Medical Device Daily Associate

Much has been made about the push in hospitals to acquire technologies to help their staff perform their jobs more efficiently and to do so more quickly, particularly with an ever-increasing healthcare staffing shortage.

One company that is playing a part in this increasingly important drive is Sonitor Technologies (Hopewell Junction, New York/Oslo, Norway), whose ultrasound indoor positioning system (IPS) was installed at Brigham and Women's Hospital (BWH; Boston) as part of the SMART (Scalable Medical Alert and Response Technology) patient tracking and monitoring project.

Using the Sonitor IPS system, selected patients in the emergency department (ED) waiting area will be tracked and located by room in real time.

The ED was designated as the testing site for the initial deployment, refinement and evaluation of the SMART project because of its high patient volume and turnaround times.

The SMART project is a collaborative effort by researchers from Brigham and Women's, Harvard Medical School (Boston) and the Massachusetts Institute of Technology (MIT; Cambridge, Massachusetts).

Thomas Stair, MD, director of research for the emergency room department and a co-principal investigator of the SMART program at BWH, said that the SMART program was begun with funds from a grant that his colleague at the hospital, SMART co-principal investigator Lucila Ohno-Machado, MD, PhD, was awarded by the National Library of Medicine – a part of the National Institutes of Health (Bethesda, Maryland) – about 2-1/2 years ago.

“The main push for this set of grants was information technology for disaster response,“ Stair told Medical Device Daily. “The idea here was to be able to set up a wireless monitoring system that you can take to a disaster in the field or a field hospital.“

Stair said that he told Ohno-Machado that the ED would make a good testing ground for the study, because as he somewhat jokingly pointed out, “we're a disaster area.“

Sonitor wireless detectors are installed throughout the ED patient waiting areas – lobby, restrooms, etc. Upon registration, patients are given a Tag device that monitors, tracks and locates their position in real time. This Tag, which is incorporated into a fanny pack worn by the patient, is linked to the patient's digital file, which contains their vital signs while the patient is in the waiting area.

The motion-activated Tag transmits its unique identification signal using ultrasound waves as the patient moves throughout the emergency waiting area. Detectors, using Sonitor's digital signal processing (DSP) algorithms, transmit signals in digital format via the existing wireless local area network to a central computer unit that stores the information about the Tag's location and the time of the receipt of the Tag signal in a software program written by collaborating researchers from MIT. This information enables emergency room staff to retrieve a Tag's position and/or movement and determine precisely by room where the patient with that specific Tag is located.

Each of these fanny packs contains a personal digital assistant (PDA). Attached to the PDA are a three-lead EKG and a pulse oximeter probe that is attached to a patient's finger.

Stair said that the IPS system should help his hospital increase its ED waiting room capacity from its current level of 44 patients, “because the waiting room, the hallway and other parts of the hospital [such as] the lobby could actually be utilized and still be able to track everybody.“

Stair noted that the hardest part about getting the SMART project off the ground was finding off-the-shelf civilian technology that could be utilized for the hospital's needs. “The armed services do this now,“ he said, noting that at the very least the military already has prototypes that are gradually being incorporated into the services' medical care. However, he noted the military hardware “is all classified and not available to the rest of us.“

He said the hospital has dedicated the first 2-1/2 years of the project to developing the hardware and the monitoring and alarm software for the ED trial.

The final piece of the puzzle was the Sonitor ultrasound indoor position-sensing device, with sensors installed in the ED waiting room.

“We are delighted that our ultrasound indoor positioning system was selected for such a prestigious research project,“ said Terry Aasen, president and CEO of Sonitor. “Ultrasound signals by nature confine themselves to the room where they originate; therefore, our IPS system makes room identification and accuracy virtually fail-proof,“ he told MDD. “Moreover, our patented Ultrasound-DSP technology ensures that the detectors interpret a Tag's signals without risk of interference from any environmental noise or other signals nor interfere with sensitive instruments, which is particularly important in a hospital setting.“

Assen said the company's technology incorporated in the SMART project originally was designed to keep track of patients' charts in hospitals. It then evolved as a way to track medical equipment and the move to patients is part of the natural evolution of the technology in the healthcare arena, which the company believes will be the most lucrative market for the technology.

A further benefit of the Sonitor ultrasound IPS, said Assen, is that it is easy to install and maintain, requiring no complex calibrations to compensate for signal reflections from metallic objects etc., as is required with radio frequency-based systems.

Most likely starting next week, Stair said the hospital would begin using the fanny packs on real patients. Thus far, he noted, it only has tested the devices on healthy volunteers to work out any kinks.

“We'll see how [patients] tolerate it, how the nurses like it and how the alarm system works on it as well,“ said Stair. “If it's successful, we might start using this sort of thing instead of the hodge podge of other monitors that we use in the emergency department that people tend to ignore.“ He also suggested that the trackers could be placed on key hospital equipment as well to help keep track of it.

Aside from the ED, Stair said these types of tracking system could have practical applications in other parts of the hospital, including the operating room (OR). He said that at Massachusetts General Hospital (Boston) a different system incorporating radio frequency is being used to track patients, staff and equipment in an experimental three-area operating room, in which one patient is being induced and another patient is being recovered at the same time that an operation is going on.

Assen said he believes that industry has barely scratched the surface as far as what it can provide to hospitals to help them maximize their resources. “The private hospital industry is looking for a return on their investment, and products like ours are great efficiency and productivity tools for them,“ he said. “Ultimately, what these tools will allow the hospitals to do is spend more time together with patients.“