Embodiments of the present invention are generally related to centralized physiological monitoring of patients, and, more particularly, to a system and method for reducing the workload of a tele-tech monitoring physiological conditions of a plurality of patients at a centralized physiological monitoring station.
Various devices are known for monitoring physiological parameters, such as electrocardiogram (ECG), non-invasive blood pressure (NBP), and specific blood oxygen (SpO2) of patients being treated for medical conditions. Typically, such devices continually provide vital sign information based on the monitored physiological parameters to enable medical personnel, such as physicians, nurses, and other health care providers to provide appropriate care. However, in typical hospital environments where numerous patients are cared for, it can be difficult for medical personnel to monitor the vital sings of multiple patients on a continuous basis while maintaining responsiveness to problems of an individual patient.
In an attempt to alleviate demands on medical personnel for monitoring vital signs of multiple patients, centralized monitoring systems that collect physiological data from monitored patients and display the collected data at a central location have been developed. Such centralized monitoring systems are typically manned by telemetry technicians, or “tele-techs”, to alleviate a workload of medical personnel in providing direct care to patients. Vital sign information provided to the tele-tech is typically in the form of alerts or alarms. Upon recognizing an alert or alarm condition, the tele-tech notifies a clinician or nurse assigned to provide care to the corresponding patient generating the alert or alarm. Although such systems shift a continuous monitoring burden away from clinicians, tele-techs monitoring vital signs at a centralized location may experience work overload when they are required to monitor and respond to too many alerts and alarms within a prohibitively short period of time.
In an example embodiment, the invention includes a system for reducing a workload of a user monitoring respective physiological conditions of a plurality of patients at a centralized physiological monitoring station. The system includes a plurality of patient measurement systems generating respective alarms indicative of a patient's physiological condition and a centralized physiological monitoring station receiving the alarms from the patient measurement systems. The system also includes a processing module in communication with the centralized physiological monitoring station configured for adaptively controlling a presentation of the alarms at the centralized physiological monitoring station responsive to at least one of patient history information, historical alarm information, electro-physiological data, quality of service data, and staff assignment information so as to reduce a workload on a user monitoring the presentation of the alarms and a display in communication with the adaptive processing module for displaying the presentation of the alarms to the user at the centralized physiological monitoring station.
In another example embodiment, the invention includes a method for reducing a workload of a user monitoring respective physiological conditions of a plurality of patients at a centralized physiological monitoring station. The method includes providing a plurality of patient measurement systems for generating respective alarm signals indicative of a patient's physiological condition, providing a centralized physiological monitoring station for receiving the alarm signals from the patient measurement systems, and receiving alarms indicative of respective physiological conditions of a plurality of patients at the centralized physiological monitoring station. The method also includes monitoring patterns in the alarms for each of the patients, establishing individualized historical alarm information for each of the patients responsive to monitored trends in the alarms, and determining an urgency of the respective alarms according to the individualized historical alarm information. The method further includes providing notifications to a user monitoring the respective physiological conditions at the centralized physiological monitoring station, wherein the notifications are prioritized according to the urgency of the alarms so as to reduce a workload on the user by limiting a need of the user to respond to less urgent alarms so that the user is able to concentrate on more urgent alarms.
In another example embodiment, the invention includes computer readable media containing program instructions for reducing a workload of a user monitoring respective physiological conditions of a plurality of patients at a centralized physiological monitoring station. The computer readable media includes a computer program code for providing a plurality of patient measurement systems for generating respective alarm signals indicative of a patient's physiological condition, a computer program code for providing a centralized physiological monitoring station for receiving the alarm signals from the patient measurement systems, and a computer program code for receiving alarms indicative of respective physiological conditions of a plurality of patients at the centralized physiological monitoring station. The computer readable media also includes a computer program code for monitoring patterns in the alarms for each of the patients and a computer program code for establishing individualized historical alarm information for each of the patients responsive to monitored trends in the alarms. The computer readable media also includes a computer program code for determining a urgency of the respective alarms according to the individualized historical alarm information and a computer program code for providing notifications to a user monitoring the respective physiological conditions at the centralized physiological monitoring station, wherein the notifications are prioritized according to the urgency of the alarms so as to reduce a workload on the user by limiting a need of the user to respond to less urgent alarms so that the user is able to concentrate on more urgent alarms.
