medical system and method

专利摘要:
Medical System and Method The present invention relates to a method and a corresponding system (300) for monitoring patients based on their state of activity and posture. According to the present method, measurements of a patient's state of activity and / or posture are made. Additionally, one or more vital signs of the patient are measured according to a schedule. Based on the measurement of the patient's activity and / or posture status and one or more measured vital signs, the schedule is adjusted and / or the patient's clinical deterioration is monitored. 1/1
公开号:BR112015013554A2
申请号:R112015013554
申请日:2013-12-13
公开日:2020-01-21
发明作者:Gegner Guenter；Cao Hanqing；Greiner Harald；Gourmelon Lena；Zimmermann Steffen；De Waele Stijn；Van Den Heuvel Teun；Gerhard Emmrich Thomas；Alexander Rudolf Aarts Vincent；Meier Wilhelm
申请人:Koninklijke Philips Nv；
IPC主号:

专利说明:

MEDICAL SYSTEM AND METHOD [001] The present invention relates generally to the monitoring of patients. The invention has specific application in conjunction with the monitoring of subacute patients based on the state of activity and posture and will be described with specific reference to that segment. However, it must be understood that the invention can also be applied in other situations of use and is not necessarily limited to the aforementioned application.
[002] In hospital settings for subacute treatment, 1 to 5% of patients experience Serious Adverse Events (EAGs) that require transfer to the intensive care unit (ICU), resuscitation or other rescue procedures. Additionally, it is known that the patient's clinical deterioration could be detected hours before these EAGs. The Early Warning Scores (EAP) and the Rapid Response Teams (RRT) are two combined mechanisms that were introduced to detect, respectively, early signs of clinical deterioration of the patient and act in response to early alerts to prevent EAGs.
[003] Patients in subacute treatment are typically monitored through intermittent, manual and random measurements of the patient's vital signs. Common vital signs that are measured include pulse, oxygen saturation (SpO2), respiration, non-invasive blood pressure (PAN), temperature and carbon dioxide. These spot checks are carried out at regular intervals, typically every 6 to 8 hours. The frequency depends on the severity of the patient's condition and the number of team members. In addition, to ensure adequate monitoring,
2/64 the requirements are indicated in the schedule of spot checks. An example of a requirement may be that the time between spot checks cannot exceed 8 hours.
[004] When an EAP system is used, each of these vital sign measurements is translated into a score (score), which is then added together to provide a total score related to the patient's condition. An increasing score provides an early warning of the patient's clinical deterioration. Often, when he realizes that the patient's condition is getting worse or that the patient requires more attention, the nurse increases the frequency of spot checks. Additionally, the nurse can use monitoring devices to make automatic spot checks measurements between consecutive manual spot checks. This is advantageous because a patient's condition could deteriorate between two consecutive spot checks, resulting in delays in detecting the condition and therefore increasing the risk to the patient.
[005] A challenge with regard to manual spot checks is that they represent a large workload for nurses. In addition, with spot checks, it is important to make sure that the patient has rested for some time before starting measurements to ensure that the results reflect the patient's baseline level rather than natural fluctuations related to some physical activity or variation in posture. In view of this, another challenge with manual point checks is that nurses who measure vital signs may not adequately ensure that the patient is in the correct (resting) position before obtaining vital signs.
3/64 [006] The aforementioned challenges regarding manual one-off checks are compounded by the growing pressure to reduce health care costs, leading to more and older patients, less staff, fewer trained and certified professionals and patients who are transferred earlier from the intensive care unit (ICU) to the ward. Consequently, there is a trend towards unattended automated spot checks.
[007] Monitoring devices that include sensors that are kept connected to the patient can perform unattended monitoring. Monitoring devices for subacute hospital settings should be different from those in hospital settings for treating acute patients in several respects. Monitoring devices must allow for outpatient monitoring. Patients in subacute treatment should not have mobility restrictions and should be able to walk normally. Wireless monitoring devices are therefore preferred. Due to a low nurse / patient ratio, monitoring devices should require minimal maintenance by nurses. Monitoring devices must provide reliable and useful information, avoiding uncontrollable excess of false and / or irrelevant alerts.
[008] A typical sampling scheme for such monitoring systems and / or devices is to perform the measurement at a fixed sampling interval, such as every six hours, corresponding to the point verification interval. Although higher sampling rates are possible,
4/64 low sampling rates may be preferred to extend the battery life of wireless monitoring systems and / or devices. In addition, infirmary patients are, in general, at lower risk than ICU patients, so a low sample rate is typically sufficient. Alternatively, these monitoring systems and / or devices can be used to perform the measurement at a fixed sampling interval between manual spot checks.
[009] A challenge with non-assisted spot checks is that measurements may not be comparable due, for example, to measurements obtained in different states of the patient (for example, walking versus at rest). This is likely to occur in nursing patients who are using wireless monitoring systems and / or devices. The measurements obtained with the patient in different states can result in inaccuracies in the derived results, such as scores (for example, early warning score (WBS)), and clinical deteriorations of patients detected automatically, as well as a greater number of irrelevant alerts. For example, a patient's heart rate may be high because the patient has climbed stairs a few moments ago. This would lead to a clinically meaningless alert of high heart rate.
[010] One approach to address this challenge is to correct alarm limits based on a patient's activity level, for example, obtained from an accelerometer. However, in practice, it is very difficult to safely adjust the alarm limits based on the activity level. For example, based on the example above, the relationship between
5/64 activity and heart rate is not very stable. It varies significantly depending on disease conditions, as well as between patients, and depends on the type of activity, which is difficult to obtain from an accelerometer.
[011] Another challenge associated with unattended spot checks is that spot checks can occur when the patient is asleep. This can disturb the patient's sleep and have an adverse effect on the patient's recovery. Automated blood pressure measurements are specifically prone to disturb a patient's sleep.
[012] Another challenge with unattended spot checks is the frequency with which spot checks are performed. Not all patients require the same level of monitoring. For patients at risk of deterioration, certain vital signs need to be measured more frequently. To ensure that patients with deteriorating clinical conditions are properly monitored, one approach is to configure the monitoring devices to perform the measurement at a high sampling frequency for all patients. However, there are several disadvantages to this approach.
[013] Blood pressure measurements are obstructive to patients, as such measurements involve cuff inflation. This can cause discomfort to patients, thus reducing their satisfaction and delaying their recovery. In addition, the increased frequency of monitoring reduces the battery life of the monitoring devices. This results in a greater workload for nurses, since it will be necessary to replace the batteries more frequently. In addition, the workload associated with reinstalling missing or bad contact sensors (SpC> 2, ECG) increases because the sensors need to be applied more frequently when the monitoring schedule requires frequent sampling.
[014] Additionally, a system with a high frequency of monitoring can produce an unacceptably high number of false alerts. This is due to the fact that the majority of subacute ward patients have a stable condition and that there is only a small percentage of them that present deterioration. Possible solutions that can be used to continue sampling vital signs at a high frequency include averaging the samples over a long period of time in order to increase their accuracy, or modify the limits and introduce reconfirmation measurements.
[015] Another approach to adjust the frequency of spot checks is to have nurses manually select an appropriate sample rate per patient, depending on the patient's condition. However, if the nurse / patient ratio is low, this will result in a significant workload for nurses. This condition is made worse by the fact that the patient's condition may change over time. A patient who appears stable on admission may become unstable over time. This implies that regular nurse attention is necessary.
[016] As the spot checks measurements themselves are being automated, there is a need to automate the verification of a baseline situation as well. A well-known method for this is the use of detection
7/64 movement (for example, by means of accelerometry or video actigraphy). See, for example, US Patent No. 5,593,431, which describes motion detection using an accelerometer. For the assessment of mental aspects of activity status, such as sleep detection, methods such as those based on electroencephalography (EEG) can be used (for example, as described in US patent application publication 2010/0099954). In addition, information about the patient's activity can be obtained through automatic interaction with the patient (for example, using an electronic questionnaire).
[017] The present invention provides new and improved methods and systems that overcome the problems mentioned above and also others.
[018] According to one aspect, a medical system is provided. At least one processor is programmed to measure a patient's state of activity and / or posture and measure one or more patient's vital signs according to a schedule. Based on the measurement of the patient's state of activity and / or posture and one or more measured vital signs, at least one processor is additionally programmed for at least one of the actions to adjust the schedule and monitor the patient's clinical deterioration.
[019] According to another aspect, a medical method is provided. A patient's state of activity and / or posture are measured, and one or more of the patient's vital signs are measured according to a schedule. Based on the measurement of the patient's state of activity and / or posture and one or more measured vital signs, the schedule is adjusted and / or the patient's clinical deterioration is monitored.
8/64 [020] According to another aspect, a medical system is provided. A patient preparation system is configured to prepare a patient for automatic spot checks using the patient's state of activity and / or posture. An adaptive patient monitoring system is configured to adjust one or more monitoring frequencies for automatic point checks using patient vital signs measurements and to monitor the patient's clinical deterioration based on the patient's vital signs measurements and status patient's activity and / or posture.
[021] According to another aspect, an adaptive patient monitoring system includes a score processing system. The scoring scheme for a patient can include vital sign limits and a list of measured vital signs. The adaptive patient monitoring system can be configured to adjust the scoring scheme based on the measurements of the patient's vital signs and the patient's state of activity and / or posture.
[022] One advantage is more reliable patient monitoring.
[023] Another advantage is in reducing the workload of nurses.
