New Pediatric ICU Technology Acts as DVR for Kids’ Vital Signs
|Dr. Jose Pineda, director of the neurocritical care program at St. Louis Children's Hospital, reviews the last 24 hours of vital signs for a patient in the Pediatric Intensive Care Unit (PICU), while sitting at his desk in the physician office tower.|
Like a DVR for a child’s medical history, new technology in the Pediatric Intensive Care unit at St. Louis Children’s Hospital allows physicians to rewind through hours, days or even months of vital signs for each child, enabling deeper insight into the child’s symptoms, and more accurate and informed medical care.
Before the Bedmaster System was launched in 2011, bedside monitors displayed patient vital signs -- heart rate, blood pressure, and oxygen saturation -- in 7 second intervals. Snapshots of those brief slices of data were recorded hourly in the patient’s chart, with a bedside alarm that would sound only if the data crossed a dangerous threshold.
“One hour is a long time in the ICU,” says Dr. Jose Pineda, Washington University Pediatric Intensivist and director of the Neurocritical Care Program at St. Louis Children’s. “If we wanted to make a decision based on what’s going on with a child’s blood pressure, it used to be we could go back and see blood pressure data charted at 9am, 10am, 11am, 12pm and so on. But what was the pressure at 12:15?”
Physiological signs can fluctuate dramatically in a short period of time – especially for a critically ill child.
“A seven-second interval of data represents the entire hour as well as if you were standing on the street, counting the number of yellow cars that pass in seven seconds, and adjusting that number to determine how many yellow cars passed in an hour,” explains Pineda. “It’s a very limited picture.”
Trends for each of a child’s vital signs get recorded into the Bedmaster system for the entire length of that child’s ICU stay, which allows the medical team to review patterns over time and better recognize or anticipate a crisis.
“It also helps us reconstruct the scene after a critical event and better understand what happened. What we learn from such reviews helps us prevent these events from happening again.”
Functioning within a computer network, the Bedmaster system is accessible remotely, so specialists can review real-time data from a child’s bedside from elsewhere in the hospital - or anywhere in the world.
“If we are worried a patient may be having an arrhythmia, we can call a highly specialized electrophysiologist at home and she can instantly log in, check the monitor and say ‘yes, I recognize that arrhythmia – we need to try this medicine.” We call this local telemedicine.
Whether that medical intervention was effective will be evident within minutes through real-time data streams now available. With the old system, doctors would either have to wait for the next round of hourly data, or physically stand at the patient’s bedside and watch the 7-second monitor for an extended period. Sharing data remotely frequently meant faxing low resolution print-outs of vital sign reports.
The Bedmaster system was created by Excel Medical Electronics, and implemented through a $500,000 grant from an anonymous donor to the St. Louis Children’s Hospital Foundation. The system is capable of tracking all vital signs recorded by the hospital’s bedside monitors, including heart rate, blood pressure, oxygen saturation, carbon dioxide and intracranial pressure.
Dr. Pineda and his team have already begun developing the next generation application for the Bedmaster program – real time computer analysis of each stream of data into an algorithm that may mathematically predict the patient’s clinical course. St. Louis Children’s Hospital is the first pediatric hospital in the country to partner with IBM and Excel Medical Electronics to build a platform that interprets physiological data trends into predictive medicine.
“What if you could use this data to know whether a child in the ICU is likely to have a cardiac arrest in the next 12 hours, or to predict how a patient will do after discontinuing therapy with a breathing tube? What we’re doing with IBM is trying to predict potentially catastrophic, life-threatening events.“
The idea is that if doctors can predict adverse events, they can quickly implement appropriate therapies and save more lives.
“Until now we could only look at the trees. We couldn’t zoom out and look at the forest. With this tool, we can. It makes things so much clearer for everyone on the team. We are finding that this kind of data review also helps parents understand their child’s condition in the ICU environment.”