Today's methods are not good enough

There is a lack of basic vital sign monitoring in most hospital wards today. Only patients in the intensive care unit (ICU) have access to devices providing continuous vital sign monitoring.

Patient monitoring in general wards

Monitoring of basic vital signs such as heart rate, blood pressure, respiration, SpO2, and temperature is an integral part of patient care at hospitals. They are often the earliest indication of any abnormalities and precede critical illnesses (Evans et al. 2001).
Modern intensive care units (ICUs) have access to powerful instruments that provide accurate and continuous measurements of vital signs for each patient. Though these machines are great for the critically ill patients, they are more of a hassle for the general ward.
In a study where ICU like monitoring was introduced into normal wards, only 16% of patients remained connected for the 72 hour study period (Bonnici et al. 2013). The most common reason for removal was the limited ability to move freely. These machines are tethered to the patient, limiting movement, and as a result, recovery.
A typical room in a modern Norwegian Hospital. There is no patient monitoring equipment in the room, all observations are spot checks.
The machines also tend to be resource demanding in terms of time used by staff. This complicates the process of gathering vital signs in the general ward. As patients now live much longer and experience more complex health issues, an increasing number of critically ill patients are being placed in general wards. These patients require more frequent measurements than they are given today. The situation is that most patients are still monitored in the same way they have been for decades: where nurses take intermittent rounds of measuring vital signs.

The intermittent vital signs workflow

Nurses are responsible for visiting each patient and recording their vital signs. Rounds are typically made every 8 to 12 hours, but visits will increase if there is suspicion of deterioration (Leuvan and Mitchell 2008). The decision to increase the monitoring rate is often made using an Early Warning Score system (EWS).
If no monitoring devices are stored in the patient rooms, as is the case in most wards, nurses use a trolley to move the monitoring devices between rooms. They will then need to do each separate vital sign reading. These rounds take up a large chunk of nurses time. (Sahandi et al. 2010).
A normal vital signs workflow today
1
Locate NEWS sheet and portable trolley
2
Bring trolley to patient
3
Consciousness
Talk to patient, write down the state
4
Blood pressure
Apply, measure, write down values
5
SpO2 & heart rate
Apply, measure, write down values
6
Temperature
Apply, measure, write down value
7
Respiration
Count and write down value
8
Remove trolley and clean devices before next patient visit
The equipment needs to be cleaned before the nurse moves on to a new patient. When this is done, the nurse will take the collected data, often written down on paper or in some cases transcribe it into the patients EPJs. Given this time-consuming process, it is clear that an increase in the rate of manual observations is not feasible.
Trolley with equipment used for collecting vital signs
Paper NEWS sheet used to record vital signs
There are many reasons why one would like measurements as often as possible. The most commonly cited reason is sepsis, often referred to as blood poisoning. "Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death. In other words, it’s your body’s overactive and toxic response to an infection." Sepsis Alliance. 

While the immune system under normal function fights off any bacteria or parasites to prevent infection, sometimes in ill patients, it will turn on itself and deteriorate the body. Sepsis is a widespread condition that oddly very few in the general public know of, in fact, sepsis is one of the main reasons why patients die at the hospital (Faix 2013).
A disturbing part of sepsis is how fast it deteriorates the patient, for every hour a case of sepsis goes undetected, the chance of survival drops by about 8% (Kumar et al. 2006). The good news is that sepsis has distinct symptoms that make the condition detectable. The early symptoms include a fast heart rate, rapid breathing, shivering and a high (or low) body temperature.

Healthcare challenges & the needs of tomorrow

With a population that is getting older, living longer, with an increasing number of chronic and lifestyle diseases, it has been clear for quite some time now that current practices for care will not suffice in the future.
The pressing situation is clear from new estimates produced by St. Olavs Hospital. They state that if they are to be able to provide the same care as today, the number of hospital beds will have to be increased by 45% within 2035 (St. Olav Hospital 2018). They also estimate that 35% of all students graduating high school in 2035 will have to go into healthcare related jobs.
We keep hearing stories about how caregivers are not able to spend time with patients due to their hectic and stressful work environments. Nurses report that they feel pressured to increase their productivity and while also experiencing increased administrative workloads (Kieft et al. 2014).
St. Olavs estimate that 35% of all students graduating high school in 2035 will have to go into healthcare related jobs.
To make matters worse, Norway currently has a shortage of about 5900 nurses, this is an increase of 47% compared to 2017 when the number closer to 4000 (NSF 2018). This shortage is not an unforeseen surprise, it has been predicted and warned about for quite some time now. Yet, here we are. An insufficient nursing staff could have dire consequences, potential medication errors, increased numbers of infections and, in general, patients not receiving the care they require.
There are no simple solutions to this crisis. We have a vicious cycle where the current shortage is making the working condition worse for nurses, in turn making it harder to attract new nursing students. Current trends suggest that Norway will have a shortage of 30.000 nurses in 2035 (NSF 2018). So, on one hand, we have St. Olav Hospital estimating that they will require a drastic increase in the number of healthcare staff, and on the other, we have data pointing to a future with an extreme shortage.
We do not know how to solve this whole crisis. We're hoping to make a difference by creating powerful tools for nurses and doctors. By making and implementing our products in a thoughtful manner, we aim to make an impactful improvement to patient safety and the daily lives of healthcare personnel.
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