[024] Another advantage is in monitoring devices that allow outpatient monitoring.
[025] Another advantage is in monitoring devices that require minimal maintenance.
[026] Another advantage is in non-obstructive patient monitoring.
9/64 [027] Another advantage is the monitoring that takes into account the patient's condition.
[028] Another advantage is in the improved detection of the patient's clinical deterioration.
[029] Another advantage is in the description of the dependencies of the measurements of vital signs and in the activity and / or posture of the patient.
[030] Another advantage lies in simplifying the clinical workflow and judging the patient's condition.
[031] Another advantage is the reduction of misinterpretations of vital signs and misjudgments of the patient's condition.
[032] Still other advantages of the present invention will be understood by those skilled in the art after reading and understanding the detailed description below.
[033] The invention can take shape in various components and component arrangements and in various stages and stage arrangements. The drawings serve only for the purpose of illustrating the preferred embodiments and are not to be considered as limiting the invention.
[034] FIGURE 1 illustrates a patient preparation system for intelligent intermittent monitoring of vital signs.
[035] FIGURE 2 illustrates a system of communication with the patient.
[036] FIGURE 3 illustrates an activity and / or posture measurement system.
[037] FIGURE 4 illustrates a patient preparation management system.
10/64 [038] FIGURE 5 illustrates the functionality of a combination of a patient preparation management system and a patient communication system.
[039] FIGURE 6 illustrates a vital signs monitoring management system.
[040] FIGURE 7A illustrates an example of spot check time management.
[041] FIGURE 7B illustrates another example of spot check time management.
[042] FIGURE 8 illustrates an adaptive patient monitoring system.
[043] FIGURE 9 illustrates an example of adjusting the monitoring frequency based on a three-parameter early warning score (WBS) system.
[044] FIGURE 10 illustrates an example situation in which an adaptive patient monitoring system can be applied.
[045] FIGURE 11 illustrates another exemplary situation in which an adaptive patient monitoring system can be applied.
[046] FIGURE 12 illustrates an improved clinical workflow system.
[047] FIGURE 13 illustrates an example of a vertical activity bar.
[048] THE FIGURE 14A illustrates examples in bars in activity horizontal for two levels in activity many different [049] THE FIGURE 14B illustrates examples in bars in activity vertical to two levels of activity many different.
11/64 [050] FIGURE 15A illustrates an example of a horizontal activity level display.
[051] FIGURE 15B illustrates an example of a vertical activity level display.
[052] FIGURE 16 illustrates an example of the numerical display of the activity level.
[053] FIGURE 17A illustrates an example of a horizontal activity bar and the corresponding numerical value.
[054] FIGURE 17B illustrates another example of a horizontal activity bar and the corresponding numerical value.
[055] FIGURE 17C illustrates an example of a vertical activity bar and the corresponding numerical value.
[056] FIGURE 18 illustrates an example of a horizontal trend line of activity level.
[057] FIGURE 19 illustrates different approaches to displaying an activity bar on a trend line.
[058] FIGURE 20 illustrates a table of keywords or phrases and the corresponding icons that can be used to describe posture.
[059] FIGURE 21A illustrates an example of posture display.
[060] FIGURE 21B illustrates another example of posture display.
[061] FIGURE 22 illustrates a table of keywords or phrases and the corresponding icons that can be used to describe dynamic posture.
12/64 [062] FIGURE 23A illustrates an example of a list of keywords or phrases, and the corresponding time indications, for posture.
[063] FIGURE 23B illustrates an example of a list of icons, and the corresponding time indications, for posture.
[064] FIGURE 24 illustrates an example of a posture timeline.
[065] FIGURE 25A illustrates an example of a timeline that uses groupings of icons to indicate a plurality of icons.
[066] FIGURE 25B illustrates an example of a timeline that uses arrows to indicate a plurality of icons.
[067] FIGURE 25C illustrates another example of a timeline that uses arrows to indicate a plurality of icons.
[068] FIGURE 25D illustrates another example of a timeline that uses an abstract symbol to indicate a plurality of icons.
[069] FIGURE 25E illustrates another example of a timeline that uses icons misaligned in a direction perpendicular to the time axis to indicate a plurality of icons.
[070] FIGURE 26 illustrates a mapping between postures and visual styles.
[071] FIGURE 27 illustrates an example of a posture bar.
[072] FIGURE 28 illustrates an example of moving a time window (interval) to a posture bar.
[073] FIGURE 2 9 illustrates an example of a posture bar that uses classification.
13/64 [074] FIGURE 30 illustrates an example of event estimation by moving the time window and reviewing the position change in the posture bar.
[075] FIGURE 31A illustrates an example of a relevance indicator while a patient is in the supine position (supine position).
[076] FIGURE 31B illustrates an example of a relevance indicator while a patient is walking.
[077] FIGURE 32 illustrates an example of a relevance indicator that includes both activity level and posture.
[078] FIGURE 33 illustrates an example of using the compacted form of posture for display as an indicator of relevance.
[079] FIGURE 34A illustrates an example of using an activity level trend as an indicator of relevance.
[080] FIGURE 34B illustrates another example of using an activity level trend as an indicator of relevance.
[081] FIGURE 35 illustrates an example of a medical system within which a patient preparation system, an adaptive patient monitoring system and an improved clinical workflow system can be employed.
[082] Although motion detection can passively check whether the patient is and / or has been at rest or not, it does not have the capacity of a nurse to actively instruct the patient to switch to a resting state. The present invention provides a system and method for enabling this capability in an automatic system, so
14/64 that the time-consuming spot checks traditionally performed by nurses can in fact be completely automated.
[083] With reference to FIGURE 1, a patient preparation system 10 for intelligent intermittent monitoring of vital signs is shown. The patient preparation system 10 is typically used in situations where patients are expected to be able to move around and responsive to automated instructions. General wards (low acuity) in hospitals are a relevant example.
[084] A patient communication system 12 allows for unidirectional and / or bidirectional communication between the patient preparation system 10 and an associated patient. The communication system with the patient 12 can be realized, for example, by a conventional display system, a touch screen system, an audio system, a lighting system, a touch interface system, or a combination of any or all of these systems.
[085] The patient communication system 12 receives requests and / or messages to the patient from other systems in the patient preparation system 10. For example, the patient communication system 12 could receive a request for a resting patient maintain a resting position for a specified period of time (and dynamically updated) until vital sign measurements are completed. In response to a request and / or message to the patient, an interface for patient 18 (see Figure 2) of the
15/64 communication with the patient 12 to instruct the patient and, in some cases, receive ordering information. The patient interface is, for example, one or more unidirectional or bidirectional means of communication, such as audio systems, lighting systems, display systems, touchscreen systems, audible alarm systems, etc. The interface for the patient could also include environmental aspects, such as curtains, windows, doors, etc.
[086] With reference to FIGURE 2, an example of the communication system with patient 12 is shown. A module for handling requests and / or messages 20 receives requests and / or messages. These requests and / or messages are translated into instructions for an interaction management module 22, which controls the interface for patient 18 according to the instructions. The interaction management module 22 can receive feedback from the interface to patient 18, which is passed back to the module for handling requests and / or messages 20.
[087] Again with reference to FIGURE 1, a workload management and communication system for team 24 allows for unidirectional and / or bidirectional communication between the patient preparation system 10 and the staff of a medical institution, such as a hospital , which employs the patient preparation system 10. Communication can be done using, for example, one or more unidirectional or bidirectional means of communication, such as audio systems, lighting systems, display systems, screen systems touch sensitive, audible alarm systems, etc. Additionally, the
16/64 team workload and communication management 24 can allow modification of team workflows. For example, a nurse's workflow could be modified to increase the frequency of spot checks.
[088] An activity and / or posture 26 measurement system measures the patient's state of activity and / or posture. Activity can include one or more of current and recent levels of physical activity, types of physical activity, sleep states, mental states, etc. A primary example of a state of activity is a state of rest (that is, a state in which a patient's vital signs are likely to reflect a baseline situation). The posture may include, for example, the supine and prone positions (prone position).
[089] The state of activity and / or posture can be determined automatically with the use of one or more sensors 28 according to well-known techniques. For example, the physical aspects of the patient's state of activity can be determined using motion detection with, for example, accelerometry or video actigraphy. The mental aspects of the activity state can be determined using, for example, sleep detection methods, such as those that employ electroencephalography (EEG). In addition, the state of activity and / or posture can be determined using the patient communication system 12 and / or the workload management and communication system of team 24. For example, the state of activity and / or posture can be achieved through automatic interaction with the patient (for example, using
17/64 of an electronic questionnaire). As another example, the state of activity and / or posture can be obtained from nurses who carry out spot checks.
[090] With reference to FIGURE 3, a modality of the activity and / or posture measurement system is shown
26. The patient's activity status monitoring system receives signals from the sensors 28, which are processed by a signal processing module 30. The signal processing module 30 extracts signal characteristics, which are used by a classification module 32 to classify the patient's state of activity and / or posture. Features can include, for example, acceleration.
[091] Again with reference to FIGURE 1, a vital sign measurement system 34 automatically measures one or more vital signs using one or more sensors 36. These sensors 36 can be used in addition to the sensors 28 used to determine the state of activity and / or posture. Vital signs can include, for example, one or more of the pulse, oxygen saturation (SpO2), breathing, non-invasive blood pressure (PAN), temperature and carbon dioxide. Measurements are typically performed periodically according to a schedule. For example, measurements could be performed periodically every hour. In addition, measurement schedules can be configured individually for each vital sign, globally for all vital signs, or individually for sets of vital signs. For example, non-invasive blood pressure (PAN) can be measured every 4 hours, oxygen saturation (SpO2) can be measured every 1 hour, and breathing can be measured every 15 minutes.
