Technology

What if the doctor has been watching but never?

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This new system for continuous monitoring and collection of patient data has recently become wireless. It is being tested on patients in a hospital in Birmingham, UK, but it and similar remote systems may be used in patients’ homes in the future. The more I read on this topic, the more I realize that remote patient monitoring can fundamentally change medicine: speed up medical response and improve health outcomes; re-planning of healthcare areas; but it may also change in ways that we may not welcome The idea of ​​a doctor like me.

Watch closely Since ancient times, patients have been the universal duty of all doctors. For thousands of years, medical practitioners have used their senses to assess the condition of patients. Even now, our doctors are trained to recognize the hard candy breathing of a diabetic patient, the click of a glass bottle when intestinal obstruction occurs, and the cold, clammy sensation of the patient’s skin when blood circulation stops. But the systematic recording of numerical observations is a surprising new phenomenon.

In the late 1800s, the instrument was designed to measure a set of standardized health indicators. These are the four main vital signs: heart rate, breathing rate, body temperature, and blood pressure. Just before the turn of the last century, these vital signs (also called observations) were systematically recorded for the first time.after The first world war They are often used. Research on these charts shows that when these vital signs are normal, people basically do not die; the heart does not stop suddenly. But for most of a century, the art of interpreting these so-called obs charts was as mysterious as reading tea leaves to the untrained.

Then, in 1997, a team at James Paget University Hospital in Norfolk, England, developed an early warning system that nurses can use to quickly convert vital signs into scores. If the score exceeds the threshold, it is a sign that a doctor’s help is needed. Such systems have been steadily promoted for use in adult patients, but it is not clear whether they are suitable for children, because children have different physiological responses to diseases than adults.

Heather Duncan knew about the early warning system for adult patients in 2000, when she worked as a general practitioner in South Africa and had a keen interest in child health. Usually, observations made in hospitals are not related to observations made in primary care clinics in the early stages. But Duncan tried to connect these two data sets-from the community and the hospital-to create a more meaningful and continuous story about what happened to the patient. She took the trouble to scrutinize the records of her most seriously ill children, plotting their vital signs, from their first record in a primary care facility to discharge or death in the hospital. “I noticed that the children were in cardiac arrest or entered the intensive care unit, and we actually missed the opportunity to take further action,” she recalled.

Her nagging feeling that she could do more for these children was later confirmed by the British government. Confidential investigation of child deaths, It found that more than a quarter of children in National Health Service hospitals died of avoidable causes. In 2003, Duncan completed an intensive care study at the Toronto Sick Children’s Hospital, where he developed the Pediatric Early Warning System (PEWS) together with pediatric intensive care doctor Chris Parshuram, a bedside scoring system designed for sick children.

Duncan is now a pediatric intensive care physician at Birmingham Children’s Hospital. Last October, I found her on Zoom. Duncan worked from home, wearing an oversized cream woolen sweater to welcome the arrival of British autumn, her hair was combed back into a loose bun, and she wore blue-rimmed glasses that matched her eyes. She speaks with an elegant South African accent and has a calm attitude. Working in such a stressful profession is undoubtedly an asset.Her hospital adopted the PEWS score in 2008 and saw reduce The number of children who died after cardiac arrest—increased from 12 in 2005 to no deaths in 2010.

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