Patent Application
20190267136
The present disclosure is directed generally to health care. More particularly, but not exclusively, various methods and apparatus disclosed herein relate to organizing multiple individuals such as patients in areas such as waiting rooms into a patient monitoring queue to monitor changes in their conditions.
When patients visit the hospital, they typically are triaged to determine various information about the patients, such as their names, ages, heights, weights, vital signs, reasons for visiting, and other similar information. Once triaged, the patients are sent to an area such as a waiting room to wait for hospital resources such as physicians to become available to examine and/or treat the patients. Wait times for the patients may be significant depending on availability of hospital resources. It is not uncommon for patients to deteriorate while waiting, and medical personnel may not always become aware of the deterioration in a timely fashion.
The present disclosure is directed to methods, systems, and apparatus for organizing multiple individuals such as patients in areas such as waiting rooms into a queue to monitor changes in their conditions. For example, a plurality of triaged patients may wait in a waiting room until they can be seen by an emergency room (“ER”) physician. The patients may be included in a patient monitoring queue (also referred to simply as a “patient queue”) that is ordered or ranked, for instance, based on a measure of acuity associated with each patient (referred to herein as a “patient acuity indicator”) that is determined based on information obtained/acquired from the patient by a triage nurse, as well as other data points such as patient waiting time, patient presence, etc. In some embodiments, medical personnel may be dispatched to manually obtain one or more updated vital signs from each patient, e.g., in an order of the patient queue. In other embodiments, one or more “vital sign acquisition cameras” mounted in the waiting room may be configured to periodically perform contactless and/or unobtrusive acquisition of one more vital signs from each patient. Whether obtained by medical personnel manually, or automatically using vital sign acquisition cameras or other means such as wearable sensors, these updated vital signs may include but are not limited to blood pressure, temperature, pulse, oxygen saturation (“SO2”), respiration rate, skin color, posture, sweat levels, and so forth.
The resources used to monitor the patients—for example the vital sign acquisition cameras—may be limited. Accordingly, the patient queue may be ranked or “prioritized” in various ways to properly schedule the patients to be monitored. In some embodiments, the patient queue may be prioritized using first-in-first-out (“FIFO”) techniques, round robin techniques, and so forth. However, in other embodiments, the patient queue may be prioritized so that more urgent patients are monitored more frequently than less urgent patients, e.g., because more urgent patients may be more likely to deteriorate while waiting. For instance, in some embodiments, the patient queue may be prioritized based at least in part on patient acuity indicators associated with the patients. For example, the patient acuity indicators may be used to determine and assign next scheduled times for monitoring to the patients, and the patient queue may be prioritized by the next scheduled times for monitoring.
Generally, in one aspect, a method may include: receiving, by one or more processors, a patient acuity indicator associated with each patient of a plurality of patients in an area that can be captured by one or more vital sign acquisition cameras, wherein the patient acuity indicator associated with each patient is based on one or more initial vital signs acquired from the patient; establishing, by one or more of the processors, a patient monitoring queue that includes the plurality of patients prioritized based at least in part on the patient acuity indicators; selecting, by one or more of the processors, from the patient queue, a patient at the head of the patient monitoring queue; unobtrusively acquiring, by one or more of the vital sign acquisition cameras, one or more updated vital signs from the selected patient; and altering, by one or more of the processors, the patient monitoring queue in response to an outcome of the unobtrusive acquiring.
In various embodiments, the patient queue may be prioritized further based on next scheduled times for the patients to be monitored. In various embodiments, a next scheduled time for each patient to be monitored may be determined based at least in part on a patient acuity indicator associated with the patient. In various embodiments, the outcome of the unobtrusive acquiring may include providing, by one or more of the processors, output alerting medical personnel of deterioration of the selected patient, and the altering may include removing the selected patient from the patient queue.
In various embodiments, the outcome of the unobtrusively acquiring may include a failure to unobtrusively acquire the one or more updated vital signs, and the altering comprises re-queuing the selected patient. In various embodiments, the outcome of the unobtrusively acquiring may include successful acquisition of the one or more updated vital signs, and the altering may include re-queueing the selected patient based at least in part on a patient acuity indicator associated with the selected patient. In various embodiments, re-queueing the selected patient may include calculating a next scheduled time for the selected patient to be monitored based at least in part on the patient acuity indicator associated with the selected patient. In various embodiments, re-queueing the selected patient may include inserting the selected patient into a selected position of the patient queue. The selected position may precede another patient in the patient queue with a next scheduled time to be monitored that is later than, or greater than, the next scheduled time for the selected patient to be monitored.
In various embodiments, the method may further include identifying, by one or more of the processors, the selected patient among the plurality of patients in the area based on a reference image depicting the selected patient. In various embodiments, the reference image is captured by one or more cameras associated with a triage station or registration desk associated with a medical waiting room. In various embodiments, the method may further include: setting, by one or more of the processors, a watchdog timer to a predetermined time interval; re-selecting the selected patient from the patient queue in response to a determination that the predetermined time interval has elapsed since updated vital signs were last unobtrusively acquired from any patient in the patient queue; and resetting the watchdog timer in response to detection of an attempt to unobtrusively obtain updated vital signs by the one or more vital sign acquisition cameras.
It should be appreciated that all combinations of the foregoing concepts and additional concepts discussed in greater detail below (provided such concepts are not mutually inconsistent) are contemplated as being part of the subject matter disclosed herein. In particular, all combinations of claimed subject matter appearing at the end of this disclosure are contemplated as being part of the subject matter disclosed herein. It should also be appreciated that terminology explicitly employed herein that also may appear in any disclosure incorporated by reference should be accorded a meaning most consistent with the particular concepts disclosed herein.
In the drawings, like reference characters generally refer to the same parts throughout the different views. Also, the drawings are not necessarily to scale, emphasis instead generally being placed upon illustrating the principles of the disclosure.