18/64 [092] A vital signs monitoring management system 38 intelligently performs spot checks on the patient (ie, collects vital signs measurements) when the patient's state of activity and / or posture is in a state of activity and / or posture required, such as a baseline level state (for example, the resting state). Vital sign measurements can be collected automatically from the vital sign measurement system 34, the team workload and communication management system 24, the patient communication system 12, or any other system in the patient preparation system 10. For example, the team may be asked to take measurements of vital signs. In addition, if a patient is not in a required state of activity and / or posture after a certain amount of time (ie, the convenience period), the vital signs monitoring management system 38 may interact with one or more among the vital signs measurement system 34, the workload management and communication system of the team 24, the patient communication system 12, or any other system of the patient preparation system 10 to deal with the situation.
[093] The vital signs monitoring management system 38 receives information on the patient's current state of activity and / or posture from the activity and / or posture measurement system 26 and monitoring parameters from the management system of the workload and communication of the team 24. The monitoring parameters can specify one or more among the frequency of the spot checks, the state of activity
19/64 and / or posture required of the patient, a point check interval within which point checks need to be carried out, and the like. The frequency of spot checks is typically adjusted based on the hospital's policy and / or the patient's severity. In addition, the frequency of spot checks can be individually adjusted for vital signs. The spot check interval provides a margin around a scheduled spot check within which the spot check could be performed. In addition, the spot check interval can, for example, be centered around the time scheduled for a spot check. For the sake of illustration, suppose that a spot check is scheduled for 2:00 pm and that there is a 40 minute spot check interval around that scheduled spot check. In this example, the spot check could be carried out between 13:40 and 14:20.
[094] Using the patient's current state of activity and / or posture and monitoring parameters, the vital signs monitoring management system 38 attempts to obtain measurements of vital signs according to the frequency of spot checks. From the beginning to the end of a spot check interval of a scheduled spot check, the vital signs monitoring system 38 monitors the current state of activity and / or posture in relation to the required state of activity and / or posture. If a match is found, vital sign measurements are collected, typically automatically, using the vital sign measurement system 34. If vital sign measurements are not collected before the end of the
20/64 spot check interval, the team can be alerted about the absence of a measurement using the team's workload management and communication system
24.
[095] After a predetermined amount (for example, a percentage) has elapsed of the spot check interval without collecting measurements, a patient preparation management system 40 can be employed to instruct the patient to assume the state of activity and / or posture required. For example, the patient may be instructed to stay in a resting position. The percentage could be, for example, 0% (that is, always instruct the patient), or 50% (that is, after half the point verification interval).
[096] The patient preparation management system 40 receives information about the required state of activity and / or posture and the period of time within which the patient should be instructed (that is, the current time until the end of the verification). Additionally, the patient management system 40 receives information about the patient's current state of activity and / or posture. Based on this information, the patient communication system 12 is controlled to instruct the patient. The instruction is typically done by means of one or more of a screen, a light, an audio signal and an audible alarm intended for the specific patient, for example, incorporated into sensors 28 and / or the activity measurement system and / or posture 26. If the patient assumes the required state of activity and / or posture or if the point verification interval ends, the patient instructions will be disabled.
21/64 [097] Referring to FIGURE 4, a modality of the patient preparation management system 40 is shown. A preparation scheduling module 42 uses the current state of activity and / or posture, as well as the state of activity and / or posture required and time aspects, to establish a patient preparation schedule. This schedule is fed into a request and / or message management module 44, which translates the schedule into individual preparation requests and / or messages that can be handled by the patient communication system 12. The request and response management module / or messages 44 can receive feedback on the handling of requests and / or messages, which, in turn, can be used to provide feedback to the preparation scheduler module 42.
[098] With reference to FIGURE 5, a flow chart illustrates the functionality of a combination of the patient preparation management system 40 and the patient communication system 12 according to a modality. Detections above the dotted line are performed by the patient preparation management system 40 and the action below the dotted line is performed by the patient communication system 12. When the current state of activity and / or posture of the patient indicates that the patient is active and the required state of activity and / or posture is that the patient is inactive, the patient 12 communication system is employed to emit an audio alarm. For example, the audio could notify the patient to go to bed.
22/64 [Ο99] Again with reference to FIGURE 1, to improve the quality of a patient's sleep, the patient preparation management system 40 can prevent disturbances caused by clinic visits or automatic measurements (for example, an inflated cuff automatically to measure non-invasive blood pressure) when the patient's current state of activity and / or posture indicates that the patient is asleep. The frequencies of spot checks and / or non-disturbing vital signs schedules could be adjusted and / or increased to fill the suppressed vital signs gap (for example, the pulse can be determined from oxygen saturation (SpO2) instead non-invasive blood pressure (PAN)).
[0100] Additionally, depending on the monitoring technology available and the working practices in force, it may sometimes be necessary for a clinician to make at least some measurements of vital signs manually. In this case, the patient's state of activity needs to match the clinician's workflow as much as possible to achieve optimal efficiency. The patient preparation management system 40 can address this with the use of a combined approach. Patients can be instructed to assume the required state of activity and / or posture using the patient preparation management system 40, and the clinician's workflow schedule can be dynamically adapted depending on the actual state of activity and / or patient's posture using the clinician's workflow and communication management system 24.
[0101] For the sake of illustration, suppose a patient is sleeping while his vital signs need
23/64 be measured by a nurse with only moderate urgency. The nurse's workflow schedule can be adapted to let the patient sleep while the nurse first performs other tasks (for example, measuring vital signs in patients already awake).
[0102] With reference to FIGURE 6, a modality of the vital signs monitoring management system 38 is shown. A measurement scheduler module 46 receives information about the current state of activity and / or posture and the monitoring parameters, as well as updates, from a measurement recording and analysis module 48 and schedule feedback from a measurement request management module 50. Based on this information, measurement scheduler module 46 generates a schedule (or individual schedules for signals measurements request module 50. In addition, the measurement schedule module 46 provides information on the required state of activity and / or posture, as well as time information for the measurement management system. patient preparation 40.
[0103] The measurement request management module 50 attempts to collect vital sign measurements from the vital sign measurement system 34 and / or the clinic and communication workflow management system 24 according to the schedule of measurements. Feedback from the measurement request management module 50 is provided to the measurement scheduler module 46 describing the attempt to collect vital sign measurements.
24/64 [0104] The measurement recording and analysis module 48 receives measurements of vital signs from the vital signs measurement system 34 and / or the team's workload and communication management system 24. Based on on this information, an analysis is made to assess whether patient alerts should be generated. Alerts can be provided to the team through the team's workload management and communication system 24. Additionally, updates can be made to the monitoring parameters used by the measurement scheduler module 46. For example, if the measurement analysis vital signs indicate that a patient's condition is deteriorating, the frequency of spot checks may be increased.
[0105] With reference to FIGURES 7A and 7B, two examples of punctual verification time management are shown according to the patient preparation system 10. In the illustrated examples, the required state of activity and / or posture is a level of low activity. In addition, the solid lines represent some sign of activity level, and the dotted line corresponds to the maximum activity level of spot checks measurements. AL corresponds to the activity level, t corresponds to time, PR corresponds to the preparation request, SC corresponds to the spot check, and I _S c corresponds to the spot check interval.
[0106] In the example in FIGURE 7A, a spot check interval (that is, a time interval within which a spot check measurement needs to be made) coincides with a 'rest' period, so that the
25/64 punctual verification can be performed right after the activity level falls below the maximum allowed level. In the example in FIGURE 7B, the patient's activity level is too high for a spot check measurement during the initial part of the defined interval, and therefore the patient is instructed to switch to a rest state. In response to the instructions, the patient is placed in a resting state (that is, the activity level falls below the maximum allowed level) and a valid point verification measurement can be made within the required point verification interval. Note that in these examples, the patient receives an instruction only when it seems necessary to make a valid point verification measurement, as is the case of the modality shown in the example in FIGURE 7B.
[0107] Similar to the case where a nurse adapts the frequency of spot checks to the patient's condition, the present invention provides a system and method for adapting the monitoring scheme to the patient's condition. This is done by automatically increasing the monitoring frequency in case of worsening of the patient's condition in order to ensure the issuance of alerts in a timely manner and the control of further deterioration.
[0108] With reference to FIGURE 8, an adaptive patient monitoring system 100 is shown. As described above, with the patient preparation system 10, the adaptive patient monitoring system 100 is typically employed in situations where expects patients to be able to move around. General wards (low acuity) in hospitals are a relevant example.
26/64 [0109] The adaptive patient monitoring system 100 includes a vital signs measurement system 102 that performs automatic spot checks on the patient (ie, collection of vital signs measurements). Vital signs can include, for example, one or more of the pulse, oxygen saturation, respiration, non-invasive blood pressure, temperature and carbon dioxide. To facilitate automatic spot checks, the vital sign measurement system 102 includes one or more patient measurement devices 104 for measuring patient vital signs using one or more sensors 106.
