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Discussion About the Use of ViSi Mobile at RadboudUMC


"To detect a patient's timely deterioration, Radboudumc has been using ViSi Mobile, a continuous monitoring system developed by Sotera Wireless, Inc., for some time.

Whereas previously the nurse measured the five vital signs of the patient at fixed times, this is now done 24/7 by a small box on the wrist. Recently, with the help of machine learning techniques, the decline is detected early or even predicted up to hours in advance. In addition to improved patient safety, this also saves time for the nurses.

For Zorg Enablers 2020, we spoke to Harry van Goor and SJH (Bas) Bredie, initiators of the ViSi Mobile project, about the increasing demand for continuous monitoring and its added value for the healthcare providers and patient. We talked at length about the challenges and developments during the pilot and implementation phase and what the upscaling goals are for the future."


Read the full translated article on ViSi Mobile below.

Regular assessment of the clinical condition of a patient is crucial for signs of deterioration to be detected in time. With the exception of guarded hospital wards, it proves to be a challenge to take the measurements this is adequate and structured according to fixed time intervals and to be performed on all admitted patients. The RadboudUMC makes use of ViSi Mobile (VM), a continuous wireless monitoring system. Instead of several times a day measurement, a small box on a patient's wrist provides the continuous recording of five vital functions (blood pressure, heart rhythm, temperature, respiration rate, and oxygen uptake). An algorithm continuously calculates whether there is a safe situation, or that the nurse should be alerted. A patient's deterioration is more likely to fall below attention, and more preventive and predictive action can be taken.
Initiators Prof. Harry van Goor and Dr. Bas Bredie acknowledged the problem of manual several times per day collecting the parameters of vital signs of patients by nurses. The parameters of a patient are recorded in the EPD, which is still much manual work, and this is how a Modified Early Warning Score (MEWS) calculated. The higher the number, the worse the condition of the patient, the more often intervention is required. It measuring these vital functions is often a snapshot. A clinical deterioration between two measurement moments is often not noticed because of this. This can lead to unplanned admission to the ICU with all negative consequences consequently (longer hospital stay, increased mortality, and higher healthcare costs). Especially at night when there less health care personnel available may deteriorate of a patient sometimes unnoticed until the next morning's stay. 
We wanted this to be different and to automate it measuring and documenting vital parameters seemed the right solution ”, said Prof. Harry van Goor, surgeon, and professor of surgery education in the department of surgery the RadboudUMC. The continuous monitoring system of the American manufacturer Sotera Wireless recently had FDA approval received. The innovative device stood out from other monitoring systems by making the device stand-alone could monitor five vital parameters simultaneously. And because there are no extra links with additional systems for this purpose were necessary. 
We were right at the RadboudUMC has been aware of the necessary digital healthcare innovation for some time
within healthcare. We saw a lot of potential in ViSi Mobile ”, says Dr. Bas Bredie, internist in the Internal Medicine department of the RadboudUMC.
The first two years were devoted to the implementation of usability and feasibility pilots 21. In addition, a lot of attention was paid looking forward to creating support among nurses for using VM. This resulted in an education program and e-learning. After the pilot's success, the 60-bed system became operational in mid-2018 in two departments (internal medicine and surgery) in it RadboudUMC implemented for added value to be demonstrated in daily practice 22,23. The measurement results were immediately included in the electronic health record and the MEWS is calculated automatically. Both patients and healthcare professionals were enthusiastic. Patients indicated that it allows them to ask the right questions by giving them self have more insight into the course of their health. Doctors and nurses no longer looked at blood pressure, heart rate, and respiratory rate, but assessed the trend and adjusted their actions accordingly. Just by entering continuous monitoring was applied after a year of continuous monitoring even a third less unplanned IC admissions in the two wards.
With the COVID-19 pandemic, the implementation of VM is in has accelerated and now there are already 100 beds be continuously monitored. The system offers various benefits for COVID patients. First, any deterioration in the patient's condition more quickly. Certainly in the case of COVID patients, who vary greatly clinical picture and can sometimes suddenly deteriorate suddenly that has added value. Second, it makes a difference how contact moments for the nursing staff, who are before that each time would have to change clothes and run the risk of the virus to distribute it further. As a result, it also costs less protective equipment, and the patients like that they are monitored from a distance.
Van Goor and Bredie identify various aspects that affect them and have been important to the incremental and successful implementation of ViSi Mobile. “first of all, healthcare professionals are always the lead in the implementation process. Scientific ViSi Mobile validation and pilots formed an important foundation of our implementation process. In addition, are emphatic to included the learnings from US hospitals. Think for example to a list of necessary internal concerns and external stakeholders. before the introduction of continuous monitoring. After all, technology also requires adjustments in terms of logistics, staffing, and team composition, and protocols. And acknowledge we also have the necessary ambassadorship of department heads. In close collaboration with Radboud REshape center, and later the iLab of the RadboudUMC, is met specialists carefully worked out the implementation process and guided. This also ultimately has clear protocols and a Business case delivered for possible upscaling from ViSi Mobile to other departments. Finally, we received a lot of support from the council management throughout the entire process. ” Partly thanks to a lease construction with the manufacturer can easily be scaled up turn into. Van Goor and Bredie are involved in the realization of this construct supported by the Valorisation and Purchasing departments. On the one hand due to differences in laws and regulations between the US and EU, on the other hand, because of existing cultural differences.
In the coming years, the goal is to keep it continuous monitoring system further upscaling within the RadboudUMC and can be integrated into the 150 patient rooms that are being newly built. “During the COVID-19 pandemic, we have experimented with remote monitoring of patients in strict isolation. A monitor team supported nurses with extra results of oversight in the EPD and showed deviating trends right through. IC physicians were also able to assess the clinical condition assessing distance and scaling up care if necessary coordinate. Remote monitoring contributed in this way the safety of healthcare personnel and patients ”. 
However, the goal was never the monitoring itself, but things like freeing up time for nurses, higher patient safety and to better predict patient deterioration. To this end, there is also worked hard on a forecasting model. By artificial intelligence software to analyze the data is possible there are earlier predictions when the health status of a patient. In addition, there is a movement deployed towards lean monitoring, where only that data are monitored that are actually relevant. The ultimate ambition is to have one center, where all the data come in, quickly identify which patient or client what kind of support needs. “ In the integrality full network care, continuous monitoring is limited after all, not just inside the hospital, ”says Bredie. "And it is good to leave the public and private sectors behind working together ”, adds Van Goor.
Prof. Harry van Goor is a surgeon and professor of surgery education in the Department of Surgery of the RadboudUMC. Since the introduction of the Google Glass, his interest has been aroused in technological innovations that contribute to process improvement. He is now involved with various healthcare innovation projects, which are made possible by digital technology, and he focuses his scientific research on this. He always tries to make the connection between technology, care, and society. Dr. Bas Bredie is an internist in the Internal Medicine department of the RadboudUMC and a trainer in vascular medicine. About 15 years ago he already started monitoring cardiovascular patients. Now appointed as Principal Clinician by the Board of Directors of the RadboudUMC as a forerunner in innovating patient care.
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Filed Under: Remote Patient Monitoring, Success Story, Case Study