In another example embodiment, the invention includes a system for reducing a workload of a user monitoring respective physiological conditions of a plurality of patients at a centralized physiological monitoring station. The system includes a plurality of patient measurement systems generating respective alarms indicative of a patient's physiological condition and a centralized physiological monitoring station receiving the alarms from the patient measurement systems. The system also includes a processing module in communication with the centralized physiological monitoring station configured for adaptively controlling a presentation of the alarms at the centralized physiological monitoring station responsive to at least one of patient history information, historical alarm information, electro-physiological data, quality of service data, and staff assignment information so as to reduce a workload on a user monitoring the presentation of the alarms and a display in communication with the adaptive processing module for displaying the presentation of the alarms to the user at the centralized physiological monitoring station.
The inventors have recognized that conventional centralized patient monitoring systems may be prone to causing work overload conditions for tele-techs of the systems, such as tele-techs. For example, alarms generated by conventional monitoring equipment may not be immediately actionable by tele-techs monitoring the system, and may require the tele-tech to refer back to raw waveform data to verify the accuracy and consistency of the alarm. In addition, tele-techs may be required to manually note the status of actions in progress, which may take longer to complete than the persistence of the alarm itself. Another problem facing tele-techs is that staff assignments in hospitals tend to be highly dynamic, making it sometimes difficult for a tele-tech to locate an appropriate clinician to respond to an alarm. Furthermore, in wireless monitoring systems that include ambulatory patients, a higher number of artifacts, or false alarms, may be generated than for monitoring systems monitoring non-ambulatory patients. Although such false alarms generally are considered to have low priority, they may create a large distraction to the tele-tech monitoring many patients. Finally, typical centralized monitoring systems may not provide an indication of when or whether a requested intervention action has been performed, or whether it has been successful.
The centralized physiological monitoring station 16 may provide information, such as visual and auditory indicia, on display 22. The centralized physiological monitoring station 16 may be in communication with one or more databases 20, such as a hospital information database (HIS) capable of supplying additional information such as admissions data, patient medical history, or laboratory test results. The centralized physiological monitoring station 16 may also be in communication with a medical personnel notification system (PNS) 24 that may in turn include paging, digital voice (voice-over IP), or telephony capability, an auditory alarm system, and/or a personnel tracking system (e.g., badges, RFID) and/or security system.
In an aspect of the invention, the centralized monitoring system 10 is configured to reduce the workload of centralized monitoring staff, such as tele-techs, and, by extension, reduce workloads of primary clinicians responsible for care and treatment of inpatients at a medical facility. Accordingly, the centralized monitoring system 10 may include a processor 18 in communication with the centralized physiological monitoring station configured to monitor patterns in alarms for each of the patients and to establish individualized historical alarm information for each of the patients responsive to monitored patterns in the alarms. The historical alarm information may be stored in a database 20. The processor 18 may also be configured to determine an urgency of the respective alarms according to the individualized historical alarm information. In addition, the processor 18 may be configured be to provide notifications to a user, such as a tele-tech, monitoring the respective physiological conditions at the centralized physiological monitoring station 10. The notifications may be prioritized according to the urgency of the alarms so as to reduce a workload on the tele-tech. By providing notifications prioritized according to urgency, a need of the tele-tech to respond to less urgent alarms may be reduced so that the tele-tech is able to concentrate on more urgent alarms.
In an example embodiment, the processor 18 may be configured to identify ones of the alarms that do not require a response by the tele-tech and to ignore these alarms. The processor 18 may also be configured to establish historical false alarm information based on ones of the alarms that do not require a response, and to store this information in a database, such as database 20. In other example embodiments, the processor 18 may be configured to determine the urgency of the respective alarms according to predetermined guidelines and/or an availability of responders to the respective alarms.
The processor 18 may further be configured to determine whether a tele-tech has responded to the notifications and to modify priorities of notifications when the tele-tech has not responded within a predetermined time. In another example embodiment, the processor 18 may be configured to establish respective tasks to be performed responsive to the notifications, and to determine when the respective tasks have been completed. The processor may also be configured to establish historical task information responsive to the respective tasks that have been completed. This information may be stored in a database, such as database 20, and accessed to determine the urgency of the respective alarms according to the historical task information stored therein. The processor 18 may also be configured to access patient admission data, for example, stored in database 20. The system 10 may further include a display in communication with the processor 18 for providing the notification to, i.e., alerting of, the tele-tech, such as by providing visual and/or auditory indicia corresponding to a priority of the notification.
