A neonate undergoes a tremendous number of manipulations, or touch-points, in a neonatal intensive care unit. These manipulations can be invasive (such as central line) or non-invasive (such as a diaper change).

THE PROBLEM

“On average, a neonate undergoes 768 manipulations and 1,341 procedures during their hospital stay,” said Dr. Gautam Yadav, a pediatric physician at Kalawati Hospital in Rewari, in the Indian state of Haryana. “It is important to study the effect of these manipulations on the clinical outcome. We needed access to technology to noninvasively monitor critical patients in the NICU to ensure any early insights into patient condition.”

PROPOSAL

Kalawati Hospital sought out some unique technology from Child Health Imprints, a vendor of neonatal health data technology, along with live-streaming video technology from vendor Wowza.

The Child Health Imprints system includes a NEO device that fetches live physiological data from medical devices, and that combines with the Wowza live video-streaming technology that takes the data of the neonate through an attached camera. This data is made available to clinicians through a web platform, iNICU, for informed decision-making.

"With our technologies, video streaming of neonates is being annotated in real time with any changes in physiological or clinical state of patients."

Dr. Gautam Yadav, Kalawati Hospital

“The third layer, an analytics layer, has the capability of autonomously tagging the manipulations – touch-points to the neonate – in live videos, correlating the physiological signals and identifying the pattern of variability in physiological signal while the neonate is being manipulated,” Yadav explained. “Further, it also identifies the duration and frequency of these manipulations. The complete technology solution studies the impact of manipulations on neonatal care and its association with adverse outcomes.”

MEETING THE CHALLENGE

Kalawati Hospital has used the technology at the bedside of critical patients in the NICU. It is used by doctors and nurses for quality control and training.

“This technology is linked with data of various biomedical equipment in the NICU from GE, Philips, Draeger and Nihon Kohden,” Yadav explained. “It also is linked with the EHR and lab information system. The analysis layer of video streaming allows clinicians to see changes in physiological data – such as heart rate, respiratory rate and oxygen saturation – during different manipulations.”

RESULTS

Yadav offers four success-metric areas of using the combined neonatal data and video-streaming technologies that Kalawati Hospital is studying.

“It is hypothesized that in emerging countries, especially India, an oversight on nursing staff through an automated computer vision platform will have significant improvement in clinical outcomes,” he said. “We are still collecting data with live streaming and [an] integrated platform, and it will take us a few more months to publish improvement in clinical outcomes – on a statistically significant population – and get it peer reviewed.”

On another front is the movement index – tone and body postures. It is well documented that early symptoms of disease can be picked by monitoring body tone and movement indexes, he noted. Currently, this is done manually by doctors during daily rounds in two to three minutes. With the technologies, it is hoped that, with data across many NICU areas of both healthy and diseased patients, it will allow the platform to aid in early disease-identification in an autonomous manner, he said.

“Then there is the command center for remote management/telemedicine,” Yadav said. “Most of the telemedicine solutions do not have [the] synchronized temporal data of a patient’s physiology, video and its correlation with patient well-being. With our technologies, video streaming of neonates is being annotated in real time with any changes in [the] physiological or clinical state of patients. This will allow artificial intelligence and deep learning applications to further improve clinical outcomes.”

And finally, manipulation frequency and duration.

“We have been able to see the number and duration of manipulations – both invasive and noninvasive – on the neonates,” Yadav explained. “We have submitted the results in a peer-reviewed publication for sharing the same with other NICUs. This has allowed us to baseline data of our existing outcomes and enabled us to initiate quality improvement. This has also allowed us to build a staff education program for team members with non-planned care manipulations.”

ADVICE FOR OTHERS

“Video streaming in critical care can allow direct visualization to clinicians and help us in informed decision-making, including remote access,” Yadav said. “This has aided in better accuracy of manipulations and its relationship with vital sign data. This tool has allowed our clinical staff to determine their operational performance. It will potentially allow the NICU staff to determine if certain manipulations are associated with adverse outcomes.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
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