When patients visit the hospital, they typically are registered and triaged to determine various information about the patients, such as their names, ages, heights, weights, vital signs, reasons for visiting, and other similar information. Once triaged, the patients are sent to an area such as a waiting room to wait for hospital resources such as physicians to become available to examine and/or treat the patients. Wait times for the patients may be significant depending on availability of hospital resources. Occasionally patients deteriorate while waiting, and medical personnel may not always become aware of the deterioration in a timely fashion. Accordingly, techniques described herein facilitate monitoring of patients' conditions in an area such as a waiting room, in an order that prioritizes more critical patients while ensuring that all patients, no matter how critical, are periodically monitored.
The following are definitions of terms as used in the various embodiments of the present invention. The term “database” as used herein refers to a collection of data and information organized in such a way as to allow the data and information to be stored, searched, retrieved, updated, and manipulated and to allow them to be presented into one or more formats such as in table form or to be grouped into text, numbers, images, and audio data. The term “database” as used herein may also refer to a portion of a larger database, which in this case forms a type of database within a database. “Database” as used herein also refers to conventional databases that may reside locally or that may be accessed from a remote location, e.g., remote network servers. The database typically resides in computer memory that includes various types of volatile and non-volatile computer storage. Memory wherein the database resides may include high-speed random access memory or non-volatile memory such as magnetic disk storage devices, optical storage devices, and flash memory. Memory where the database resides may also comprise one or more software for processing and organizing data received by and stored into the database.
At block 108, the new patient may be registered. Registration may include, for instance, collecting information about the patient such as the patient's name, age, gender, insurance information, and reason for visit. Typically, but not exclusively, this information may be manually input into a computer by medical personnel such as a triage nurse. In some embodiments, one or more reference images of the patient may be acquired, e.g., by a camera that is integral with a computing device operated by the triage nurse, by a standalone camera, and/or by a vital sign acquisition camera (in which case at least some vital signs may be optionally acquired at registration). In many instances, the triage nurse additionally may acquire various initial vital signs at block 110 using various medical instruments. These initial vital signs may include but are not limited to blood pressure, pulse, glucose level, SO2, photoplethysmogram (“PPG”), respiration rate (e.g., breathing rate), temperature, skin color, and so forth. While not depicted in
In some embodiments, during triage, the patient may be assigned a so-called “patient acuity indicator,” which may be a measure that is used to rank a severity of the patient's ailment, and in some instances may indicate an anticipated need for emergency room resources. Any number of commonly used indicators and/or clinician decision support (“CDS”) algorithms may be used to determine and/or assign a patient acuity indicator, including but not limited to the Emergency Severity Index (“ESI”), the Taiwan Triage System (“TTS”), the Canadian Triage and Acuity Scale (“CTAS”), and so forth. For example, in some embodiments, vital signs of the patient may be compared with predefined vital sign thresholds stored in a system database, or with published or known vital sign values typical for a given patient age, gender, weight, etc., to determine the patient's initial patient acuity indicator and/or the patient's initial position in the patient queue. Once the patient is registered and their initial vital signs acquired, at block 112, the patient may be sent to waiting room 104. In some embodiments, various physiological and other information about the patient may be fed into a trained model (e.g., regression model, neural network, deep learning network, etc.), case-based reasoning algorithm, or other clinical reasoning algorithm to derive one or more acuity indicators. In some embodiments, the information used for deriving the patient acuity indicator may include or even be wholly limited to vitals or other information that may be captured by the vital sign acquisition camera. In some embodiments, the information used for deriving the acuity indicator may alternatively or additionally include information such as information from a previous electronic medical record (“EMR”) of the patient, information acquired from the patient at triage, information from wearable devices or other sensors carried by the patient, information about other patients or people in the waiting room (e.g., vitals of others in the room), information about family members or others associated with the patient (e.g., family member EMRs), etc.
At block 114, it may be determined, e.g., using one or more cameras, sensors, or input from medical personnel, that a patient has left the waiting room. Block 114 may include scanning each person currently within the waiting room (e.g., as part of a seeking function that attempts to locate the patient once the patient is at top of a queue of patients for which vitals are to be captured, such as an execution of block 120 described below, or cycling through each person in the room to capture vitals, as multiple executions of the loop including blocks 118 and 120 described below) and determining that the patient was not located. In some embodiments, the system may wait until a predetermined number of instances of the patient missing is reached or a predetermined amount of time has passed during which the patient is missing before the patient is deemed to have left the waiting room to account for temporary absences (e.g., visiting the restroom or speaking with clinical staff in a triage room). For example, the patient may have been taken into the ER proper because it is their turn to see a doctor. Or the patient's condition may have improved while they waited, causing them to leave the hospital. Or the patient may have become impatient and left to seek care elsewhere. In some instances, the patient may leave and then come back, e.g., after using the restroom. Whatever the reason, once it is determined that the patient has left the waiting room for at least a threshold amount of time, at block 116, the patient may be released from the system, e.g., by removing them from a queue in which registered patients are entered. In some cases, a nurse or other medical personnel may document the patient's absence, and their return if they come back.
At block 118, a patient in waiting room 104 may be identified for monitoring using techniques described herein. For example, in some embodiments, information associated with a plurality of patients in the waiting room (e.g., information obtained at triage) may be ranked in a patient monitoring queue, e.g., by their respective patient acuity indicators, in addition to or instead of other measures such as waiting times, patient presence in the waiting room (e.g., missing patients may be searched for to further determine if they have left without being seen, or just went to a restroom or vending machine), etc. In yet other embodiments, patient acuity indicators may not be considered when ranking the patient monitoring queue, and instead only considerations of patient waiting times, patient presence, etc., may be considered.
However such a patient monitoring queue is ranked, in some embodiments, the first patient in the queue is identified as the one to be monitored next. It is not required (though it is possible) that the patient monitoring queue be stored in sequence of physical memory locations ordered by patient acuity indicators. Rather, in some embodiments, a ranked patient monitoring queue may merely include a rank or priority level value associated with each patient. In other words, a “patient monitoring queue” as described herein may refer to a “logical” queue that is logically ranked based on patient acuity indicators, waiting time etc., not necessarily a contiguous/ordered sequence of memory/database locations. Patients may be identified for monitoring at block 118 in an order of their respective ranking in the patient monitoring queue.