Accordingly, the operation of the system 10 includes screening and verifying alarms received from patient measurement systems, classifying alarms by severity, and determining what form of notification is appropriate for a tele-tech and/or for clinicians on a ward. Workflow tasks may be initiated for alarms that require the involvement of medical personnel, and such tasks may include the incorporation of paging, telecommunications, or remote display devices in proximity to medical personnel. Other tasks may also be initiated and/or remotely displayed for other medical personnel, such as ward administrative personnel, tele-runners (who change batteries), and/or aides, when patients being monitored wirelessly are out-of-range of a receiving node. Tasks may be associated with a specific patient, and may include display indicia corresponding to an urgency of the task. Completed tasks may be logged into a case base that may be used, along with historical data from each patient, to automatically adjust alarm configuration suitable to a condition of the patient. This may involve the adjustment of alarm priorities and/or limits (for example, using machine learning) to adapt alarms to the patient's current state or medical condition. The information stored in the case base may also be used to augment historical data, and to support quality-of-service monitoring, auditing, and staffing system information.
The system 10 may be configurable for different hospital workflow practices, staffing policies, patient management protocols, etc. The system 10 may automatically provide adjustments suitable for staffing shortages periods of high workload, such as power outages or local emergencies), or other hospital-related circumstances. The system 10 may further include automatic physician notification outside the hospital environment.
Alarms may be classified using a variety of known techniques. In an embodiment, a technique incorporating unsupervised learning, such as the k-means clustering algorithm, or semi-supervised learning may be used. Support vector machine algorithms for clinical alarm pattern detection and classification may also be used to classify alarms. For example, given a large unlabeled dataset, such as a dataset of sequential clinical alarms, a k-mean clustering algorithm may be used to select a small, e.g., 5% to 10%, representative sample for alarm pattern detection. In another example embodiment, a combined labeled-unlabeled dataset may be classified using a semi-supervised support vector machine (SVM). In another example embodiment, a growing self-organizing map (GSOM) and an SVM machine technique may be used for alarm pattern detection and classification.
Workflow support and tracking block 32 may prioritize alarms and provide suggested measures for responding to the alarms, perform job scheduling and resource optimization, and dispatch clinicians for alarm servicing. The workflow support and tracking block 32 may also manage current active or in-progress alarms and update an individual's alarms status. For example, the workflow support and tracking block 32 may be configured for determining whether alarms have had a respond and reprioritizing ones of the alarms that have not had a respond. To perform the above procedures, the workflow support and tracking block 32 may receive information from the alarm pattern detection and classification block 30, information from a staff assignment system 42, feedback from a paging system 44, for example to verify that tasks have acted upon, and/or from quality-of-service data 38. The workflow support and tracking block 32 may generate prioritized visual and/or auditory alarms based on the information provided.
The level and limit adaptation block 34 may adaptively change parameter settings 52 of patient measurement systems based on an individual patient's alarm patterns. The level and limit adaptation block 34 may receive electro-physiological data 46, information from the alarm pattern detection and classification block 30, information from a staff assignment system 42 (derived, for example, from medical personnel status and location tracking 54), feedback from a paging system 44 to verify that tasks have acted upon, (responsive, for example, to patient condition and location 56), historical alarm information from an alarm history 37; and/or information from quality metrics 38. Alarms limits and levels may be determined using classification methods such as a known boosting decision tree technique and/or a known neural network technique.
Based on the foregoing specification, the invention may be implemented using computer programming or engineering techniques including computer software, firmware, hardware or any combination or subset thereof, wherein the technical effect is reducing a workload of a tele-tech monitoring physiological conditions of a plurality of patients at a centralized physiological monitoring station. Any such resulting program, having computer-readable code means, may be embodied or provided within one or more computer-readable media, thereby making a computer program product, i.e., an article of manufacture, according to the invention. The computer readable media may be, for instance, a fixed (hard) drive, diskette, optical disk, magnetic tape, semiconductor memory such as read-only memory (ROM), etc., or any transmitting/receiving medium such as the Internet or other communication network or link. The article of manufacture containing the computer code may be made and/or used by executing the code directly from one medium, by copying the code from one medium to another medium, or by transmitting the code over a network.
One skilled in the art of computer science will easily be able to combine the software created as described with appropriate general purpose or special purpose computer hardware, such as a microprocessor, to create a computer system or computer sub-system embodying the method of the invention. An apparatus for making, using or selling the invention may be one or more processing systems including, but not limited to, a central processing unit (CPU), memory, storage devices, communication links and devices, servers, I/O devices, or any sub-components of one or more processing systems, including software, firmware, hardware or any combination or subset thereof, which embody the invention.
While certain embodiments of the present invention have been shown and described herein, such embodiments are provided by way of example only. Numerous variations, changes and substitutions will occur to those of skill in the art without departing from the invention herein. Accordingly, it is intended that the invention be limited only by the spirit and scope of the appended claims.