Aug 31, 2023

By Jerry Zeidenberg August 31, 2023 MARKHAM, ONT. – Oak Valley Health, consisting of Markham Stouffville Hospital and Uxbridge Hospital, has been testing a new Early Warning System (EWS) that predicts when in-patients are in declining health and may suffer a catastrophic episode – such as cardiac arrest. These events are referred to as code blues in hospitals and they trigger the rapid assembly of teams of healthcare providers, something that can happen around the clock. But with Oak Valley Health’s EWS, the decline can be detected well in advance of the patient actually crashing, giving doctors and nurses a much better chance to provide effective care and to stabilize the patient. The system is electronic, providing real-time information as nurses input vital signs and other information into the MEDITECH record solution. Using an AI-based algorithm created by Oak Valley in partnership with ThoughtWire, a technology solutions company, the system automatically sends alerts to the charge nurse on duty and to the appropriate clinicians. “The technology is proving to be extremely reliable,” said Mark Farrow, CIO of Oak Valley Health. “It’s getting to the point where an inpatient going to a code blue should be seen as a health system failure. We should be able to predict it.” The system monitors vital signs, symptoms and observations that are entered into the electronic health record system by nurses. An AI-powered algorithm measures the data against a ‘digital twin’ to determine whether the patient is in danger, and whether help is needed. An electronic communication system shows who has been sent the notification as well as who responded, closing the loop on messaging. Farrow was previously CIO at Hamilton Health Sciences, where he was involved in a project to implement an EWS. He is bringing that expertise to Oak Valley Health, where he says the initial pilot has been welcomed and has won the approval of clinicians. While several hospital organizations across Canada have deployed electronic EWS, using automated algorithms and alerting solutions, Oak Valley Health is moving in a new direction by rolling its EWS out to long-term care facilities as well. Oak Valley Health – part of the Eastern York Region North Durham Ontario Health Team – has been testing the solution in two nursing homes and has plans in the works to expand into more of them. The system for long-term care has been tweaked so that it detects deterioration in the health of residents using information collected in the PointClickCare record solution, an electronic system that is used in many nursing homes. The LTC centres are both within Oak Valley Health’s catchment area, and the idea is to spot problems before residents need to be rushed to the Emergency Department or ICU. “We believe that early intervention will prevent hospital visits,” said Farrow. That’s good for the health of the residents, who will be treated before their condition turns into an emergency. It also saves the healthcare system significant costs as beds in the ER and ICU are expensive. As well as physical problems, the system is also being designed to spot mental health issues in long-term care residents, such as cognitive declines and emotional issues, as well as clients who are slipping into dementia. That won’t, of course, prevent the onset of dementia, but by catching it earlier, treatment and care can begin sooner. Farrow said the team is considering using even more futuristic technologies, such as sensors in the rooms of long-term care residents to detect if there is unusual activity. For example, if the resident is staying too long in bed, or hasn’t used the toilet. That data can be assessed by the algorithm – and measured against the ‘digital twin’ – to determine if the behaviour should be investigated. He added that an additional benefit of detecting declining health in long-term care patients is to prepare families for the end of life. And by detecting problems sooner, steps can be taken to care for the resident in the long-term care setting, including hospice care, instead of in hospital. “It’s about maintaining the dignity of the resident, too,” said Farrow, explaining it will be much more comfortable for the patient in a long-term care facility, surrounded by family and familiar caregivers, than in the hospital. While the project in the hospital and the long-term care facilities is less than a year old, Farrow would like to expand it quickly. So far, the team has accomplished the rollout with a budget of about $600,000. Expansion will depend on obtaining further funding. He said they’re currently working on studies to show the return on investment, both in the hospital and in the long-term care setting. Farrow believes there are significant cost savings in both, as hospital inpatients are prevented from being transferred to expensive ICU settings. Similarly, long-term care patients may avoid being rushed to hospital if a decline in their health can be detected. Interestingly, Oak Valley Health in the past few years has been the developer of an EWS for paediatric care. Because this system has been a success, and has shown real value, the executive team at the hospital was in favour of a system for the larger inpatient population. “It was an easy sell, because we’re doing it on the paediatric side and it works,” said Farrow. However, he pointed out that it wasn’t simply a case of expanding the usage of the paediatric EWS system. “Measuring the vitals of babies and adults is very different,” said Farrow. “You can’t really merge the two systems, but the concept of an Early Warning System is transferrable.” Farrow said the design of system is also very important. It has to be easy to use. And it must not add to the staff workload. “Any time you ask someone to do something on top of what they’re already doing, it’s difficult. People are already stretched.” He said the EWS uses the data that’s already being collected by nurses and that’s transferred to the electronic health record system. It takes this data, runs it through the algorithm on its own, and makes decisions. If the trending of vital signs and other observations hits certain levels, the system will automatically alert the appropriate clinicians. This actually reduces the workload of nurses, as they’re not required to contact physicians – the system does it on its own. “It takes a lot of stress away from the nurses,” said Farrow. “In some cases, they’re not sure of whether they should bother a doctor, especially if it’s 2 a.m. They may be hesitant to call. But the system will automatically do it, once it reaches certain thresholds.” Farrow said many staff members at Oak Valley Health have dedicated time to further developing the algorithm and digital twin technology that was devised by ThoughtWire. As well, about 10 people at the long-term care organizations – from executives to frontline caregivers – have helped fine tune the solution for use in nursing homes. Dale Hall, executive VP and co-founder at Thoughtwire, noted that the EWS at Oak Valley Health monitors more than just vital signs of patients. It also models the patient’s medications, orders, clinician assignments and more – all in real-time. As a result, it’s creating a ‘digital twin’ of the patient. It’s an effective way of predicting the decline of a patient into cardiac arrest, sepsis, and other acute care problems. “The system is monitoring about 14 factors,” said Hall. In addition to vital signs, the EWS takes cognitive acuity and pain scores into consideration, issues that are logged by nurses. On the long-term care front, Hall said the system has been expanded to meet the needs of nursing homes and their residents. More behavioural factors are monitored, such as nutrition and whether the resident has been eating, and whether he or she has been interacting well with staff and other residents. Declines can be flagged, alerting a wider range of staff to the resident’s issues. Hall observed that the system is becoming a means of sharing information among staff members, as it’s collected and displayed in a central place.