm event or incident group 63.
The incident severity value 79 may take any form capable of indicating the relative severity of a particular incident group 63. For example, the incident severity value 79 may be provided on a numerical scale, a color scale, or similar. In one embodiment, the incident severity value 79 may be calculated by allocating weights to the various values for the respective incident groups—e.g., duration, alarm types, alarm level, clinician or collective clinician time spent, number of clinicians, involved clinician(s) skillset levels, device resources, etc.—and locating the resulting value on a scale from least severe (e.g., requiring minimal resources) to most severe (e.g., requiring a significant amount of resources). For example, the number of alarm events 58, 59, alarm types, and alarm levels may be used as indicators of the amount of resources required to respond to the incident group 63. Certain alarm types, such as technical alarm types, may be considered to require minimal resources. For example, in certain situations technical alarm types may receive treatment by dedicated technicians rather than nurses. In such situations technical alarm types may then be associated with minimal resource usage as compared to physiological alarm types. Similarly, alarm level can also indicate an amount of resources utilized to respond to each alarm event 58, 59, and thus the incident group 63 as a whole. For example, each alarm event 58, 59 may include indication of an alarm level, such as based on the alarm limits exceeded and how far the physiological parameter data recorded by the respective sensing device 3a-3c exceeds those alarm limits. Likewise, alarm level may account for a code call, which requires significant resources (both clinician resources and device resources) to respond. Additionally, care team support resources (e.g., time, skillset) such as Centralized Monitoring Technicians or eICU nurses and physicians who may be involved in alarm/alert notification and response, patient monitoring, etc. processes can be envisioned to be included in the incident analysis module 24 and subsequent exemplary severity or resource utilization factors. These resources typically perform their responsibilities from a command and control like workstation located in the hospital or at a remote facility and do not tend to move to perform their care delivery support activities.
In certain embodiments, each possible alarm type and alarm level is allocated a numerical value according to the amount of resources typically required by that respective alarm type and alarm level. In such an embodiment, a numerical value may be calculated as the incident severity value 79, which then can be associated with and indicate the amount of resources required to respond to the respective incident group 63. In the non-limiting example illustrated at
In
For example, the clinician time usage for each alarm incident may be determined based on the clinician location(s) 66, such as how many clinicians had a clinician location 66 equaling the patient location 68 and how long each clinician spent at the patient location 68. This again can be determined as a numerical value, such as a total amount of clinician time (e.g., in minutes or seconds) is spent at the respective patient location 68. Additionally, such calculation may also account for the type of clinician at the patient location 68. For example, physician time may be weighted heavier than nurse time, and nurse time may be weighted heavier than technician time.
Likewise, clinician time usage may also account for the availability indicator 64 of each clinician whose clinician location 66 pattern indicates that they are attending to the alarm event 58 or incident group 63 for a patient. This can allow tracking of clinician time even as the clinician moves away from the patient location 68, such as to get needed supplies, devices, medication, input orders or information, etc. For example, the clinician device 70 may be configured to automatically set the availability indicator 64 to “unavailable” and link the clinician to the respective patient once the clinician location 66 reaches the patient location 68 during an alarm event 58 or incident group 63. The availability indicator 64 may continue to list the clinician as attending to the alarming patient until the incident group is terminated or the clinician provides input to change the value of the availability indicator 64. Thereby, the clinician time for that clinician may be tracked as the clinician moves about the care facility as needed to attend to the patient. As described previously, care team support resources such as Centralized Monitoring Technicians or eICU nurses and physicians who may be involved in alarm/alert notification and response, patient monitoring, etc. processes can also be envisioned to be included in the alarm/alert response clinician time determination. These resources typically perform their responsibilities from a command and control like workstation located in the hospital or at a remote facility and do not tend to move to perform their care delivery support activities. Although they perform their function away from the patient's room, their association, resource usage, etc. with the patient may be acquired and from staffing, assignment, workforce management, etc. systems.
