Doctor Faith Ndebele, Consultant Psychiatrist, shares her experience of collaborating with DigitalHealth.London Accelerator company, Oxehealth, on a research project looking at how they can use technology to better care for patients in a psychiatric intensive care unit (PICU) in Coventry.
During the COVID-19 pandemic we have changed not only our way of life but the way we deliver care to patients. Not least, we have had to find novel ways of working while maintaining physical distancing.
I work in the psychiatric intensive care unit (PICU) at Caludon Centre in Coventry, where I am the principal investigator for a research project with Oxehealth.
This project started long before the pandemic began. It illustrates how we can use technology to safely monitor and care for our patients – a topic of even more importance as we build resilience into our new ways of working.
Oxehealth developed Oxevision, a technology that combines an optical sensor (camera + infrared illumination) with software to detect activity, breathing rate and pulse rate – which gives warnings, alerts, reports and observations to the clinicians on a ward. No device is attached to the patient.
Our partnership with them first started in two dementia wards to help prevent falls. After seeing positive patient outcomes (48% reduction in falls and 68% reduction in A&E visits), we extended our work together to our acute services.
Patients and staff feel the technology is improving safety
The project was conducted over a two-year period, starting in 2019 and taking place on three wards. All our patients have their own bedroom (where the technology is installed) and en-suite bathroom.
We have seen a really positive impact on safety including a reduction in incidents of assaults, self-harm and restrictive interventions. Over the duration of the study we have seen:
- 22% reduction in self-harm including 66% reduction in bathroom ligatures in Acute wards
- 26% reduction in assaults and 40% reduction rapid tranquillisation in PICU ward
We were undertaking research, so patients must give their consent for the technology to be switched on. We had high levels of acceptance.
When we surveyed the patients, they all reported feeling reassured that the system was there to keep them safe, and felt their wellbeing would improve as a result.
As one patient said, “I know that I am being monitored, I would have said for my own benefit and my health, whenever I am in the room. It’s peace of mind knowing that if anything happens to me the staff are alerted and they can come in and do what’s necessary”.
We have patients on enhanced observations, who need to have somebody with them, all the time. But for patients who do not need that degree of input, the technology gives staff additional reassurance that they are safe.
For example, staff are alerted when somebody is in the en-suite bathroom for more than two minutes, prompting them to visit and intervene earlier to prevent patients from harm in instances such as self-harm and contraband use.
When we surveyed our staff, we found that 74% said having this tool on the ward had helped them to prevent a potential incident from occurring, and 83% said they had identified incidents they otherwise would not have known about.
A boost in physical health monitoring, especially during the pandemic
Using the technology, we can obtain breathing and pulse rate remotely, without disturbing patients in their rooms.
As this was a research study, we followed the usual standard of care that we had in place before it began; but we quickly found that the technology enhanced our practice.
For example, when a patient is so distressed that we need to administer rapid tranquilisation, we need to monitor them closely. This can be difficult if the patient is very agitated. Now, we can check their pulse and breathing rate remotely without making the situation worse.
Or, to take another example, at night we monitor patients by looking into their rooms through an observation window. If we cannot see that they are breathing, we go into their room with a torch.
Now, we can use the technology to reduce how often we disturb their sleep; helping us to create the space that patients need to rest and take responsibility for their own recovery.
During COVID-19, we have been able to use the technology to monitor our patients whilst maintaining our physical distance and minimising the risk of infection.
New data to help inform care
For me one of the most exciting things about the system is that it is generating data that we did not have before.
Now, I can come onto the ward in the morning and look back at trends over time to see how long a patient has spent out of their room, or on their bed, or in the bathroom, and how their vital signs trended overnight. These reports seem to correlate well with what staff observe about a patient, and provide objective data that helps us to understand how people are responding to treatment.
It was no surprise to us that, when we surveyed the staff, 91% said the system has helped them to make better care or clinical decisions.
My trust has been very supportive of this project. We have ward champions who train others, and regular meetings to swap ideas. Oxehealth has also been an excellent partner – resolving any problems quickly and being open to ideas about how to make its technology work for me and my patients.
This hasn’t been one of those projects where we struggled to ‘engage’ clinicians. Instead, it has breathed new life into our practice and helped us as we adapt our ways of working in this changing environment.
I have felt stimulated to be in at the start of something new like this; trialling a piece of technology that could shape a whole new way of working in inpatient psychiatry.
About the author: Faith Ndebele is a consultant psychiatrist, working in the psychiatric intensive care unit of the Caludon Centre, a purpose-built inpatient facility run by Coventry and Warwickshire Partnership NHS Trust. Dr Ndebele is also the medical lead for the acute service and the principal investigator for the Oxehealth research project.
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Oxehealth is currently one of 20 digital health companies on the DigitalHealth.London Accelerator programme.
The DigitalHealth.London Accelerator is a collaborative programme funded by London’s three Academic Health Science Networks – UCL Partners, Imperial College Health Partners, and the Health Innovation Network, MedCity, CW+ and receives match funding from the European Regional Development Fund.