Virtual High-Dependency Unit (vHDU)
This project seeks to address a long-recognised problem in hospital wards: the failure to recognise and act on physiological indicators of worsening illness quickly enough. The vHDU project focuses on developing a system that uses wearable ambulatory monitoring systems (AMS) to continuously monitor patients' vital signs and alert clinical staff to potential deterioration.
This project was split into several phases, aiming to develop a wearable, usable and acceptable monitoring system for use in clinical practice:
Phase 1: Wearability testing of ambulatory vital sign monitoring devices. A prospective observational cohort study.
We selected the most wearable commercially available pulse oximeters and chest patch for further testing.
https://mhealth.jmir.org/2020/12/e20214/
Phase 2: Qualitative study of patient and nursing staff experiences of monitoring practices in a surgical ward and early opinions of wearable continuous monitoring.
We gained crucial insights into current monitoring practices and perceptions of how wearable monitoring could support clinical care. Important considerations included alarm noise and the value of patient/staff contact.
https://onlinelibrary.wiley.com/doi/10.1111/jan.15055
Hypoxia: diagnostic accuracy study to evaluate the specificity and sensitivity of ambulatory monitoring systems in the prompt detection of hypoxia and during movement.
We selected the most accurate pulse oximeter and chest patch for use in the system. In testing, SpO2 accuracy varied significantly. Although the Nonin 3150 BLE under-read by up to 2% it was selected as the most appropriate as it under- rather than over-read.
https://www.jmir.org/2022/2/e28890/
https://www.jmir.org/2021/9/e27547/
Phase 3: Locational testing of ambulatory monitoring systems on a surgical ward.
We optimised the system for the study wards, prior to pausing due to COVID-19 pandemic.
Phase 4: Ambulatory monitoring system user interface integration and alerting algorithm development.
We gained clear staff feedback which supported development of the UI and system. This was implemented rapidly to allow deployment into clinical practice during the COVID-19 pandemic, where further system refinement took place in response to staff feedback.
COVID-19 deployment: Service evaluation of the use of the system
We rapidly deployed the system into clinical practice during the pandemic, and refined the interface based on staff feedback to maximise usability with minimal training. Interviewed staff described how the system support prioritisation of their workload which was also demonstrated in quantitative analysis (pending publication).
https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15977
VHDU Phase 5: Pilot randomised controlled trial of ambulatory monitoring system for the detection of clinical deterioration in surgical patients
240 pilot RCT in surgical patients – under analysis.
https://clinicaltrials.gov/study/NCT05118477?term=NCT05118477&rank=1