At block 120, the patient identified at block 118 may be located in waiting room 104. In some embodiments, one or more vital sign acquisition cameras (not depicted in
In other embodiments, no patient monitoring queue may be established. Instead, vital sign acquisition cameras may simply be configured to pan, tilt, and/or zoom so that their respective fields of view move across predetermined trajectories of waiting room 304. For example, vital sign acquisition cameras may be configured to sequentially scan across rows of chairs, and/or to sequentially scan through areas of waiting room 104 known to be commonly inhabited by patients. In yet other embodiments, one or more cameras with a wide field of view may be used to detect, identify and monitor many or all patients simultaneously. In such embodiments, as each face is captured, it is matched against patient records to identify the patient to which the face corresponds so that vitals may be captured and correlated to the correct patient or person.
In various embodiments, the system may not be limited to only monitor patients that have been registered in the system (e.g., according to steps 108-112). For example, it is possible that a companion of a patient in the waiting room may develop a condition that requires attention, even though they themselves were not registered as a patient. As another example, a patient may not go through registration 108-112 and simply sit down in the waiting room because the waiting room/registration stations are busy, they do not know to register, they choose not to register, etc. In such embodiments, the system may detect a non-registered person by capturing an image/video of their face (or capture other identifying features) and fail to find a matching patient record among the registered patients. In such a case, the system may create a new record to represent the unknown patient, capture vitals for storage in the record as initial vitals measurements, and record the image/video as a reference image (or attempt to capture one or more additional images/videos, potentially from better angles, for subsequent use as reference images). If an alert or other information about the unknown patient is to be displayed to the waiting room staff (e.g., as described below), the information may be displayed along with one or more of these reference images/videos to aid the staff in identifying the person in the waiting room to which the alert or other information corresponds. If the person is later registered according to steps 108-112, the new information may be merged into the “unknown person” record either manually (e.g., by staff manually selecting the existing record which is to be supplemented with registration information) or automatically (e.g., by later comparing the reference images of the two records and determining they correspond to the same person, or by later encountering difficulty/ambiguity by matching the person to both records during a vitals capture sequence).
At block 122, one or more vital sign acquisition cameras mounted or otherwise deployed in or near waiting room 104 may be operated to perform unobtrusive (e.g., contactless) acquisition of one or more updated vital signs from the patient identified at block 118 and located at block 120. These vital sign acquisition cameras may be configured to acquire (without physically contacting the patient) a variety of different vital signs from the patient, including but not limited to blood pressure, pulse (or heart rate), skin color, respiratory rate, PPG, SO2, temperature, posture, sweat levels, and so forth. In yet other embodiments, updated vital signs may be obtained manually, e.g., by medical personnel, rather than automatically using vital sign acquisition cameras. In yet other embodiments, updated vital signs may be obtained automatically using other devices such as wearable sensors.
In some embodiments, vital sign acquisition cameras equipped to perform so-called “contactless methods” to acquire vital signs and/or extract physiological information from a patient may be used as medical image devices. Non-limiting examples of such cameras are described in United States Patent Application Publication Nos. 20140192177A1, 20140139656A1, 20140148663A1, 20140253709A1, 20140235976A1, and 20140275880A1, which are incorporated herein by reference for all purposes.
In some embodiments, one technique for determining a patient's heart rate or pulse may be to monitor the patient's facial skin color. Micro-changes in skin color that are caused by blood flow may be detected by a vital sign acquisition camera. These detected micro-changes may be used to determine a pulse rate of the patient. Facial skin color changes due to varying heart rate changes may not be visible to the naked eye, but the use of vital sign acquisition cameras described herein may allow detection of micro-changes in skin color.
Another vital sign measurable by vital sign acquisition cameras described herein is a patient's respiratory rate. In some embodiments, a vital sign acquisition camera may zoom in to the patient's chest and/or abdominal area to track the patient's chest or abdominal movements. The medical image device may then determine the patient's respiratory rate, which may be determined by monitoring the movement of the patient's chest or diaphragm area. Additionally or alternatively, a patient's body temperature may be determined by vital sign acquisition cameras described herein that are configured to capture thermographic or infrared images/video.
At block 124, it may be determined, e.g., by one or more components depicted in
At block 126, it may be determined (again, by one or more components of
Registration module 242 may be configured to receive, e.g., as manual input from a duty nurse, registration information of new patients. This may include, for instance, the patient's name, age, insurance information, and so forth. Triage module 244 may be configured to receive, e.g., as manual input from a duty nurse or directly from networked medical equipment, vital signs such as those described above and/or other physiological data, such as weight, height, the patient's reason for the visit, etc. In various embodiments, vital signs received by triage module 244 and/or a patient acuity indicator (e.g., ESI in
Alarm module 248 may be configured to receive information indicative of various events, such as patient deterioration, and raise various alarms and/or alerts in response. These alarms and/or alerts may be output using a variety of modalities, including but not limited to visual output (e.g., on display screens visible to hospital personnel), intercom announcements, text messages, emails, audio alerts, haptic alerts, pages, pop-up windows, flashing lights, and so forth. Modules 242-248 of hospital information system 240 may be operably coupled, e.g., via one or computer networks (not depicted), to a hospital information system interface 250 (“H.I.S. Interface” in
Hospital information system interface 250 may serve as an interface between the traditional hospital information system 240 and a patient monitoring system 252 configured with selected aspects of the present disclosure. In various embodiments, the hospital information system interface 250 may publish, e.g., to other modules of the patient monitoring system 252, various information about patients such as registration information, patient acuity indicators (e.g., ESI), prescribed and/or administered medications, whether a patient has been released, various alarms/alerts, and so forth. As will be described below, in some embodiments, these publications may be provided to an event publish and subscribe (“EPS”) module 270, which may then selectively store them in database 272 and/or selectively publish them to other modules of patient monitoring system 252. In some embodiments, hospital information system interface 250 may additionally or alternatively subscribe to one or more alerts or publications provided by other modules. For example, hospital information system interface 250 may subscribe to alerts from deterioration detection module 268, e.g., so that hospital information system interface 250 may notify appropriate components of hospital information system 240, such as alarm module 248, that a patient is deteriorating.