The incident analysis module 24 may further generate a visual indicator to be provided on a display device to visually indicate each incident group 63, such as in conjunction with the display of physiological parameter data recorded by one or more of the sensing devices 3a-3c. The particular configuration of and information provided by the visual indicator may be configurable to provide inclusion or exclusion of different types of incident groups, such as those consisting of particular alarm types that may be of interest.
Both the incident bar 82 and the incident group bar 83 depict the initiation time T0 and termination time Tt for each incident group 63a, 63b. For example, the visual indicator 81 may be generated based on the information provided in the incident group designator 69 and/or based on the incident severity value 79. The exemplary display shown in
The exemplary display of
The incident analysis module 24 is a set of software instructions executed on one or more processors within the healthcare resource tracking system 132, which in some embodiments may include the computing system 235 of the host network 30 (or portions thereof) and/or include a computing system 135 of the patient monitoring system 1 (or portions thereof). In various embodiments, the incident analysis module 24 may be stored and executed within a computing system 235 of the host network 30. Alternatively or additionally, the incident analysis module 24 may be contained locally within the physiological monitoring system attached to or associated with the patient. For example, the incident analysis module 24 (or a portion thereof) may be stored in and executed by a computing system 135 within the hub 15 and/or in one or more of the sensing devices 3a-3c. Further, in certain embodiments, the incident analysis module 24 may be provided in multiple devices within the system 132, such as to carry out various aspects or steps of the methods described herein. In the embodiment of
In certain examples, communication between the host network 30 to the hub 15 may be via a publish-subscribe messaging pattern, or model. In such an embodiment, the host network 30 may publish information, and the hub 15 and/or the clinician device 70 subscribe to the published “messages” from the location tracking module 22 and/or the incident analysis module 24, or vice versa. Accordingly, the host network 30 does not need to establish a direct communication link with the hub 15 or the clinician device 70, and vice versa, and each can continue to operate normally regardless of the other.
Although the computing system 235 as depicted in
The processing system 219 may include any one or more processing devices, such as one or more microprocessors, general purpose central processing units, application-specific processors, microcontrollers, or any other type of logic-based devices. The processing system 219 may also include circuitry that retrieves and executes software 237 from storage system 221. Processing system 219 can be implemented within a single processing device but can also be distributed across multiple processing devices or sub-systems that cooperate in executing program instructions, such as in the cloud-computing application described above.
The storage system 221, which includes the patient medical record database 33, can comprise any storage media, or group of storage media, readable by processing system 219, and capable of storing software 237. The storage system 221 can include volatile and non-volatile, removable and non-removable media implemented in any method or technology for storage of information, such as computer-readable instructions, data structures, program modules, or other data. Storage system 221 can be implemented as a single storage device but may also be implemented across multiple storage devices or sub-systems. For example, the software 237 may be stored on a separate storage device than the medical record database 33. Likewise, medical record database 33 can be stored, distributed, and/or implemented across one or more storage media or group of storage medias. Similarly, medical record database 33 may encompass multiple different sub-databases at different storage locations and/or containing different information which may be stored in different formats. Storage system 221 can further include additional elements, such a controller capable of communicating with the processing system 219.
Examples of storage media include random access memory, read only memory, optical discs, flash memory, virtual memory, and non-virtual memory, magnetic sets, magnetic tape, magnetic disc storage or other magnetic storage devices, or any other medium which can be used to store the desired information and that may be accessed by an instruction execution system, as well as any combination or variation thereof, or any other type of storage medium. Likewise, the storage media may be housed locally with the processing system 219, or may be distributed in one or more servers, which may be at multiple locations and networked, such as in cloud computing applications and systems. In some implementations, the storage media can be a non-transitory storage media. In some implementations, at least a portion of the storage media may be transitory.