[0110] Patient measurement devices 104 are typically positioned on the patient, in or near the patient. In addition, patient measurement devices 104 are typically wireless devices to allow movement of the patient through the clinic. Vital signs are measured at a minimum frequency, which ensures sufficient coverage between two consecutive manual spot checks performed by a clinician. For example, if manual spot checks are performed every 4 hours, automatic spot checks can be done every hour between manual spot checks or schedules for individual vital sign measurements, such as non-invasive blood pressure (PAN), can be defined. ) every hour and oxygen saturation (SpO2) every 15 minutes.
[0111] A workload management and communication system for team 106 allows for unidirectional and / or bidirectional communication between the adaptive patient monitoring system 100 and the staff of a medical institution, such as a hospital, that employs the adaptive system in
27/64 monitoring of patients 100. Communication can be done using, for example, one or more unidirectional or bidirectional means of communication, such as audio systems, lighting systems, display systems, touchscreen systems , audible alarm systems, etc. In addition, the team's workload management and communication system 106 can allow modification of team workflows. For example, a nurse's workflow could be modified to increase the frequency of spot checks.
[0112] A score processing system 108 estimates the patient's condition based on all vital sign measurements received from the vital sign measurement system 102. For example, a score could be assigned to each vital sign and then vital sign scores could be totaled to determine a total monitoring score indicative of the patient's condition. In some modalities, measurements of vital signs are obtained from the patient preparation system 10 of FIGURE 1.
[0113] If the patient's score for one or more vital signs worsens or improves compared to the previous spot check, the score processing system 108 automatically repeats measurements of those vital signs and / or other vital signs (e.g. using the vital signs measurement system 102b) after a certain period of, for example, one, five, ten or fifteen minutes has elapsed. This ensures that the condition is neither temporary nor caused by the artifact. If an increase in a given score is observed, a system for controlling the
28/64 monitoring frequency 110 automatically increases the frequency of automatic spot checks for the given vital sign, a subset of vital signs or all vital signs. Similarly, if a decrease in a given score is observed, the monitoring frequency control system 110 automatically decreases the frequency of automatic point checks for the given vital sign, a subset of vital signs, or all vital signs.
[0114] The monitoring frequency control system 110 controls the frequencies of the spot checks according to the monitoring parameters and the scores determined by the score processing system 108. The monitoring parameters can specify one or more within limits (upper and / or lower) for vital sign monitoring frequencies, standard monitoring frequencies for vital signs, and the like. In addition, the monitoring parameters can be specified based, for example, on the information entered by the clinician (for example, using the team's workload management and communication system 106), the policy of the medical institution that employs the system adaptive patient monitoring 100, on the condition of the patient, and the like.
[0115] As for the information entered by the clinician, when a clinician performs a manual spot check, the time and data of the vital signs measurements can be entered in the monitoring frequency control system 110. Thus, the time of the next check expected manual point is known and can be used to
29/64 decide when a clinician should be notified, as described below. In addition, clinicians can adjust a monitoring frequency as they see fit. For example, suppose that a patient received a medication that resulted in an increase in his heart rate. As the clinician is aware of such medication, he can adjust the monitoring frequency to 1 measurement per hour and override a monitoring frequency of 1 measurement every 30 minutes that the monitoring frequency control system 110 would use.
[0116] When the frequency of spot checks on a vital sign is automatically varied due, for example, to the deterioration of the vital sign, the new frequency of spot checks will depend on the condition of the patient. For example, there could be four different automatic monitoring frequencies: 1) 1 measurement per hour; 2) 1 measurement every 30 minutes; 3) 1 measurement every 15 minutes; and 4) 1 measurement per minute, each corresponding to a score or score range. The worse the patient's score, the higher the monitoring frequency.
[0117] The frequency of each vital sign is typically adapted independently of the other signs and based on the specific score of each vital sign. However, the frequency of each vital sign may depend on other signs and be based on the total score. For example, all vital signs can share a common frequency based on the total score. As another example, if the total score is high, the frequency of spot checking for each parameter may increase one or more levels (for example, from 1 measurement per hour to 1
30/64 measurement every 15 minutes) than it would actually be if it were adjusted independently of the other vital signs. Otherwise, the frequency of each vital sign is adjusted independently. The total score is high when it exceeds a limit defined by the operator of the adaptive patient monitoring system 100, a limit that is defined by the operator himself to indicate a high total score.
[0118] Additionally, when the adaptive patient monitoring system 100 is initialized, a first set of measurements is performed. The first set of measurements is used by the score processing system 108 and the monitoring frequency control system 110 to determine the baseline level monitoring score and to select the baseline level monitoring frequency, respectively.
[0119] The monitoring frequency control system 110 and / or the score processing system 108 can be used to inform a clinician about a change in the frequency of spot checks and / or a change in the score, respectively, which can be clinically significant. A clinically significant change can be one in which the extent of the change exceeds a limit defined by an operator of the adaptive patient monitoring system 100, a limit that is indicative of a clinically significant change. In addition, a nurse can be notified to perform one or more of the steps of adding other patient measurement devices, performing a spot check and checking other vital signs (for example, awareness), for example, by the frequency control system.
31/64 monitoring 110. Notifications can be transmitted to a clinician using the team's workload management and communication system 106. For example, a message can be displayed in a preferred interface, such as, for example, a central station or a nurse calling device or a pager.
[0120] With reference to the table in FIGURE 9, an example is shown of how the monitoring frequency could be adjusted automatically based on a three-parameter early warning score (WBS) system. The table shows the relationship between the monitoring frequency, the measurement of vital signs and individual scores. The monitoring frequency can be independently associated with the score of each vital sign or with the total of early warning scores (WBS). In the first case, each vital sign has a specific monitoring frequency associated with the corresponding vital sign score. In the second case, all vital signs have the same monitoring frequency corresponding to a specific WBS.
[0121] Assuming that all vital signs have the same monitoring frequency, assume that the total EAP score is greater than or equal to 3. In this case, the minimum monitoring frequency of 1 measurement / 15 minutes is used. If there is an increase in any of the individual scores, the corresponding measurement is repeated after a certain time (for example, 1 minute or 5 minutes) to confirm that this condition remains. If the condition persists, a notification is sent to a clinician and the frequency of monitoring is increased based on
32/64 in the table in FIGURE 9. Otherwise, this temporary worsening of the patient's condition can be ruled out and the monitoring frequency remains unchanged.
[0122] With reference to FIGURE 10, a table of an exemplary situation is shown in which the adaptive patient monitoring system 100 can be applied. As can be seen, at 14:00 the pulse rate increased and at 14:31 the pulse frequency decreased. The temporary increase in pulse rate may have been caused by some patient effort and was not considered clinically relevant. The adaptive patient monitoring system 100 adjusted the sampling frequency automatically to ensure safe patient monitoring. The pulse rate monitoring frequency was automatically set back to the minimum monitoring frequency when the patient's pulse rate returned to normal, to reduce power consumption of patient metering devices 104. no notification message about the increase the frequency of monitoring the pulse rate was sent to the nurse because no further action was required. To avoid overloading clinicians with information that is not clinically relevant, only changes in the patient's condition that should require actions by clinicians are reported. One way to obtain this behavior from the 108 scoring system is to request a repeat measurement and then confirm the deterioration condition. On the other hand, if activity information is available for the 108 score assignment system, the
33/64 scores 108 can suppress the repetition of the measurement and immediately send a notification if an activity is within an acceptable range.
[0123] With reference to FIGURE 11, a table associated with another exemplary situation is shown in which the adaptive patient monitoring system 100 can be applied. At 13:55, the patient went through a critical situation with an abnormally low respiratory rate due to an excessively high dose of analgesia. The nurse knew that the patient was at risk for respiratory distress due to patient-controlled analgesia (PCA) and therefore adjusted a higher monitoring frequency to the respiratory frequency. The adaptive patient monitoring system 100 set the monitoring frequency to the highest level when the respiratory rate decreased further. The nurse was alerted about the patient's condition because this situation required rapid action by the patient.
[0124] Again with reference to FIGURE 8, the monitoring frequency control system 110 may additionally or alternatively employ other approaches to adjust the vital sign monitoring frequencies. One of these approaches is based on the fact that the workflow in hospitals often dictates that manual spot checks should be performed more often when there is a concern about the patient's clinical deterioration. Consequently, the frequency of automatic point checks can be increased for patients who have a higher frequency of manual point checks.
34/64
For example, the frequency of automatic spot checks can be adjusted in linear proportion to the frequency of manual spot checks. This approach can complement the approach described above in the sense that it allows to adjust the frequency of automatic point checks for patients where the potential for deterioration is determined by the team from information obtained externally to the measured vital signs.
[0125] Another approach is based on the fact that the workflow in hospitals can determine that an accuracy level is defined for each patient. For example, a green color could be used to indicate that the patient is stable and / or at low risk, while a red color could be used to indicate that the patient is at high risk. This indicator is typically used to adjust the frequency of manual spot checks, and can similarly be used to adjust the frequency of automatic spot checks.
[0126] Another approach to the adaptive patient monitoring system 100 is to reconfigure the scoring scheme assigned to the patient. The scheme for assigning individual scores to patients may include vital sign limits and a list of measured vital signs. The adaptive patient monitoring system 100 can be configured to adjust the individual score assignment scheme based on the measurements of the patient's vital signs and the patient's state of activity and / or posture.
[0127] The present invention includes a system and method in which the additional information available on the patient's state of activity and posture is used
35/64 to increase the validity and quality of vital sign measurements and derived results, such as scores. Measurement relevance indicators based on activity and posture status can be used to describe the dependencies of vital sign measurements and the patient's activity and / or posture status. Additionally, measurements of vital signs can be collected based on the state of activity and / or posture, and notifications can be generated based on the state of activity and / or posture.