Patient monitoring system 252 may include a variety of components that facilitate monitoring of patients in an area such as waiting room 104 to ensure that patients are served in a manner conducive with their actual medical condition. Patient monitoring system 252 may include, for instance, a patient capture module 254 that interfaces with one or more cameras 256, a patient queue module 258, a patient locator module 260, a dynamic calibration module 262, a face/torso acquisition module 264, a vital signs measurement module 266, a deterioration detection module 268, the aforementioned EPS module 270, and one or more databases 272, 274. As noted above, each of modules 250, 254, and 258-274 may be implemented using any combination of hardware and software. And while these modules are depicted separately, that is not meant to be limiting or to suggest each is implemented on a separate piece of hardware or software. For example, one or more modules may be combined and/or omitted, and one or more modules may be implemented on one or more computing systems operably connected via one or more computer networks (not depicted). The lines depicted connecting various components of
Patient monitoring system 252 may also include one or more vital sign acquisition cameras 276 that are configured to acquire, e.g., from some distance from a patient, one or more vital signs of the patient. Examples of such vital sign acquisition cameras were described above. In various embodiments, a vital sign acquisition camera 276 may be a pan-tilt-zoom (“PTZ”) camera that is operable to pan, tilt, and zoom so that different parts of an area such as waiting room 104 are contained within its field of view. In this manner, it is possible to scan the area being monitored to locate different patients, so that updated vital signs may be acquired unobtrusively.
Patient capture module 254 may receive, from one or more cameras 256, one or more signals carrying captured image data of a patient. For example, in some embodiments, patient capture module 254 may receive a video stream from camera 256. Patient capture module 254 may perform image processing (e.g., face detection, segmentation, shape detection to detect human form, etc.) on the video stream to detect when a patient is present, and may capture a reference image of the patient in response to the detection. In some embodiments, the reference image may be captured at a higher resolution than individual frames of the video stream, although this is not required. In some embodiments, camera 256 may be a standalone camera, such as a webcam, a PTZ camera (e.g., 276), and so forth, that is deployed in or near pre-waiting room area(s) 102. The one or more images captured by camera 256 may be used thereafter as reference patient images that are associated with the patient and used later to identify the patient in the area being monitored.
Patient queue module 258 may be configured to establish and/or maintain a patient monitoring queue, e.g., in a database, of patients in the area being monitored. In various embodiments, the patient monitoring queue may be ordered by various parameters. In some embodiments, patients in the patient monitoring queue may be ranked based in part on patient acuity indicators (i.e. by priority based on health status) and/or other parameters, such as waiting time, arrival time, etc. In some embodiments, updated vital signs may be acquired from patients waiting in the area being monitored, such as waiting room 104, in an order of the queue. In other embodiments, updated vital signs may be acquired from patients in a FIFO or round robin order. In other embodiments, updated vital signs may be acquired from patients in an order that corresponds to a predetermined scan trajectory programmed into vital sign acquisition camera 276 (e.g., scan each row of chairs in order).
Patient locator module 260 may be configured to use one or more signals received from vital sign acquisition camera 276, in conjunction with one or more reference patient images captured by patient capture module 254, to locate one or more patients in the area being monitored (e.g., waiting room 104). Patient locator module 260 may use various image processing techniques to identify patients using various visual features of patients. These visual features that may be used to recognize patients may include but are not limited to facial features, torso features, clothing, hair, posture, and so forth.
In some embodiments, patient locator module 260 may search an area being monitored for particular patients from which to obtain updated vital signs. For example, patient locator module 260 may search the area being monitored for a patient identified by patient queue module 258, which may be, for instance, the patient at the head of the patient monitoring queue. In some embodiments, patient locator module 260 may cause vital sign acquisition camera(s) 276 to scan the area being monitored (e.g., waiting room 104) until the identified patient is identified.
Dynamic calibration module 262 may be configured to track the use of vital sign acquisition camera(s) 276 and calibrate them as needed. For instance, dynamic calibration module 262 may ensure that whenever vital sign acquisition camera 276 is instructed to point to a particular PTZ location, it always points to the same place. PTZ cameras may be in constant or at least frequent motion. Accordingly, their mechanical components may be subject to wear and tear. Small mechanical errors/biases may accumulate and cause vital sign acquisition camera 276 to respond, over time, differently to a given PTZ command. Dynamic calibration module 262 may correct this, for instance, by occasionally running a calibration routine in which landmarks (e.g., indicia such as small stickers on the wall) may be used to train a correction mechanism that will make vital sign acquisition camera 276 respond appropriately
Once a patient identified from patient queue 258 is recognized by patient locator module 260, face/torso acquisition module 264 may be configured to pan, tilt, and/or zoom one or more vital sign acquisition cameras 276 so that their fields of view capture a desired portion of the patient. For example, in some embodiments, face/torso acquisition module 264 may pan, tilt, or zoom a vital sign acquisition camera 276 so that it is focused on a patient's face and/or torso. Additionally or alternatively, face/torso acquisition module 264 may pan, tilt, or zoom one vital sign acquisition camera 276 to capture the patient's face, and another to capture the patient's torso. Various vital signs may then be acquired. For instance, vital signs such as the patient's pulse, SpO2, respiratory rate, and blood pressure may be obtained, e.g., by vital signs measurement module 266, by performing image processing on an image/video of the patient's face captured by vital sign acquisition camera(s) 276. Vital signs such as the patient's respiratory rate, general posture (which may indicate pain and/or injury), and so forth may be obtained, e.g., by vital signs measurement module 266, by performing image processing on an image/video of the patient's torso captured by vital sign acquisition camera(s) 276. Of course, the face and torso are just two examples of body portions that may be examined to obtain vital signs, and are not meant to be limiting.
