A breath of fresh air – How interactive technology could transform the patient experience in intensive care

24 September 2018 – A doctor’s experience of dealing with acute trauma on the battlefield is being used to help improve the lives of critically ill civilian patients in intensive care units (ICUs). Dr Charlotte Small and the critical care research team at the Queen Elizabeth Hospital Birmingham (QEHB) in the UK are working with technology and product design firm Cambridge Design Partnership (CDP) on a novel approach to the complex task of weaning recovering patients off ventilators.

Millions of people are admitted to ICUs around the world each year – with the majority recovering and eventually returning home. But discharge from the ICU is often not the end of the story – many patients experience significant and persistent physical, psychological or social problems. One key contributor to these issues can be the process of weaning patients off ventilator support after an extended period of chronic critical illness.

The weaning process involves various regimens of progressive reduction in mechanical support – analogous to athletic or resistance training. But, unlike athletic training, the ICU process is out of the control of patients – who may also be disorientated, confused and suffering short-term memory loss. As a result, they can be prone to distress or panic when breathing support is partially or temporarily withdrawn. As well as contributing to psychological trauma, this can lead to extended ICU stays and poorer long-term outcomes.

Now Dr Small and CDP are harnessing interactive technology in a bid to make the process more patient friendly. With funding from the National Institute for Health Research (NIHR), they are creating a ‘digital liberation from ventilation’ (DELVE) system to give patients easy-to-understand information on a screen about their breathing performance – both real time and historical – and so engage them in the weaning process. The dashboard will also enable clinicians to see at a glance a patient’s breathing performance and improve their understanding of an individual’s progress – mechanical ventilator devices currently provide no easy way of viewing historical patient data, so doctors usually piece together data from multiple sources such as vital signs monitors and clinician notes.

Loss of muscle mass whilst on mechanical ventilation is another significant challenge to patient recovery. Patients typically undergo physiotherapy sessions to rebuild body strength as soon as they are medically stable enough on the ICU. The dashboard could include a gamification element to make breathing exercises more interesting and enable patients to do them on their own – speeding up the process of building up their diaphragm muscles and relearning how to breathe for themselves.

“This novel approach has the potential to improve the patient experience – and patient outcomes – whilst preserving precious healthcare resources,” said Matt Brady, partner and head of medical therapy systems at CDP. “It’s a fantastic example of what can be achieved when human factors, design and user experience expertise are combined with electronic and software skills in a cost-effective way for the benefit of the patient and the healthcare system.”

Dr Small works in anaesthesia and pain medicine at the QEHB. Her previous role as an anaesthetic trainee in the Royal Air Force led her to undertake research and quality improvement work into the management of acute trauma-related pain. She is the chief investigator for a programme of work at the NIHR Surgical Reconstruction and Microbiology Research Centre investigating how interactive technology could benefit the experience and performance of patients during early rehabilitation in ICUs – which includes a feasibility study of the DELVE system.

“This exciting programme of work has huge potential for patients and their loved ones,” said Dr Small. “By improving understanding of the process of recovery from critical illness – and combining that with the knowledge gained from our research – we aim to enhance clinician decision making and prediction of recovery pathways. Working with the CDP development team – with its understanding of the technical aspects, as well as patient and clinician perspectives – has been crucial to bringing our ideas to life.”

The NIHR Surgical Reconstruction and Microbiology Research Centre funding the project is a partnership between the NIHR, the Ministry of Defence, University Hospitals Birmingham NHS Foundation Trust (which runs the QEHB) and the University of Birmingham. The initiative brings both military and civilian trauma surgeons and scientists together to share advanced clinical practice on the battlefield and innovation in medical research to benefit all trauma patients in the NHS at an early stage of injury.

Notes for editors
Cambridge Design Partnership is a technology and product design partner focused on helping clients grow their businesses. Some of the world’s largest companies trust CDP to develop their most important innovations. Located in both Cambridge (UK) and in Palo Alto, California (US), CDP specialises in the consumer products, healthcare, energy and industrial equipment markets. Its multidisciplinary staff have the expert knowledge to identify opportunities and tackle the challenges its clients face. For more information, visit: www.cambridge-design.com.

The National Institute for Health Research: improving the health and wealth of the nation through research. Established by the Department of Health and Social Care, the NIHR funds high-quality research to improve health; trains and supports health researchers; provides world-class research facilities; works with the life-sciences industry and charities to benefit all; involves patients and the public at every step. For more information, visit: www.nihr.ac.uk

The NIHR Surgical Reconstruction and Microbiology Research Centre is a national centre for trauma research, transferring innovation used in the treatment of injured military personnel to improve outcomes for all patients. It brings together the pioneering advances in surgery and infection control made by military and civilian scientists and medics working together. Launched in January 2011, the national trauma research centre will share its discoveries with the wider NHS to support delivery of excellence in a complex area of acute care. Based at the Queen Elizabeth Hospital Birmingham (QEHB), the centre harnesses expertise from the Ministry of Defence, the University of Birmingham and the QEHB and has been funded over five years with a total investment of £15 million investment. For more information, visit: www.srmrc.nihr.ac.uk

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