[0128] Referring to FIGURE 12, an enhanced clinical workflow system 200 is shown. The enhanced clinical workflow system 200 can be used in any environment where the patient's condition is assessed as a whole only intermittently and additional intermediate measurements are made automatically (unattended).
[0129] The enhanced clinical workflow system 200 includes a patient communication system 202 that allows unidirectional and / or bidirectional communication between the enhanced clinical workflow system 200 and an associated patient. The patient communication system 202 can be realized, for example, by a conventional display system, a touch screen system, an audio system, a lighting system, a touch interface system, or a combination of any or all of these systems.
[0130] A 204 workload management and communication system allows unidirectional and / or bidirectional communication between the 200 enhanced clinical workflow system and an institution's staff
36/64 medical, such as a hospital, that employs the 200 enhanced clinical workflow system. Communication can be performed using, for example, one or more unidirectional or bidirectional means of communication, such as audio systems, lighting systems, display systems, touchscreen systems, audible alarm systems, etc. In addition, the 204 team's workload and communication management system allows modification of the team's workflows. For example, a nurse's workflow could be modified to increase the frequency of spot checks.
[0131] A system for monitoring patient activity status 206 determines the patient's activity status and / or posture. The state of activity can include one or more of current and recent levels of physical activity, types of physical activity, sleep states, mental states, etc. A primary example of a state of activity is a state of rest (that is, a state in which a patient's vital signs are likely to reflect a baseline situation).
[0132] The state of activity and / or posture can be determined automatically with the use of one or more sensors 208 according to well known techniques. For example, the physical aspects of the patient's state of activity can be determined using motion detection with, for example, accelerometry or video actigraphy. The mental aspects of the activity state can be determined using, for example, sleep detection methods, such as those that employ electroencephalography (EEG). Additionally, the state of activity and / or posture
37/64 can be determined using the patient communication system 202 and / or the workload management and communication system of team 204. For example, the state of activity and / or posture can be obtained by means of automatic interaction with the patient (for example, using an electronic questionnaire). As another example, the state of activity and / or posture can be obtained from nurses who carry out spot checks.
[0133] A vital sign measurement system 210 automatically measures one or more vital signs using one or more sensors 212. These sensors 212 can be used in addition to the sensors 208 employed to determine the state of activity and / or posture. The vital signs may include, for example, one or more of the pulse, oxygen saturation, respiration, non-invasive blood pressure, temperature and carbon dioxide. Measurements are typically performed periodically according to a schedule. For example, measurements can be performed periodically every hour.
[0134] A 214 vital signs monitoring management system performs spot checks on the patient (ie, collects vital signs measurements). Vital sign measurements can be collected automatically from the vital sign measurement system, typically when the patient is in a predetermined range of state of activity and / or posture. Vital sign measurements can also be collected from the team's workload and communication management system 204, the patient communication system 202, or any other system in the improved clinical workflow system 200. For example, the team can
38/64 receive a request to take measurements of vital signs. Patient monitors can be used for baseline vital sign measurements, and devices used by patients or individual clinician observations can be used for intermittent measurements.
[0135] A score processing system 216 estimates the condition of the patient based on all vital sign measurements received from the vital sign measurement system 210 (typically through the vital sign monitoring management system 214). For example, a score could be assigned to each vital sign and then the vital sign scores could be totaled to determine a total monitoring score indicative of the patient's condition. In some cases, these vital signs considered by a score processing system operator to have a high dependence on the state of activity and / or posture can be suppressed when the state of activity and / or posture is outside a range acceptable. The suppression of a vital sign may include, for example, the use of the last measurement obtained when the state of activity and / or posture were within the acceptable range in place of the current measurement.
[013 6] If the patient's score for one or more vital signs worsens compared to the previous spot check, the 216 score processing system can automatically repeat the measurement of these vital signs (typically through the monitoring system of monitoring of vital signs) vital signs 214) after a certain time, such as one or five minutes. Alternatively, if the patient's total score worsens compared to the
39/64 previous point verification, the score processing system 216 will be able to automatically repeat the measurement of all vital signs after a certain time has elapsed. In both cases, the elapsed time can be adjusted by a user of the 216 score processing system or adjusted based on the patient's state of activity and / or posture.
[0137] Alternatively, the repetition of the measurement can be delayed until the state of activity and / or posture (for example, activity level) is within an acceptable range. In addition, a measurement schedule safety measure can be implemented to repeat the measurement after a maximum amount of time has elapsed (ie an upper limit). The upper limit can be set by a user of the 200 score processing system or adjusted based on the patient's activity status and / or posture.
[0138] If, after repeating the measurement, the score (for example, the total score or the score of an individual vital sign) worsens, a deterioration notification will be generated using the workload management system and team communication 204. For example, the notification can be shown on a patient's monitor, recorded for later review, or transmitted to a clinician who cares for the patient. If the state of activity and / or posture is outside an acceptable range (for example, the level of activity is above a predetermined threshold set by an operator of the 204 score processing system as being indicative of a high level of activity) , the notification may also include a restriction on activity status and / or posture. Otherwise,
40/64 the notification will be unconstrained. There are, therefore, two types of deterioration reports (for example, constricted and non-constrained deterioration reports) to assist the caregiver in assessing the patient's change in acuity. In some cases, if a notification for a certain severity of deterioration is generated under the condition of restricted state of activity and / or posture, a notification of deterioration of the same severity could be announced again in a situation where the state of activity and / or posture were within an acceptable range.
[0139] Alternatively, if, after the repetition of the measurement, the score worsens and the state of activity and / or posture is outside an acceptable range, a notification may be generated indicating that due to the state of activity and / or posture a notification deterioration is unreasonable with the use of the 204 workload management and communication system.
[0140] An activity and posture monitoring system 218 monitors the patient's state of activity and / or posture and generates notifications about posture and / or activity for clinicians using a 204 team workflow and communication system. notifications include posture and activity notifications. The notification can, for example, be shown on a patient's monitor, registered to be reviewed later, or transmitted to a clinician who cares for the patient.
[0141] Posture notifications can be generated periodically and include features extracted from a posture trend over a predetermined period of time. In addition, posture notifications can
41/64 be generated in the event that certain conditions are met. These conditions can be based on a combination of multiple (configurable) postures, typically decubitus positions.
[0142] For example, an activity notification may be generated if a patient has been in a position or subset of postures for longer than a predetermined period of time (configurable by an operator of the activity and patient monitoring system 218) . FIGURE 20 shows examples of positions that will be described in detail later in this document. In addition, FIGURES 27 to 30 show posture bars illustrating postures over time using the posture mapping shown in FIGURE 26. These figures are described in more detail below. After a certain amount of time within a set or subset of configurable postures (for example, lying on the left side), a notification can be generated.
[0143] As another example, a notification can be generated after a patient leaves one of these positions, and the notification will indicate how long the patient has remained in the position. As another example, a notification can be generated if the frequency of switching to different positions exceeds a limit. In some cases, notifications are delayed after a condition is met and are generated only if the condition persists. As an example, a posture notification may ask the clinician to change a patient's position or pay attention to the patient.
42/64 [0144] Posture notifications need to tolerate the patient's temporary movements to other positions to avoid unnecessary false notifications. Therefore, the laying conditions can, for example, additionally include an absolute time range outside the expected position before a notification is generated. For example, N minutes must elapse outside the expected green positions before an alarm is generated. Alternatively, these conditions may include, for example, a relative time range over a period set outside the expected position before a notification is generated. For example, x% (percentage) of time outside the expected position.
[0145] Activity notifications can be generated periodically and include features extracted from a trend of the activity state over a predetermined period of time, such as the sum of the activity level, the maximum activity level, the values / period of activity. maximum times, and the like. In addition, activity notifications can be generated if certain conditions are met based on these or other characteristics. For example, an activity notification can be generated if a patient has been in an activity state (for example, activity level) for longer than a predetermined period of time.
[0146] As another example, an activity notification may be generated if a patient has not reached a certain level of activity over a predetermined period of time during which, for example, the patient is expected to be out of bed and walking (how can it be
43/64 seen, for example, in FIGURE 18). As another example, an activity notification can be generated if an unexpected peak in activity level is detected when, for example, the patient should be at rest in bed (as can be seen, for example, in FIGURE 19). These two examples, in addition to others, can be determined by translating the trend line in FIGURES 18 and 19. More generally, FIGURES 18 and 19, described in more detail below, can be translated to automatically generate activity notifications for the keeper, since it cannot be assumed that the keeper will review the chart. Handlers will be able to receive notifications via a pager or a display screen.
[0147] Activity notifications need to tolerate levels of temporary, unexpected, or other patient activity to avoid unnecessary false notifications. Therefore, activity conditions can, for example, additionally include an absolute time range outside the expected activity level before a notification is generated. For example, generate notification only after a predetermined amount of time (for example, 10 minutes) of occurrences of unexpected activities / other activities. In other words, notifications are delayed after a condition is satisfied and are generated only if the condition persists. An example of an activity notification is a notification that asks a clinician to check the patient's exercise status if a condition persists for 10 minutes.