Deterioration detection module 268 may be configured to analyze one or more signals to determine whether a condition of a registered patient is deteriorating, improving, and/or remaining stable. In some embodiments, the patient condition may be represented, at least in part, by the same patient acuity indicators described above for determining order of patients for monitoring. As such, the deterioration detection module 268 may include one or more CDS, case-based reasoning, or other clinical reasoning algorithms as described herein or other clinical reasoning algorithms (e.g., trained logistic regression models or other machine learning models) for assessing patient condition measures other than acuity indicators described herein. In some embodiments, the algorithms for assessing patient acuity or other measures of patient condition employed by deterioration detection module 268 may be updated from time to time by, for example, writing new trained weights (e.g., theta values) for a selected machine learning module or providing new instructions for execution by a processor (e.g. in the form of a java archive, JAR, file or compiled library). These signals may include, for instance, a patient's initial vital signs and other physiological information (e.g., obtained at blocks 108-110 of
EPS module 270 may be a general communication hub that is configured to distribute events released by various other components of
In some embodiments, EPS module 270 may be in communication with one or more databases, such as database 272 and/or archive 274 (which may be optional). In some embodiments, EPS module 270 may accept remote procedure calls (“RPC”) from any module to provide access to information stored in one or more databases 272 and/or 274, and/or to add information (e.g., alerts) received from other modules to databases 272 and/or 274. Database 272 may store information contained in alerts, publications, or other communications sent/broadcast/transmitted by one or more other modules in
It will be apparent that various hardware arrangements may be utilized to implement the patient monitoring system 252. For example, in some embodiments, a single device may implement the entire system 252 (e.g., a single server to operate the camera 276 to perform the vitals acquisition functions 260-266 and to perform the vitals analysis and alerting functions including deterioration detection 268 and queue management 258). In other embodiments, multiple independent devices may form the system 252. For example, a first device may drive the camera 276 and implement functions 260-266 while another server may perform the remaining functions. In some such embodiments, one device may be local to the waiting room while another may be remote (e.g., implemented as a virtual machine in a geographically distant cloud computing architecture). In some embodiments, a device (e.g., including a processor and memory) may be disposed within the camera 276 itself and, as such, the camera 276 may not simply be a dumb peripheral and, instead may perform the vital signs functions 260-266. In some such embodiments, another server may provide indications (e.g. identifiers, full records, or registered facial images) to the camera 276 to request that vitals be returned for further processing. In some such embodiments, additional functionality may be provided on-board the camera 276 such as, for example, the deterioration detection 268 (or preprocessing therefor) and/or patient queue 258 management may be performed on-board the camera 276. In some embodiments, the camera 276 may even implement the HIS interface 250 or EPS 270. Various additional arrangements will be apparent.
In some embodiments, one or more updated vital signs of the patients 378 may be acquired using video cameras 376A, 376B. Additionally or alternatively, vital sign acquisition cameras 376 may analyze patients 378 for abnormal breathing patterns such as heavy or irregular breathing. An image or video of a patient with a very pale skin color that also depicts the patient experiencing shortness of breath may be compared to the patient's reference image, e.g., stored by hospital information system 240, to determine that the patient is experiencing a heart attack. In such a scenario, an alert may be sent immediately to medical personnel, e.g., by text message, intercom announcement, output on a display screen, etc.
Suppose that in
Techniques described herein are not limited to hospital waiting rooms. There are numerous other scenarios in which techniques described herein may be implemented to achieve a variety of technical advantages. For example, disclosed techniques may also be used for security monitoring of crowds in airports, arenas, and other public places. In such scenarios, rather than monitoring patients to determine patient acuity deterioration, individuals may be monitored for other types of measurements, such as risk measurements.
As another example,
In some embodiments, at the start of the monitoring process, e.g., when first athlete 478A enters the gym to workout, one of the two vital sign acquisition cameras 476 may identify first athlete 478A, e.g., based on a reference image captured previously (e.g., when first athlete 478 joined the gym and received a photo ID). Vital sign acquisition camera 476A may zoom in to a facial area of first athlete 478A to acquire a heart rate. The acquired vital signs may be transmitted by vital sign acquisition camera 476A to a computing device (not depicted, one or more components of patient monitoring system 252) for further analysis, and may be stored in a database (e.g., 272, 274). If the acquired vital signs exceed a certain threshold level, a notification (e.g., in the form of audible signal or a visual alert) may be generated to alert training instructor 486 about the exceeded threshold. In some embodiments, the computing device may recommend specific steps to be performed by first athlete 478A, such as stretching and adequate breaks between training sessions. Similar techniques may be applied to other athletes, such as second athlete 478B, depending on their respective health conditions. In some embodiments, rather than monitoring for signs of injury, techniques described herein may be used in a gym or similar setting to track calories burned or other physiological metrics, e.g., based on athlete movement, weight, temperature, pulse, respiration rate, etc., that are tracked by vital sign acquisition cameras 476 over time. To adapt the system of
At block 502, individual health indices (e.g., patient acuity indicator, workout intensity measure, ESI, etc.) may be received, e.g., from medical personnel (e.g., at triage), for a plurality of individuals (e.g., patients, athletes, residents of a nursing home, etc.) located in an area such as a waiting room that is capable of being captured in fields of view of the above-described vital sign acquisition cameras (which as noted above may have adjustable fields of view by virtue of panning, tilting, and/or zooming). For example, in various embodiments, prior to entering the monitored area, one or more initial vital signs may be acquired from each individual, e.g., by a triage nurse or trainer. Based on these initial vital signs, individual health indices may be determined, e.g., by medical personnel, for each individual in the area at block 502.
At block 504, the system may establish (or update, if it already exists) a queue (e.g., a patient queue) of individuals in the area. In various embodiments, the queue may be ordered and/or ranked based at least in part on the individual health indices determined at block 502. Additionally or alternatively, in some embodiments, the queue may be ordered based on other data points, including but not limited to the time each patient arrived, how long each patient has waited, and so forth.
At block 506, the system may select a given individual from which updated vital signs are to be acquired. For example, the system may select a patient having a highest patient acuity indicator, which in many cases may be the first patient in the queue. In other embodiments, the system may select individuals in different orders, such as using FIFO and/or round robin.
