During the first COVID-19 outbreak in Europe, hospitals faced an acute demand for (ICU) beds and a high workload for personnel under difficult circumstances. The disease proved to be unpredictable and heterogeneous in its expression and course, and to require a long hospital stay. COVID-19 patients typically deteriorate very rapidly, leaving little time to initiate (oxygen) therapy, and prepare patients and relatives for a potential ICU admission. Care professionals reported they could not rely on clinical signs in predicting deterioration and making medical decisions. General nursing wards are not equipped for advanced monitoring; standard of care consists of intermittent manual measurement of vital signs only 1-3 times a day. However, continuous measurement is crucial for early detection of deterioration and minimizes undesirable physical contact. In particular, respiratory rate (RR), oxygen saturation (SpO2), heart rate (HR), and variability (HRV) are identified as important parameters in COVID-19. Anticipating a potential second COVID-19 outbreak, decision support for timely escalation to medium or intensive care is urgently needed.
The need for in-hospital continuous vital signs monitoring was already addressed in the ongoing Interreg EMR project wearIT4health, in which a prototype of a decision support system at technology readiness level (TRL) 5 was developed and is currently tested in hospitals.
It consists of:
1. A wearable continuous monitoring device measuring: ECG and PPG (to determine HR(V), RR, SpO2, blood pressure), activity & temperature
2. Algorithms that, based on these parameters, estimate Early Warning Scores (EWS) to support care professionals in daily practice
3. A monitoring platform to integrate the device parameters into hospital IT systems to be viewed and used by care professionals
State of the art systems lack either the necessary TRL level, parameters, accuracy, continuous measurement, seamless integration into hospital IT systems and/or warning scores for COVID-19 patients. Therefore, the wearIT4health partners aim to optimize their system for COVID-19 patients specifically and perform clinical pilot testing at TRL6/7
1. Optimization of the wearIT4health monitoring device: improving accuracy and reliability of the parameters SpO2 and RR, relevant to overcome specific COVID-19 patient couching and sneezing artefacts
2. Development of algorithms for monitoring and predicting COVID-19 Warning Scores (CWS), which will take into account COVID-19 patient specific conditions
3. Integration of additional monitoring devices and the CWS algorithms into the monitoring platform. Due to new insights into COVID-19, additional parameters may become relevant during the course of the project. Also, CWS algorithms and security featues will be further integrated into the platform to increase efficiency of daily care and security
4. Clinical pilot testing to assess the functionality, usability, validity and accuracy of the entire monitoring system at general wards in Belgian and Dutch hospitals
Main expected results
Anticipating a potential 2nd COVID-19 outbreak, the result of the project will be an optimized monitoring system with an emphasis on the monitoring of COVID-19 patients and an increased TRL level for clinical pilot testing. A higher TRL level shortens the time line towards final production and implementation of the system by interreg EMR industrial partners. By using the system, hospitals will be able to optimize care for COVID-19 patients with minimum physical contact, thereby lowering workload and capacity problems. Many citizens, specifically patients and their relatives, and also care professionals will benefit from this optimization
Added value of cooperation
The partners are complementary in: coordination (ITF ULiège), clinical care/implementation (CHU of Liège, ZOL, MUMC+) and technological development (Microsys ULiège, KULeuven, UHasselt, UM). The partners worked together successfully in the wearIT4Health project, the basis for an efficient and effective execution of the project within the limits on funding and time. The technological partners have expertise to optimize the monitoring device and work together with hospitals for intermediate tests and end-user feedback. The 3 EMR region hospitals provide patient data to KULeuven to develop the CWS algorithms. Development of the monitoring platform is led by the IT department of the CHU of Liège together with the other hospital IT departments, required for a seamless implementation of the system in the hospitals, and technological partners for the integration of additional devices, the CWS algorithms and security features. The hospitals together will test the system on patients in 3 EMR regions.