[0148] A 220 display system provides a consistent approach to viewing activity status
44/64 and / or patient posture on a display device with ο use, for example, the 204 team workload and communication management system. A consistent presentation is important to allow easy recognition of activity status and / or posture and the (implicit) recognition of what values are shown (specifically in small form factors). As described later in this document, visualization can be done using display elements, such as icons and graphics. The display elements may be of variable size, but they are more than reduced or enlarged graphic images. Instead, the display elements become more abstract as they decrease in size.
[0149] When displaying the activity status, the activity level is typically used. The level of activity can be shown using a vertical or horizontal bar, the length of which extends between two ends, a first end and a second end. The first end represents the minimum activity level and / or the unavailability of data on the activity level (for example, sensors that measure activity status and / or posture are not connected to the patient), while the second end represents the maximum activity level. As the activity level increases, a higher percentage of the bar is defined between the first end and the second end. Adjusting a percentage of the bar includes coloring or otherwise visually modifying the region to be highlighted from the remaining portion of the bar. Similarly, as the level of
45/64 activity decreases, a smaller percentage of the bar is defined between the first end and the second end.
[0150] With reference to FIGURE 13, an example of the use of a vertical activity bar is shown which comprises 5 display elements spaced between the two ends of the length of the vertical bar. As the level of activity increases, more and more elements are activated (for example, colored or otherwise visually modified to be distinguished from other non-activated elements). Similarly, as the level of activity decreases, more and more elements are not activated. The first column (that is, the leftmost one) represents the bar with a minimum activity level and / or the lack of activity level data. The sixth column (that is, the rightmost one) represents the bar with a maximum activity level. The columns between the second and the fifth columns represent the bar with an increasing level of activity. The vertical bar could also be used horizontally. In addition, more elements could be used.
[0151] With reference to FIGURES 14A and 14B, horizontal and vertical activity bars are shown. FIGURE 14A illustrates two horizontal bars, each adjusted to a different activity level. FIGURE 14B illustrates two vertical bars, each adjusted to a different activity level. With reference to FIGURES 15A and 15B, a horizontal representation and a vertical representation of the activity level are shown, respectively.
[0152] Another approach to display the activity level is to show the activity level using a numerical value representing the patient's activity level. O
46/64 numerical value can be in the range of a first end to a second end, the first end indicating the minimum activity level and / or the unavailability of data on activity level, and the second end indicates the level maximum activity. For example, the numerical value can be in the range of 0 to 5, where zero indicates unavailability of data, 5 indicates the maximum activity level, and 0 to 5 representing increasing levels of activity. With reference to FIGURE 16, an example of numerical display of the activity level is shown.
[0153] Yet another approach to display activity level is to show activity level as a combination of the activity bar and numerical value approaches described above. For example, with reference to FIGURES 17A-C, three display examples are shown. FIGURES 17A and 17B show a horizontal activity bar and its corresponding numerical value. FIGURE 17C shows a vertical activity bar and its corresponding numerical value.
[0154] To assist in the connection process of sensors that measure the state of activity and / or posture to the patient, the numerical value and / or the activity bar can be updated in real time or in near real time. For example, the numeric value and / or the activity bar can be updated every second. It may even be useful to show a trend in the numerical value and / or the activity bar with, for example, one-second intervals.
[0155] The activity level can be shown on a vertical or horizontal trend line using
47/64 of the activity bar described above as shown, for example, in FIGURE 18. When the trend line is vertical, horizontal activity bars are used. Similarly, when the trend line is horizontal, vertical activity bars are used. An activity bar is added to the trend line every predetermined period of time, such as every 10 seconds. Each activity bar represents the interval between the previous activity bar and the activity bar. For example, the activity bar can represent the average, the maximum or the minimum level of activity level over the range.
[0156] Intervals during which activity level data are not available have no activity bars. Activity bars that correspond to intervals during which the activity level was unavailable or partially unavailable can be shown enlarged. For example, such activity bars can be shown thinner, as at half the usual width, as illustrated by [h], [k] and [n] in FIGURE 19. As another example, these activity bars can be shown with a lighter color tone (for example, gray instead of black), as illustrated by [g] and [m] in FIGURE 19, or simply shown with their outline and without padding, as illustrated by [f] and [ 1] in FIGURE 19.
[0157] In some cases, it is advantageous to show both the maximum activity level and the average activity level. For example, the average activity level can be shown as described above and the maximum activity level can be shown by a dot, cross or thin vertical line, such as
48/64 illustrated by [b], [c] and [d] in FIGURE 19. Typically, the maximum and average activity levels for an interval are shown in the same visual style (for example, color, pattern, etc.) .
[0158] As illustrated in FIGURE 18, the maximum activity level is shown by a dot. Displaying the maximum activity level and the average activity level helps to distinguish intervals during which the patient has been at rest (for example, sleeping) for a long time and intervals during which the patient has been lying in bed or sitting in a bed. chair (for example, low level of average activity), but got up and walked a little. In relation to the first case, the average activity level is low and no point is visible because the maximum and average activity levels are basically the same. In relation to the latter case, the point corresponds to a value much greater than the average value. In the middle section of FIGURE 7, the patient exercised continuously (ie, high activity level and no stitches) and then started to pause at the following intervals. The average activity level was still high, but the maximum activity level was higher (that is, there were times with less activity).
[0159] In addition, in some cases, it is advantageous to show average activity levels, 90% and maximum. For example, the average and maximum activity levels can be shown as described above, and the 90% activity level can be shown as thinner, as with half the usual width, as illustrated by [e], [1], [m] and [n] on
FIGURE 19. Typically, the average activity levels, 90% and maximum for a given interval are shown in the same visual style (for example, color, pattern, etc.).
49/64 [0160] Typically, there is no clinical need to show the minimum value or the 10% value, as is done with a conventional style, an example of which is illustrated by [a] in FIGURE 19. What you have with this practice is just unnecessary data. Show only the average and maximum values (illustrated by [b], [c], [d], [f], [g], [h] and [k] in FIGURE 19) or the average value, 90% and the maximum value (illustrated by [e], [1], [m] and [n] in Figure 19) is more appropriate. However, it should be considered that the value of 10% and / or the minimum value can additionally be shown using the techniques described (for example, using different widths) and / or in place of at least one among the average, 90% and maximum values.
[0161] The posture can be shown with one or more of a keyword or phrase describing the posture (for example, supine), an icon or a combination of these items. With reference to FIGURE 20, a table is shown that illustrates keywords or phrases and the corresponding icons that can be used to describe posture. The above postures are static (that is, they can be determined instantly from sensor measurements, such as accelerometer measurements). FIGURES 21A and 21B illustrate two examples of posture. FIGURE 21A shows an icon and a keyword or phrase, while FIGURE 21B shows only one icon.
[0162] A dynamic posture can also be displayed. A dynamic posture takes into account the sequence and timing of posture changes. With reference to FIGURE 22, a table is shown that illustrates keywords or phrases and the corresponding icons that can be used to describe dynamic posture. Other keywords or phrases
50/64 that can be used include climbing stairs, descending stairs, falling and getting out of bed.
[0163] In some cases, a new posture is shown only after a time limit has elapsed and / or a change in position (eg angle) has been made. This avoids changing the displayed position if a measurement is made between two positions or the position is not yet a stable position. If a position remains unstable for an extended time, a specific position of unstable may be shown.
[0164] The posture can be shown as a single keyword or phrase, or an icon that is constantly updated. Alternatively, the posture can be shown using a list with time indications, and keywords or phrases and / or icons, as illustrated in FIGURES 23A and 23B. FIGURE 23A shows a list of keywords or phrases, and FIGURE 23B shows a list of icons. The stance can also be displayed on a timeline using icons, as illustrated in FIGURE 24.
[0165] A timeline of icons for, for example, the posture may need to be compressed along the time axis, usually horizontally, due to space limitations (for example, to show a longer period of time). One approach to this is to use a graphic language that indicates more icons, examples of which are shown in FIGURES 25A-E. The groupings of icons shown in FIGURE 25A indicate a plurality of icons that can be expanded upon selection. The arrows in FIGURES 25B and 25C indicate a plurality of icons that can be expanded by selecting the corresponding icon. More abstract symbols can be
51/64 used in place of arrows, as shown in FIGURE 25D. Icons can also be misaligned in another dimension (for example, a direction perpendicular to the time axis), as illustrated in FIGURE 25E.
[0166] To review the patient's posture, specifically if the patient needs to be moved periodically, a more intuitive approach to display posture is to map possible postures with different visual styles (for example, color, pattern, etc.) and show a bar of the different visual styles representing the different postures. For example, the supine, reclined, vertical, forward, prone, upside down, lying on the left side and lying on the right side positions can be mapped with different colors, as shown in Figure 26. A bar of these visual styles can then be displayed, as shown in Figure 27.
[0167] Another approach is to employ a vertical or horizontal bar, the latter being typically better if time aspects are included. In this approach, the possible postures are mapped to different visual styles (for example, color, pattern, etc.), as described above. The bar is shown with a plurality of different regions extending between the ends of the bar length, with each region corresponding to a different posture detected during a time window represented by the bar. In addition, each region is shown with the visual styles of the corresponding posture and sized to fill the percentage of the bar that corresponds to the percentage of time the patient remained in the corresponding posture during the
52/64 time window. The width of the time window can, for example, be fixed, configurable or arbitrary.