At block 508, the individual selected at block 506 may be located (e.g., block 120 of
In some embodiments, at block 512, deterioration in the individual selected at block 506 and located at block 508 may be detected based on the updated vital signs obtained at block 510 and at least one of an individual health index (e.g., patient acuity indicator) associated with the given patient (e.g., determined at block 502) or initial vital signs (or updated vital signs acquired during a previous iteration of patient monitoring system 252) acquired from the given patient. If deterioration is detected, e.g., due to a difference between initial and updated vital signs satisfying a threshold, the method 500 may proceed to block 514. At block 514, various modalities of output, including but not limited to text messages, intercom announcements, visual output, audio output, haptic feedback, etc., may be provided to alert pertinent personnel of the difference, e.g., to notify a duty nurse of deterioration of a patient. In some embodiments, for example, medical personnel may be alerted of patient deterioration by displaying either a most-recently captured image of the deteriorating patient (e.g., so that medical personnel will know who to look for in the waiting room) or a live streaming video of the deteriorating patient in the waiting room. Regardless of whether method 500 proceeds to block 514 after block 512, method 500 may proceed back to block 504 to update the queue, e.g., to reorder the queue so that the patient having the next highest patient acuity indicator may be monitored).
While examples described herein have primarily involved vital sign acquisition cameras such as cameras configured to perform contactless acquisition of vital signs, this is not meant to be limiting. In various embodiments, other types of sensors may be incorporated into vital sign acquisition cameras and/or deployed separately to detect vital signs of patients. For example, motion sensors may be used, for example, to detect abnormal motions of a patient in a waiting room such as those due to a patient undergoing a seizure. Various types of motion sensors may be employed, including but not limited to infrared, optical, microwave, ultrasonic, acoustic, or tomographic based sensors, as well as those that fall under the category of occupancy sensors. Motion sensors may be passive and/or dynamic. Passive infrared sensors, for instance, detect heat movement by way of a pyroelectric sensor designed to detect infrared radiation radiated by a moving body. Ultrasonic sensors, by contrast, may leverage the Doppler-shift principle. An ultrasonic sensor may transmit high frequency sound waves in a monitored area and detect reflected wave patterns. Microwave sensors may work in a similar fashion except that they may transmit high frequency microwaves rather than sound waves.
User interface input devices 622 may include a keyboard, pointing devices such as a mouse, trackball, touchpad, or graphics tablet, a scanner, a touchscreen incorporated into the display, audio input devices such as voice recognition systems, microphones, and/or other types of input devices. In general, use of the term “input device” is intended to include all possible types of devices and ways to input information into computer system 610 or onto a communication network.
User interface output devices 620 may include a display subsystem, a printer, a fax machine, or non-visual displays such as audio output devices. The display subsystem may include a cathode ray tube (CRT), a flat-panel device such as a liquid crystal display (LCD), a projection device, or some other mechanism for creating a visible image. The display subsystem may also provide non-visual display such as via audio output devices. In general, use of the term “output device” is intended to include all possible types of devices and ways to output information from computer system 610 to the user or to another machine or computer system.
Data retention system 624 stores programming and data constructs that provide the functionality of some or all of the modules described herein. For example, the data retention system 624 may include the logic to perform selected aspects of method 500, and/or to implement one or more components of patient monitoring system 252.
These software modules are generally executed by processor 614 alone or in combination with other processors. Memory 625 used in the storage subsystem can include a number of memories including a main random access memory (RAM) 630 for storage of instructions and data during program execution, a read only memory (ROM) 632 in which fixed instructions are stored, and other types of memories such as instruction/data caches (which may additionally or alternatively be integral with at least one processor 614). A file storage subsystem 626 can provide persistent storage for program and data files, and may include a hard disk drive, a floppy disk drive along with associated removable media, a CD-ROM drive, an optical drive, or removable media cartridges. The modules implementing the functionality of certain implementations may be stored by file storage subsystem 626 in the data retention system 624, or in other machines accessible by the processor(s) 614. As used herein, the term “non-transitory computer-readable medium” will be understood to encompass both volatile memory (e.g. DRAM and SRAM) and non-volatile memory (e.g. flash memory, magnetic storage, and optical storage) but to exclude transitory signals.
Bus subsystem 612 provides a mechanism for letting the various components and subsystems of computer system 610 communicate with each other as intended. Although bus subsystem 612 is shown schematically as a single bus, alternative implementations of the bus subsystem may use multiple busses.
Computer system 610 can be of varying types including a workstation, server, computing duster, blade server, server farm, or any other data processing system or computing device. In some embodiments, computer system 610 may be implemented within a cloud computing environment. Due to the ever-changing nature of computers and networks, the description of computer system 610 depicted in
Further, in this embodiment the color sensor 890 generates three different color signals 892A, 892B, 892C, e.g. by use of a color filter array 893 having three different color filter areas provided in front of a photo detector 895 (or, more generally, the image sensor). Such a color sensor (e.g. including a color filter array having only two color filter areas) could also be used in the embodiment shown in
At block 902, a current patient queue may be established. In some embodiments, the current patient queue may be obtained from a crowd monitoring database (“CMD” in
Additionally or alternatively, the patient queue may be generated on the fly as new patients are registered and/or triaged. The patient queue may be prioritized (or “ranked’) based on various data points. For example, in some embodiments, the patient queue may be prioritized based (directly or indirectly) at least in part on patient acuity indicators associated with the multiple patients. Suppose ESI is used as the patient acuity indicator. More acute patients—i.e. those having lower ESI's—may generally be monitored more frequently than less acute patients. However, if patients were prioritized in the patient queue solely based on ESI, then the least acute patients may be at risk of perpetually being moved to the back of the patient queue (e.g., if new, more acute patients keep coming in) and never monitored (or at least monitored at an unacceptably low frequency).
Accordingly, to ensure that all patients are monitored at an acceptable frequency, in some embodiments, the patient queue may be directly prioritized based at least in part on so-called “next scheduled times” for the patients to be monitored. These “next scheduled times” may be future times at which patients should be (or are projected to be) “dispatched” from the patient queue for monitoring by one or more vital sign acquisition cameras 276. It is not required that a patient be monitored at their next scheduled time. If the monitoring resource—e.g., one or more vital sign acquisition cameras—is available to monitor a patient earlier than the patient's next scheduled time (i.e., all patients in front of the patient in the patient queue have been monitored), then the patient may be monitored ahead of the scheduled time. Likewise, if the one or more vital sign cameras fall behind schedule, patients may be monitored in their order in the queue, even if their actual monitored times are later than their next scheduled times. And of course, other metrics besides “next scheduled times for monitoring” may be used instead, such as numeric (or alphabetic) priority scores or ranks, etc.
