Deploying advanced technology to improve patient outcomes

Dr Sandeep Budhiraja, Group Medical Director – Max Healthcare and Senior Director – Institute of Internal Medicine, Max Super Speciality Hospital shares insights on the various uses of technology for better patient outcomes

With sentinel events and cardiac arrests occurring in the wards, there was a need for continuous monitoring as it helps reduce ICU stay and enhances recovery. A reduced stay in ICU will further lessen the chances of ICU-acquired infections, ICU psychosis and allow family and attendants to be around the patient leading to better overall well-being of the patient. In adherence to our efforts towards patient safety and medical excellence, we have rolled out VIOS ward monitoring system at our Saket, SMART, Gurgaon, Patparganj and Shalimar Bagh units.

Collaboration with VIOS

VIOS is a tech-enabled device for improving healthcare by providing continuous monitoring for patients in the ward. It is a remote monitoring system which monitors vitals and triggers off alarms when vitals are beyond threshold values. These threshold values can be customised for each patient. It measures SpO2, heart rate, respiratory rate, BP, ECG, temperature and posture, and activity. The vitals and alarms can be seen at the nursing station on a central monitor and enables the staff to monitor patients remotely. Additionally, clinicians can also access patient vitals and trends via a web link.

The following have been the outcomes of deploying this technology at Max Healthcare:

• Reduced Burden across ICUs

By providing continuous monitoring for patients in the ward, patients from the ICUs can be shifted to wards quickly. Patients kept in the ICU only for monitoring can now be monitored in wards using this technology. It helps to step down the patients without compromising the quality of care and monitoring required to be given to the patient. VIOS ward monitoring system has enabled availability of beds for patients who are more critical and require intensive care thereby reducing the burden in ICUs.

• Improving the quality of care in wards

VIOS ward monitoring system triggers both technical and physiological alarms. Technical alarms can be resolved by the technicians, while the physiological alarms are to be resolved by nurses. Physiological alarms reflect a change in the patient condition that could potentially lead to a deterioration in the patient’s overall conditions. As has been seen in multiple recent studies, it is critical to detect and then treat a change in condition. VIOS ward monitoring system helps in detecting early signs of deterioration in a patient. There have been positive interventions where deteriorations were caught much earlier before any significant harm could have happened.

• Effective treatment plans

VIOS Ward Monitoring system records and stores patients’ vitals. This enables clinicians to see historical trends and patterns and aids in making more effective treatment care plans for the patient.

• Improving patient experience

This technology has also helped in improving hospitalisation experience for patients and their caregivers. Long-term stay in ICU increases patient anxiety thereby impacting their recovery. With this technology, the patient can experience 24×7 monitoring even outside the ICUs which helps them recover in the presence of their loved ones.

• Reduced cost to patients

Critical care has tremendous cost burdens on the patients and their caregivers. With the help of this technology, patients are monitored in the wards in an ICU like setup. This helps reduce critical care costs as compared to ICU charges.

A comprehensive screening of a new-born child is an essential step in ensuring the future health and well-being of the child. While we had a screening system in place, a gap was felt in terms of tracking the results, communication with parents and ensuring regular vaccinations post discharge. Max Healthcare has collaborated with expert partners to help provide a comprehensive screening and vaccination solution to babies born in the hospital.

Partnership with Northgate

Northgate newborn screening and vaccination management solution enables screening management for bloodspot screening, hearing screening, physical screening as well as pulse-oximetry. The status of the sample and results can be accessed online by paediatricians, nurse, lab technicians, hospital management, as well as parents using any mobile or desktop devices. The solution also provides vaccination alerts to parents and hospital thereby ensuring well-being of the child over the period of years. A pilot study was done for a period of four months and around 250 babies were tracked during this period. After the successful completion of the pilot study, Max Healthcare has partnered with Northgate Public Services. The newborn screening and vaccination service was launched at Max Hospital, Patparganj in November 2019. The service will be gradually rolled out to other hospitals within our network.

With this service, we aim to achieve the following benefits:

• Screening
• Tracking physical, hearing, bloodspot and pulse ox screening
• Auto-generated alerts for missed cases
• Auto-generated alerts to all stakeholders for positives
• Auto-generated follow-ups for repeat sample/ repeat test/ consultation
• Vaccination
• Tracking vaccination schedule
• Auto-generated alerts for all missed cases
• Auto-generated follow-ups for repeat sample/ repeat test/ consultation
• Tracking revenue generated through vaccination sales
• Quality
• Monitoring the completeness of documentation at every step across screening and vaccination pathway
• Data retrievable in audit trail format
• Monitoring performance of vendor partners
• Customer service and experience
• Increased patient engagement and connect through mobile application
• Improved patient empowerment and self-care provision post discharge through mobile application patient education
• Enhanced patients’ exposures to hospital’s upcoming events/offers

Automation in various departments

Computation and data in medical science are expected to increasingly support healthcare through improved insights and better decision making. Some of the ways in which data is being applied in a healthcare environment are improved clinical outcomes, economic dividend, enhanced quality of care, individual risk score, personalised medicine, disease prevention and increase service efficiency of hospitals.

Hospital Acquired Infections (HAI) surveillance programme – A system driven surveillance programme has been designed, implemented and is successful in use for the four major hospital-acquired infections, viz. central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator acquired pneumonia (VAP) and surgical site infection (SSI). The surveillance algorithm was designed, based on high suspicion for HAI in the admitted patient population. A new process for tracking the HAI cases by the infection-control teams, integrated with the tracking mechanism for end-to-end surveillance and improvement in incidence of HAI cases is in use at all our hospitals for the past four years.

Venous – Thrombo Embolism prophylaxis program: This programme runs on a system triggered workflow on the Electronic Health Record (EHR) system, which makes it mandatory for every patient at risk to undergo a VTE risk assessment, during their hospital stay. The goal is to prevent the development of deep venous thrombosis in the hospitalised patients, who would be at a higher risk of complication. We track improvements and use the data streams for identifying areas that need improvement. Over the years, the programme has shown significant improvement in risk assessment and prophylaxis compliance from 40 per cent to 90 per cent.

We use Drug Resistance Index, which is a useful method for surveillance of antimicrobial resistance among bacteria, to measure the prevalence of resistance in bacteria to the drugs that would normally kill or limit their growth. Drug resistance is a global problem, particularly for infections such as MRSA (Methicillin resistant Staphylococcus aureus), VRE (Vancomycin resistant Enterococci), tuberculosis, E. coli etc. The Drug Resistance Index (DRI), developed by “The Center for Disease Dynamics, Economics & Policy” is a composite measure that combines the ability of antibiotics to treat infections with the extent of their use in clinical practice.

The Anti-Microbial Stewardship (AMS) programme relies on the online availability of microbial and antibiotic resistance information to the clinician at the bedside. A mobile app provides antibiogram access to the clinicians anytime/anywhere. The antibiogram is based on patient flora and microbial antibiotic sensitivity data at the hospital to inform the rational use of antibiotics.