[0168] In addition, the time window can be moved, for example, continuously or at fixed time intervals. For example, the bar can be shown adjacent to the trend lines for one or more vital signs (for example, respiratory rate) and a graphical representation of the time window can be superimposed on the corresponding portion of the trend line. This example is illustrated in FIGURE 28. As illustrated in FIGURE 28, a vertical bar for posture is shown, as well as the patient's signal trends for a plurality of vital signs and the time window corresponding to the vertical bar. The patient remained in a first posture (for example, on his right side) for 60% of the time window between the ti and t2 marks, and in a second posture (for example, on his left side) for 40% of the time window. time.
[0169] The posture bar described in FIGURE 28 has no time information. The patient could have remained in the first posture (for example, on his right side) for 30% of the time, and then in the second posture (for example, on his left side) for 40% of the time, and then again in the first posture for another 30% of the time. One approach to displaying time information is to use the length of the posture bar as a time axis, with the ends of the length representing the ends of the time window. The postures detected during the time window are then displayed in the corresponding time regions
53/64 using the corresponding visual styles, as illustrated in Figure 27.
[0170] Showing the time information on the posture bar as indicated in FIGURE 27 above could make the information very diffuse in the case of a patient who moves a lot. To improve the display of time information, the postures detected can be classified by the average age of their occurrence in relation to the beginning of the time window. The postures can then be shown as classified. FIGURE 29 shows a posture bar using this approach to display time information. The patient remained in a first posture (for example, on his right side) for 60% of the time window and in a second posture (for example, on his left side) for 40% of the time window. However, more recently, the patient remained in the first posture. In other words, the average age of occurrences of the first posture in relation to the beginning of the time window is greater than the average age of occurrences of the second posture. Therefore, the first posture is displayed after the second posture on the posture bar.
[0171] The posture bar with time classification allows the estimation of events by moving the time window and reviewing the position change in the posture bar. An example of this is shown in FIGURE 30. In this example, the patient was moved from a first position (for example, on his left side) to a second position (for example, on his right side) at 7:00 am. In this example, if the first posture was reclined and the second posture was supine, the patient may have slept.
54/64 [0172] Both activity status and posture can be relevant when other vital signs are assessed (for example, heart rate or noninvasive blood pressure). To indicate the state of activity and / or posture during the measurement of another vital sign and / or just before the measurement, a representation (typically small) of the state of activity and / or posture can be shown adjacent to the measurement. The state of activity and / or posture are indicators of relevance when shown adjacent to a measurement.
[0173] For example, according shown in FIGURES 31A and 31B, a patient presented a frequency cardiac in 90 while was lying on supine position (FIGURE 31A) and a heart rate of 1 35 during a walk (FIGURE 31B). How another example, as shown at Figure 32, a patient and presented a frequency cardiac in 120 during a walk and a level of
average activity (3).
[0174] For the relevance indicator, all presentation styles, preferably the small ones, described above can be used. For example, for laying, the compacted form (for example, arrows, groupings, or stacks, or any combination of these could be used) can be used, as shown in Figure 33. The range of a relevance indicator (for example, for state of activity and / or posture), such as 5 or 10 minutes, is implied from the frequency of specific checks of the corresponding vital sign. A small presentation of a tendency to state of activity and / or posture, as a
55/64 minimum value trend can also be used, examples of which are illustrated in FIGURES 34A and 34B.
[0175] The patient preparation system 10, the adaptive patient monitoring system 100 and the enhanced clinical workflow system 200 can be used individually or in combination with each other. For example, the patient preparation management system 100 can be used for measurements obtained from vital signs, and the adaptive patient monitoring system 100 can be used to adjust measurement frequencies. Improvements can also be added such as the display system 220 to show the patient's state of activity and / or posture.
[0176] In addition, the functionalities of the patient preparation system 10, the adaptive patient monitoring system 100 and the enhanced clinical workflow system 200 can each be implemented in hardware, in software or in a combination both. When software is used with one of the patient preparation system 10, the adaptive patient monitoring system 100 and the enhanced clinical workflow system 200, system 10, 100, 200 includes one or more program memories with instructions executables per processor incorporating the relevant functionality and one or more processors executing executable instructions per processor.
[0177] In addition, notifications can be submitted to the team (for example, clinicians) through any one-way or two-way means of communication. For example, data can be presented to the team through
56/64 from a display device, and data can be received by the team using a user-entered information device (D.I.U.). The display device can optionally be used to display an interface to facilitate receiving data from staff.
[0178] With reference to FIGURE 35, a medical system 300 from a medical institution, such as a hospital, is shown, within which the patient preparation system 10, the adaptive patient monitoring system 100 and the system of monitoring can be used. improved clinical workflow 200. The medical system 300 includes one or more patient data generating devices 302, optionally a patient information system 304, a clinical decision support system (SDC) 306, one or more monitoring devices remote 308 and one or more clinical devices 310. Suitably, the components of the medical system 300 are interconnected through a communication network 312, such as the Internet, a local area network, a wide area network, a wireless network, or similar.
[0179] Patient data generating devices 302 generate data for associated patients. Patient data appropriately includes measurements of vital signs such as heart rate, temperature, blood oxygen saturation (SpO2), level of consciousness, concern, pain, urine volume, etc. Patient data may also include data indicating activity status and / or posture. Patient data can be generated automatically or manually. In relation to the first case, one or more sensors 314 of the patient data generation devices 302, such as electrocardiographic electrodes
57/64 (ECG), blood pressure sensors, oxygen saturation sensors (SpO2), accelerometers, etc., can be used to measure vital signs, as well as activity status and / or posture. In relation to the latter case, one or more information devices entered by the user 316 can be employed, optionally in conjunction with one or more display devices 318 providing users with a user interface through which patient data can be entered manually. User-entered information devices 316 can also be used to configure patient data generation devices 302. Examples of patient data generating devices include, but are not limited to, patient monitors, nursing stations, monitoring devices mobile communication, wireless measurement devices, patient information systems, etc.
[0180] One or more of the patient preparation system 10, the adaptive patient monitoring system 100 and the improved clinical workflow system 200 can be implemented partially or integrally on one or more of the patient's data generation devices patient 302. For example, one or more of the activity and / or posture measurement system 26, the vital signs monitoring management system 38, the patient preparation management system 40 and the vital signs measurement system 34 of Figure 1 can be implemented in one or more of the patient data generation devices 302. As another example, one or more of the vital signs measurement system 102, the score processing system 108 and the control system gives
58/64 monitoring frequency 110 of FIGURE 8 can be implemented in one or more of the patient data generation devices 302. As another example, one or more of the activity and / or posture measurement system 206, the vital signs monitoring management 214 and the vital signs measurement system 210 of FIGURE 12 can be implemented in one or more of the patient data generation devices 302.
[0181] The patient information system 304 stores patient data generated by the medical system 300, such as patient data generation devices 302, in one or more databases. For example, the patient information system 304 can store a patient's respiratory rate data generated by one of the patient data generation devices 302. In some cases, the patient information system 304 also stores patient data generated by an information device entered by the user 322 of the patient information system 304 into the databases and / or allows the stored patient data to be viewed on a display device 324 of the patient information system 304. The display device 324 can, additionally or alternatively, be used to facilitate the receipt of data from the user-entered information device 322. Examples of patient information systems include, but are not limited to, electronic medical record systems, departmental systems, and the like.
[0182] The SDC 306 system receives patient data. Patient data is typically received from other systems in the medical system 300 (for example,
59/64 (eg patient data generation devices 302 and / or patient information system 304), but can also be received from a user-entered information device 326 of the SDC 306 system. by the user 326 can also be used to configure the SDC 306 system. A display device 328 of the SDC 306 system can additionally be used to facilitate the reception of data from the user entered information device 326.
[0183] Using patient data, the SDC 306 system typically monitors the clinical deterioration of the patient, for example, using a scoring system. In response to detecting the patient's clinical deterioration, alerts are generated and transmitted to clinicians (for example, using a communication system and / or remote monitoring devices 308). The SDC 306 system can also distribute patient data to other systems of the medical system 300. For example, the SDC 306 system can supply patient data to the patient information system 304 for storage. As another example, the SDC 306 system can transmit patient data to remote monitoring devices 308.
[0184] One or more of the patient preparation system 10, the adaptive patient monitoring system 100, and the enhanced clinical workflow system 200 can be implemented partially or in full in the SDC 306 system. For example, at least the workflow functionality of the team's workload management and communication systems
60/64
24, 106, 204 of FIGURES 1, 8 and 12, respectively, can be implemented in the SDC 306 system. As another example, the monitoring frequency control system 110 can be implemented in the entire SDC 306 system and in one or more of the patient data generation devices 302, with the SDC 306 system adjusting the monitoring frequency based on the level of accuracy and / or the frequency of the manual point checks defined for each patient and with one or more of the data generation devices patient data 302 adjusting the monitoring frequency based on the score. As another example, one or more of the score processing system 216, the activity and / or posture monitoring system 218, the score processing system 216 and the vital signs monitoring management system 214 can be implemented in the SDC 306 system.
[0185] Remote monitoring devices 308 monitor patient data and perform one or more of the following steps: 1) generate notifications of clinically significant conditions in response to patient data; and 2) display the patient data or the determined scores. Patient data is typically received from other systems of the medical system 300 (for example, the patient data generation devices 302 and / or the patient information system 304), but can also be received from information devices inserted by user 330 from remote monitoring devices 308 or from local sensors (for example, a patient monitoring device can be the same as a device generating patient data). User-entered information devices 330 can
61/64 can also be used to configure the remote monitoring devices 308. The display devices 332 of the remote monitoring devices 308 can additionally be used to facilitate the reception of data from the information devices entered by the user 330. Notifications can be displayed on display devices 330, transmitted to clinicians using a communication system, transmitted to other systems of the medical system (for example, the SDC 306 system), or stored internally in a storage memory.