Referring back to
At block 906, the patient at the head (which is a “logical” head of the queue and need not necessarily be the first in a sequence of memory locations) of the patient queue may be “dispatched” for monitoring. “Dispatch” as used herein does not necessarily refer to any deliberate action by the patient or by medical personnel. Rather, “dispatch” as used herein refers to an identity of the patient being provided to other components, so that the other components can cause updated vital signs to be acquired from a patient. For example, patient queue module 258 may dispatch a patient by publishing an identifier associated with the patient at the head of the patient queue to EPS module 270. EPS module 270 may then publish the identifier to any other modules in
At block 908, patient queue module 258 may then wait for and handle events as they arrive, e.g., from EPS module 270. One example of an event that may be provided to patient queue module 258 is a determination that the predetermined time interval associated with the watchdog timer set at block 904 has elapsed since updated vital signs were last unobtrusively acquired from any patient in the patient queue. This may suggest, for instance, that vital sign acquisition camera(s) and/or another module (e.g., 260, 262, 264, 266) has frozen or otherwise malfunctioned. In such a scenario, the patient at the head of the queue may be re-selected from the patient queue and provided to other components (e.g., patient locator module 260) for monitoring. In some embodiments, if the watchdog expires multiple times before a patient can be monitored, an alert may be raised, e.g., by alarm module 248 in response to a notification from EPS module 270, that there is a problem with one or more components of patient monitoring system 252. On the other hand, if a patient is successfully monitored (or at least an attempt is made to monitor the patient), then the watchdog timer may be reset.
A release patient event 1024 may be raised when a patient is released, e.g., because they have been taken into the emergency room or elsewhere to be treated, or because they leave the waiting room on their own volition, e.g., after notifying medical personnel that they are feeling better. In such an event, the patient may be removed from the queue at block 1026. In some embodiments, removing a patient from the queue may include deleting an entry (e.g., memory location) associated with the released patient, so that the released patient will not be considered when other patient queue alterations are performed.
A change to patient acuity indicator event 1028 may be raised when a patient acuity indicator associated with a patient changes. For example, medical personnel may, e.g., in response to a determination (based on updated vital signs obtained by vital sign acquisition camera(s) 276) that the patient is deteriorating, reexamine and/or have a conversation with the patient. The patient's deterioration may not necessarily warrant immediate treatment in the emergency room, but a patient acuity indicator of the patient may have changed, warranting more frequent (or less frequent, as the case may be) monitoring. In such case, at block 1030, the patient may be re-queued based on their new patient acuity indicator. Re-queueing such a patient may be performed in a manner similar to the method 1100 depicted in
A cannot find patient event 1032 may be raised when patient locator module 260 is unable to locate the dispatched patient using vital sign acquisition camera(s) 276. For instance, the patient may have left without notifying staff, or the patient may have gone to the bathroom or otherwise wandered off. In such event, in some embodiments, the un-located patient may be re-queued at block 1034, e.g., by performing operations similar to those depicted in
In some embodiments, re-queuing the un-located patient at block 1034 may trigger a dispatch subroutine 1070. At block 1072 of dispatch subroutine 1070, it may be determined whether this is the second (or greater) attempt to locate that patient. If the answer is yes, then an alert may be raised at 1074. For example, a duty nurse or other medical personnel may be notified—e.g., by way of a display screen, audible alert, page, text message, etc.—that that the patient cannot be found. Regardless of whether an alert is raised at block 1074, at block 1076 of dispatch subroutine 1070, the patient at the head of the queue (the missing patient was re-queued at block 1034 and therefore is no longer at the head of the patient queue) may be dispatched for monitoring. In some embodiments, the aforementioned watchdog timer may then be reset at block 1078 of dispatch subroutine.
A monitoring complete event 1036 may be raised when vital signs measurement module 266 of patient monitoring system 252 is able to operate one or more vital sign acquisition cameras 276 successfully to obtain updated vital signs. Assuming the patient has not deteriorated, the patient may be re-queued (1038) in a manner similar to that depicted in
A monitoring failed event 1040 may be raised when vital signs measurement module 266 of patient monitoring system 252 is unable to operate one or more vital sign acquisition cameras 276 to obtain updated vital signs from a dispatched patient. In such event, the patient may be re-queued at block 1042. Similarly, a monitoring partially failed event 1044 may be raised when vital signs measurement module 266 of patient monitoring system 252 is only partially successfully able to operate one or more vital sign acquisition cameras 276 to obtain updated vital signs from a dispatched patient. For example, if vital sign acquisition camera 276 is configured to acquire three different vital signs, but only manages to acquire one or two vital signs, then the monitoring may be considered a partial failure. In such event, the patient may be re-queued at block 1046. Whether the patient is re-queued at block 1042 or 1046, as indicated in
In some embodiments, when re-queuing a particular patient, a next scheduled time for monitoring the particular patient may be calculated based at least in part on whether the most recent monitoring attempt failed. For example, suppose a particular patient was successfully monitored (i.e. updated vital signs were successfully acquired by vital sign acquisition camera(s) 276 at block 1036). In some embodiments, the particular patient's next scheduled time for monitoring may be calculated, for instance, by adding a current time to a value (e.g., in minutes) associated with a patient acuity indicator of the particular patient. However, if the monitoring partially (1044) or completely failed (1040), it may be beneficial to expedite the particular patient's next scheduled time for monitoring. For example, in some embodiments, a patient's next scheduled time for monitoring after a monitoring attempt fails completely may be set to a minimum time interval (e.g., five minutes), or as a relatively small fraction of what the patient's next schedule monitoring time would have been after successful monitoring. Similarly, a patient's next scheduled time for monitoring after a monitoring attempt fails partially may be set to a shorter time interval than what the patient's next scheduled monitoring time would have been after successful monitoring (e.g., half the time), but perhaps longer than the patient's next scheduled monitoring time would have been after complete monitoring failure.