The communication interface 239 interfaces between the elements within the computing system 235 and external devices, such as various receiver/transmitters 31, 34a-34n that receive and transmit information to and from the host network 30. For example, the communication interface may operate to receive patient identifiers 61, clinician identifiers 60, and the corresponding receiver identifications 62 (providing the identification receiver 46a, 46n that received the patient/clinician identifier(s) generated via the location tracking system 40, receive alarm events 58, 59 from the hub 15 and/or directly from one or more of the sensing devices 3a-3c. The communication interface may further display of the visual indicator 81 such as at the central monitoring station 50.
Returning to step 93, if any group timer is already active, then steps are executed at step 102 to determine whether an alarm type of the alarm event is a permitted alarm type (which may be one of the first permitted alarm types or one of a new set of permitted alarm types). If the alarm type is not on any list of permitted alarm types, then the received alarm event is identified as a new first alarm event at step 104. A new group timer is started at step 106 based on the initiation time of the received alarm event, and new permitted alarm types are determined at step 108. The steps depicted in
Returning to step 102, if the alarm type of the received alarm event is a permitted alarm type, then steps are executed at step 110 to assign the received alarm event to the relevant group based on the alarm type. For example, the received alarm may be assigned to the first incident group associated with the first alarm event created at step 94, or to the incident group associated with the new first alarm event created at step 104. Numerous incident group analyses may continue simultaneously and each will have its own timer for which the control logic exemplified at
Step 112 is executed to determine whether all alarm events in the respective incident group have been terminated. If any alarm events are active, then the respective group timer remains active at step 114. Method steps, such as those exemplified at
For each incident, which may comprise an incident group or a single alarm event, steps are executed to determine the incident severity value 79. One exemplary method of determining the incident severity value is exemplified at
As described further below, a total severity value may also be calculated based on one or more incident severity values. The total severity value may be based on a group of alarm incidents for a particular patient, for a particular clinician, for a particular unit of a healthcare facility, etc. Accordingly, the total severity value may be used to indicate or assess resource utilization from a qualitative standpoint for a patient, clinician, or group of patients or clinicians.
In the example of
Whether or not any clinician has left the patient location at step 146, steps are executed at step 148 to determine whether the respective alarm incident has terminated. If not, the method continues, where the relevant clinician timers and the group timer remain active. Once the alarm incident is terminated, all clinician timers are stopped at step 150. The clinician time usage is then calculated at step 152, which in this embodiment is equal to the sum of all the clinician timers. In other embodiments, the clinician time usage may be calculated as being equal to the duration of the alarm incident. In such an embodiment, it may be assumed that a single clinician responded to the alarm incident, such as the clinician assigned to the patient, and that the clinician time required was equal to the duration of the alarm incident. Such an embodiment may be implemented, for example, in a healthcare resource tracking system 132 that does not receive input from or have access to a location tracking system 40.
Additionally, a total severity value may be calculated for each respective patient. In the exemplary embodiment, an incident severity value is calculated for each alarm incident and each nurse call event, represented at step 176. For instance, the incident severity value may be calculated according to the steps described above with respect to
Similarly, a total severity value may be calculated based on other groupings of alarm incidents, nurse call events, or other types of events, which may be collected based on a group of patients, a clinician, a group of clinicians, a unit of a healthcare facility, or the like. Accordingly, the total severity value can be determined to indicate or assess resource utilization from a qualitative standpoint, such as a degree of difficulty or how taxing or stressful the workload may have been to the clinician, group of clinicians, etc. responsible for the respective workload being analyzed.
This written description uses examples to disclose the invention, including the best mode, and also to enable any person skilled in the art to make and use the invention. Certain terms have been used for brevity, clarity and understanding. No unnecessary limitations are to be inferred therefrom beyond the requirement of the prior art because such terms are used for descriptive purposes only and are intended to be broadly construed. The patentable scope of the invention is defined by the claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the claims if they have features or structural elements that do not differ from the literal language of the claims, or if they include equivalent features or structural elements with insubstantial differences from the literal languages of the claims.