[0186] One or more of the patient preparation system 10, the adaptive patient monitoring system 100 and the enhanced clinical workflow system 200 can be implemented partially or in full on one or more of the remote monitoring devices 308. For example, one or more of the activity and / or posture measurement system 26, the vital signs monitoring management system 38, the patient preparation management system 40 and the vital signs measurement system 34 of FIGURE 1 can be implemented in one or more of the remote monitoring devices 308. As another example, one or more of the vital sign measurement system 102, the score processing system 108 and the monitoring frequency control system 110 of the FIGURE 8 can be implemented in one or more of the remote monitoring devices 308. As another example, one or more of the activity measurement system and / or post ura 206, the vital signs monitoring management system 214, the vital signs measurement system 210, the display system 220 and the data processing system
62/64 scores 216 of Figure 12 can be implemented on one or more of the remote monitoring devices 308.
[0187] Clinical devices 310 receive and display notifications and / or patient data from the medical system 300. Notifications and / or patient data are typically received from other systems of the medical system 300 (e.g. , patient data generation devices 302 and / or patient information system 304). User-entered information devices 334 can be used to communicate with other systems of the medical system 300 and / or to configure the clinical device 310. The display devices 336 of the clinical devices 310 can additionally be used to facilitate reception data from user-entered information devices 334. SDC systems client devices include pagers, smartphones, patient monitors, tablet PCs, mobile clinical assistants, laptops, workstations, etc.
[0188] One or more of the patient preparation system 10, the adaptive patient monitoring system 100 and the enhanced clinical workflow system 200 can be implemented partially or integrally on one or more of the remote monitoring devices 308. For example, the display system 220 of FIGURE 12 can be implemented in one of the clinical devices 310.
[0189] Each of the patient information system 304 and the SDC 306 system includes at least one 338, 340 server. Communication between at least one 338, 340 server can be done via a network
63/64 communication, such as the communication network 312 of the medical system 300. At least some of the components of the medical system 300 each include at least one processor 342, 344, 346, 348, 350 to execute executable instructions by computer at from at least one program memory 352, 354, 356, 358, 360 thereof. Components include patient data sources 302, at least one server 338, 340, remote monitoring devices 308 and clinical devices 310. Computer-executable instructions incorporate component functionality.
[0190] Additionally, at least some of the components each include a communication unit 362, 364, 366, 368, 370 and / or at least one system bus 372, 374, 376, 378, 380. One unit of Communication provides a corresponding processor with an interface for at least one communication network, such as the 312 communication network. A system bus allows the exchange of data between component subcomponents. Subcomponents include processors, memories, sensors, display devices, communication units, etc.
[0191] As used here, a memory includes one or more of a non-temporary computer-readable media; a magnetic disk or other magnetic storage media; an optical disc or other optical storage media; a random access memory (RAM), a read-only memory (ROM), or other electronic memory device, integrated circuit or set of integrated circuits interconnected in an operational manner; an Internet / Intranet server from which stored instructions can be extracted via the Internet / Intranet
64/64 or a local area network; and so on. In addition, as used here, a processor includes one or more of a microprocessor, a microcontroller, a graphics processing unit (UPG), an application-specific integrated circuit (CIAP), a field programmable port array (FPGA), and similar; a controller includes: 1) at least one memory with executable instructions per processor to execute the controller functionality; and 2) at least one processor to execute executable instructions per processor; a user data output device includes a printer, a display device, and the like; and a display device includes one or more of a liquid crystal display (LCD), a light emitting diode (LED) screen, a plasma screen, a projection screen, a touch screen, and the like.
[0192] The invention has been described with reference to the preferred embodiments. Modifications and changes may occur to others when reading and understanding the detailed description above. The intention is that the invention is constructed as including all these modifications and changes, insofar as these fall within the scope of the appended claims or the equivalents thereof.

权利要求:
Claims (15)
[1]
1. MEDICAL SYSTEM (300), characterized by comprising:
at least one processor (342, 344, 346, 348, 350) programmed to:
measure a patient's state of activity and / or posture;
measure one or more vital signs of the patient according to a schedule; and based on the measurement of the patient's state of activity and / or posture and one or more measured vital signs, at least one of the actions to adjust the schedule and monitor the patient's clinical deterioration.
[2]
2/6 clinical deterioration of one or more vital signs of the patient; and at least one of the steps of:
adjust the measurement frequency for each of the one or more vital signs based on the patient's cumulative clinical deterioration score; and adjust an individual patient score assignment scheme that includes vital sign limits and a list of measured vital signs.
2. MEDICAL SYSTEM (300), according to claim 1, characterized in that the schedule includes a measurement frequency for each of the one or more vital signs, and the at least one processor (342, 344, 346, 348, 350) is additionally programmed to:
determine a patient's clinical deterioration score for each of the one or more vital signs from corresponding measurements of vital signs; and adjust the measurement frequency for each of the one or more vital signs based on changes in the patient's corresponding clinical deterioration score.
[3]
3/6
3. MEDICAL SYSTEM (300), according to claim 2, characterized in that at least one processor (342, 344, 346, 348, 350) is additionally programmed to:
determine a cumulative score of clinical deterioration of the patient from the one or more scores of
[4]
4/6 compare the posture trend with an expected posture trend; and show an indication that the posture tendency is as expected, that the posture tendency is not as expected and / or that some action should be taken, such as turning the patient around, based on the posture tendency.
4. MEDICAL SYSTEM (300) according to any one of claims 1 to 3, characterized in that at least one processor (342, 344, 346, 348, 350) is additionally programmed to:
determine a patient's clinical deterioration score from measurements of vital signs; and based on changes in the patient's clinical deterioration score, at least one of the actions to adjust the schedule and generate a notification ^
in answer to a change in score in deterioration clinic of patient, repeat the measurement of a or more vital signs for confirm the change; andin response to confirmation • the change and based at change at least one of the actions of adjust O schedule and generate a notification. 5. SYSTEM DOCTOR (300) according to The claim 4, characterized by at least one processor
(342, 344, 346, 348, 350) be additionally programmed to: delay the new measurement of one or more vital signs until the state of activity and / or posture corresponds to a predetermined state of activity and / or posture.
[5]
5/6 based on changes in the patient's clinical deterioration score, at least one of the actions to adjust the schedule and generate a notification ^ in response to a change in the patient's clinical deterioration score, repeat the measurement of one or more vital signs to confirm the change; and in response to confirmation of the change and based on the change, at least one of the actions to adjust the schedule and generate a notification.
[6]
6. MEDICAL SYSTEM (300) according to any one
of claims 1 to 5, characterized by at least one processor (342, programmed to: 344, 346, 348, 350) be additionally instruct O patient to take a state predetermined activity and / or posture before measurement
one or more vital signs.
[7]
7. MEDICAL SYSTEM (300) according to any one of claims 1 to 6, characterized in that at least one processor (342, 344, 346, 348, 350) is additionally programmed to execute at least one of the actions of:
discard vital sign measurements made when the state of activity and / or posture in question does not correspond to a predetermined state of activity and / or posture; and delaying a scheduled measurement until the state of activity and / or posture corresponds to a predetermined state of activity and / or posture.
[8]
8. MEDICAL SYSTEM (300) according to any one of claims 1 to 7, characterized in that at least one processor (342, 344, 346, 348, 350) is additionally programmed to:
show a measurement of vital signs and the corresponding state of activity and / or posture, the corresponding state of activity and / or posture being shown adjacent to the measurement of vital signs.
[9]
9. MEDICAL SYSTEM (300), according to claim 1, characterized in that at least one processor (342, 344, 346, 348, 350) is additionally programmed to:
calculate a posture tendency;
[10]
10. MEDICAL METHOD, characterized by understanding:
measure a patient's state of activity and / or posture;
measure one or more vital signs of the patient according to a schedule; and based on the measurement of the patient's state of activity and / or posture and one or more measured vital signs, at least one of the actions to adjust the schedule and monitor the patient's clinical deterioration.
[11]
11. MEDICAL METHOD, according to claim 10, characterized in that the schedule includes a measurement frequency for each one or more vital signs, and said medical method additionally includes:
determine a patient's clinical deterioration score for each of the one or more vital signs from corresponding measurements of vital signs; and adjust the measurement frequency for each of the one or more vital signs based on changes in the patient's corresponding clinical deterioration score.
[12]
12. MEDICAL METHOD, according to any of the preceding claims 10 and 11, characterized in that it further comprises:
determine a patient's clinical deterioration score from measurements of vital signs;
[13]
13. MEDICAL METHOD, according to claim 12, characterized in that it further comprises:
delay the repetition of the measurement of one or more vital signs until the state of activity and / or posture corresponds to a predetermined state of activity and / or posture.
[14]
14. MEDICAL METHOD, according to any of the
claims 10 The 13, characterized by understand additionally:instruct O patient to take a state
predetermined activity and / or posture before the measurement of one or more vital signs.
[15]
15. MEDICAL METHOD, according to any one of claims 11 to 14, characterized by additionally comprising at least one of the following actions:
discard vital signs measurements made when the state of activity and / or posture in question does not correspond to a predetermined state of activity and / or posture; and delaying a scheduled measurement until the state of activity and / or posture corresponds to a predetermined state of activity and / or posture.

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