Predictive Monitoring of Patients by Combining Clinical Observations with Data from Wearable Sensors

Posted on November 13, 2018

Predictive monitoring of patients is beneficial to patients and in hospitals. It assists in monitoring the progress of a patient and warning the medics in case of any complications. By so doing, physicians can take preventative measures. The mortality rate is also reduced since necessary preventive measures are put in place. Since most patients are outpatients, it is always hard to monitor them and get early warnings of physiological changes.

---

1. Manual Monitoring

Clinicians and health workers carry out manual monitoring by observing and recording of vital signs. These signs are then given a score based on the early warning score systems (EWS). The EWS involves a clinician assigning a uni-variate scoring measure for a given sign. For instance, a score of 3 is assigned if the heart rate of a patient exceeds 130 beats per minute.

If the count attached to the vital signs exceeds a given threshold, then there is a need for a clinical care. Observations for each patient are made when they visit the facility.

The advantage of manual observation as a predictive form of monitoring patients is that patients have access to immediate hospital care should their conditions deteriorate.

Manual observation as a form of predictive monitoring has a number of disadvantages.

They include:

• The early score system to which a vital sign is assigned is always based on the clinician’s experience and discoveries. As such, they can vary from one clinician to another.
• It is associated with a significant error rate due to the workload of handling many vital signs at one go.
• The period between observations may vary, which may cause patients’ health to worsen between observations when they are far spaced.
• It shows no correlation between different vital signs.

2. Continuous Wearable Monitoring

This method of predictive monitoring allows for constant monitoring of patients. It is ideal for both in and outpatient. With this method, the monitoring device is attached to the patient for continuous acquisition of actual data. The device is then connected to a personal digital assistant which records all the required data for analysis. Health attendants can then take manual measurements which are compared with the results obtained from ECG monitors.

Wearable devices also have some disadvantages when used for predictive monitoring of patients.

Some of the disadvantages include:

• They may experience malfunctioning mainly due to battery failures as well as the battery life which may cause data incompleteness.
• Some patients may find them uncomfortable and as such their usage depends on patient compliance.
• The may also have a high false alarm rate resulting in unnecessary visits of the patient to the hospital which may be annoying to some patients.

The advantage of wearable devices over manual monitoring is that it can be used to record data even for patients that are mobile.

Some of the common wearable devices used by a clinician for predictive monitoring include;

2.1 Mobile Pulse Oximeter

This device is used to acquire photoplethysmogram from which the heart rate of a patient is obtained. This device is usually mounted on the fingers to detect your pulse. This device has a high tolerance level with the patients hence, facilitating a high monitoring time. However, patients can easily forget to put them back especially after washing, bathing, or eating. As a result, acquire photoplethysmogram patients need to be constantly reminded to wear them again.

2.2 Cardiac ECG Monitoring Devices

ECG monitoring devices record the electrical signals that the heart generates which gives the heart rate of a patient. These devices are usually placed on the chest. As such, some patients may feel uncomfortable having the devices for longer periods of time. This makes the patients being monitored using the cardiac ECG monitoring devices to be less compliant despite their small size.

2.3 Holter Monitoring Device

The holler monitoring device gives more information about a patient’s heart compared to the ECG monitor. It is usually worn for a period of about 12 to 48 hours to give the heart rate and rhythm.

3. Challenges of Remote Patient Monitoring using Wearable Devices

Chronic diseases have led to increased health care costs in most countries. Patients suffering from these chronic diseases like heart diseases have had to stay in hospitals for doctors to monitor their situation.

Wearable devices have however enabled clinicians to monitor patients with chronic diseases even when in remote places. This has helped reduce the number of patients who stay in hospital wards for monitoring.

There have however been challenges of monitoring physiological conditions of remote patients using wearable devices.

Below are some of the problems.

3.1 Training Related Challenges

Poor education of users, mostly the patients, affects the outcome of the predictive monitoring process. If patients are not well trained on how to use ECG monitoring devices, then there are low chances that the monitoring project will be successful. For higher chances of success, the training needs to be done on a personal level. And if the patients to be trained are many, the process is done in groups based on literacy level and age. This way the devices will be used appropriately.

3.2 Infrastructural Challenges

Infrastructure also can act as a barrier to the success of remote monitoring of patients. This affects data access where the doctors cannot monitor real-time changes in patients’ physiology These challenges arise when there are problems with network connectivity or Bluetooth pairing. This can be problematic especially when monitoring infections, heart conditions or during emergencies.

3.3 User-related Challenges

Some users find wearable monitoring devices to be uncomfortable. They, therefore, stop using them. The devices to be used for remote predictive monitoring of patient should have a user-friendly design. The ECG monitoring devices should be comfortable and convenient for the patients to wear them every time This consideration will help increase the success rate of using the devices for remote monitoring.

Conclusion

Wearable devices have helped clinicians in the predictive monitoring of patients. It has helped to cut health care cost while effectively monitoring patients with chronic diseases. These devices have to be appropriately used to monitor ambulatory patients effectively. Understanding and improving on the challenges of using wearable for predictive monitoring of patients is the best way to make the devices useful.

Tags: 24 Hour Holter Monitor, cardiac ecg monitor, event recorder, heart disease, heart rhythm, Holter Monitor, wearable monitoring