A watchdog timer expiration event 1048 may be raised when the aforementioned watchdog timer expires before any new attempts are made to acquire updated vital signs from a patient using vital sign acquisition camera(s) 276. As noted above, in such an event, the last dispatched patient (i.e., the “current patient”) may be re-dispatched at block 1050, e.g., sending operation back to block 1076 of dispatch subroutine 1070.
At block 1102, a new queue entry may be created, e.g., by allocating one or more memory locations (e.g., instantiating a new database record) to be populated with the monitored patient's information (e.g., patient identifier, patient acuity indicator, next scheduled time for monitoring, last known location in waiting room, etc.). Additionally, the queue entry that previously contained the monitored patient's information (which triggered the just-completed successful monitoring) may be removed from the queue. At block 1104, contents of the old queue entry removed from the queue at block 1102 may be copied into the newly-created queue entry. In other embodiments, instead of adding a new entry to the patient queue and removing the old entry, the same entry (e.g., the same memory locations and/or database entry) of the queue may be re-used.
At block 1106, the next scheduled time to monitor the monitored patient may be calculated and/or updated based at least in part on the monitored patient's patient acuity indicator. A non-limiting example of how a patient's next scheduled time to be monitored may be calculated is depicted in
Referring back to
At block 1114, the next entry in the patient queue having the same next scheduled time for monitoring but a lesser patient acuity indicator than the monitored patient may be identified “Lesser” in this context means less acute/urgent, so in embodiments in which ESI is used as the patient acuity indicator, “lesser acuity” actually means “greater ESI score”. Then, method 1100 proceeds to block 1112, and the monitored patient's new queue entry is inserted into the patient queue before the entry identified at block 1114.
The patient queue on the left side of
As noted above, in some embodiments, the next scheduled times depicted in
While several embodiments have been described and illustrated herein, those of ordinary skill in the art will readily envision a variety of other means and/or structures for performing the function and/or obtaining the results and/or one or more of the advantages described herein, and each of such variations and/or modifications is deemed to be within the scope of the embodiments described herein. More generally, those skilled in the art will readily appreciate that all parameters, dimensions, materials, and configurations described herein are meant to be exemplary and that the actual parameters, dimensions, materials, and/or configurations will depend upon the specific application or applications for which the teachings is/are used. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific embodiments described herein. It is, therefore, to be understood that the foregoing embodiments are presented by way of example only and that, within the scope of the appended claims and equivalents thereto, embodiments may be practiced otherwise than as specifically described and claimed. Inventive embodiments of the present disclosure are directed to each individual feature, system, article, material, kit, and/or method described herein. In addition, any combination of two or more such features, systems, articles, materials, kits, and/or methods, if such features, systems, articles, materials, kits, and/or methods are not mutually inconsistent, is included within the scope of the present disclosure.
All definitions, as defined and used herein, should be understood to control over dictionary definitions, definitions in documents incorporated by reference, and/or ordinary meanings of the defined terms.
The indefinite articles “a” and “an,” as used herein in the specification and in the claims, unless clearly indicated to the contrary, should be understood to mean “at least one.”
The phrase “and/or,” as used herein in the specification and in the claims, should be understood to mean “either or both” of the elements so conjoined, i.e., elements that are conjunctively present in some cases and disjunctively present in other cases. Multiple elements listed with “and/or” should be construed in the same fashion, i.e., “one or more” of the elements so conjoined. Other elements may optionally be present other than the elements specifically identified by the “and/or” clause, whether related or unrelated to those elements specifically identified. Thus, as a non-limiting example, a reference to “A and/or B”, when used in conjunction with open-ended language such as “comprising” can refer, in one embodiment, to A only (optionally including elements other than B); in another embodiment, to B only (optionally including elements other than A); in yet another embodiment, to both A and B (optionally including other elements); etc.
As used herein in the specification and in the claims, “or” should be understood to have the same meaning as “and/or” as defined above. For example, when separating items in a list, “or” or “and/or” shall be interpreted as being inclusive, i.e., the inclusion of at least one, but also including more than one, of a number or list of elements, and, optionally, additional unlisted items. Only terms clearly indicated to the contrary, such as “only one of” or “exactly one of,” or, when used in the claims, “consisting of,” will refer to the inclusion of exactly one element of a number or list of elements. In general, the term “or” as used herein shall only be interpreted as indicating exclusive alternatives (i.e. “one or the other but not both”) when preceded by terms of exclusivity, such as “either,” “one of,” “only one of,” or “exactly one of.” “Consisting essentially of,” when used in the claims, shall have its ordinary meaning as used in the field of patent law.
As used herein in the specification and in the claims, the phrase “at least one,” in reference to a list of one or more elements, should be understood to mean at least one element selected from any one or more of the elements in the list of elements, but not necessarily including at least one of each and every element specifically listed within the list of elements and not excluding any combinations of elements in the list of elements. This definition also allows that elements may optionally be present other than the elements specifically identified within the list of elements to which the phrase “at least one” refers, whether related or unrelated to those elements specifically identified. Thus, as a non-limiting example, “at least one of A and B” (or, equivalently, “at least one of A or B,” or, equivalently “at least one of A and/or B”) can refer, in one embodiment, to at least one, optionally including more than one, A, with no B present (and optionally including elements other than B); in another embodiment, to at least one, optionally including more than one, B, with no A present (and optionally including elements other than A); in yet another embodiment, to at least one, optionally including more than one, A, and at least one, optionally including more than one, B (and optionally including other elements); etc.
It should also be understood that, unless clearly indicated to the contrary, in any methods claimed herein that include more than one step or act, the order of the steps or acts of the method is not necessarily limited to the order in which the steps or acts of the method are recited.
In the claims, as well as in the specification above, all transitional phrases such as “comprising,” “including,” “carrying,” “having,” “containing,” “involving,” “holding,” “composed of,” and the like are to be understood to be open-ended, i.e., to mean including but not limited to. Only the transitional phrases “consisting of” and “consisting essentially of” shall be closed or semi-closed transitional phrases, respectively, as set forth in the United States Patent Office Manual of Patent Examining Procedures, Section 2111.03.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/EP2017/077837 | 10/30/2017 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 62420593 | Nov 2016 | US |
