The novel approach allows patients to be monitored in general wards so the ICU can continue serving the severely-ill.

 

Ng Teng Fong General Hospital’s (NTFGH) Intensive Care Medicine (ICM) Department has completed a pilot for a first, remote non-invasive ventilation (NIV) monitoring system which transmits real-time vitals of patients on NIV therapy in the general wards to respiratory therapists (RT). This remote system will enable the continuous monitoring of such patients and early detection of deterioration in a patient or a technical failure of the NIV – thus enhancing patient safety, improving response time and efficiency.

Between April to June 2021, the ICM team led by Dr Faheem Ahmed Khan, head and senior consultant, Dr Nikhil Gautam, resident physician, as well as a multidisciplinary team of RTs who play the key role in this pilot led by Ian Cendana, head of respiratory therapy, nurses, facilities and IT colleagues, partnered Philips Singapore and Johnson Controls (Singapore) to develop this prototype remote monitoring system.

This system tracks every breath taken by a patient on NIV therapy in the general ward, capturing data such as the average respiratory rate, the volume and pressure of air, and continuously transmitting this data to the ICU where it is monitored ‘live’ by the RT. Also being monitored is the patient’s pulse rate and oxygen levels (SpO2). The combined data is captured through an integrated interface and displayed on a single dashboard. When a problem is detected, the system will trigger one of six alarms on the ventilator, and the RT will be alerted via this dashboard in the ICU. The RT will then immediately alert the nurse in the general ward to swiftly address any issues picked up from the live monitoring, including escalating the patient to the ICU in a timely manner.

An SMS alert system has also been developed so monitoring is not restricted to a desktop in the ICU. In the event of a clinical or technical (disconnections or power supply) issue, an alarm message will be sent to a mobile phone carried by the care team. This allows the RT to address such issues expeditiously, while on the go. This way, patients who are on NIV therapy can be safely and confidently managed in the general wards.

Globally, we have seen how severe COVID disease places a severe strain on healthcare resources and expertise, especially in the realm of respiratory related to intensive care services. This monitoring system is therefore especially applicable in the current pandemic situation. When demands for ICU manpower and beds are high in a COVID surge, it permits non-COVID positive patients needing NIV to receive the therapy safely and reliably outside of the ICU. This way scarce ICU resources are preserved for the severely-ill COVID patients who need it most.

Twenty-one COVID-negative patients (most are above 50 years old) with chronic but stable respiratory conditions were placed on a three-month pilot where the team documented 95 episodes (alarms), with timely rectifications by the RT or the ward nurse. Of these, there were seven instances whereby timely interventions triggered by alarms activated by the remote monitoring system averted deterioration in the patients.

Shared Dr Faheem Khan, “When we had to evolve our care with the ongoing pandemic, we saw the opportunity to innovate and came up with this unique process using the existing infrastructure and equipment. The learnings from this pilot will allow us to be more prepared for future pandemics where there could be a requirement for widespread NIV usage in the wards.”

Added Dr Nikhil Gautam, “Besides pressing on with more data collection and analysis in the second phase, the team is now in the process of developing a mobile app with additional functions of logging data events, alarms, as well as catering for two-way communication between the wards and the ICU.”

Fauziah Jabil, assistant director of nursing, said, “Nurses in the wards can now enhance their competency and experience in using NIV systems, especially against the backdrop of a pandemic, to provide good respiratory support for a wide range of conditions from sleep disordered breathing to chronic obstructive pulmonary disease, and palliative care, among others.”

 

(** PHOTO CREDITS: Ng Teng Fong General Hospital)