An ambitious digitisation project that will not only improve the care of seriously ill COVID-19 patients, but also reduce the risk of infection to hospital staff, is being launched at Cape Town's Tygerberg Hospital.
The digitisation of the hospital's COVID-19 intensive care unit (ICU) will do away with paper-based patient records that have to be manually captured by the patients' bedside, and replace it with a new digital system relying on cameras and computer tablets used to monitor patients' vitals.
“Built on the strong partnership between Stellenbosch University and Western Cape Provincial Health the project will contribute to improved care for patients with COVID-19, as well as a safer working environment for health care workers in the ICU environment. This is an investment whose benefits will continue to be felt long after the current pandemic has abated," says Prof Jimmy Volmink, Dean at the Faculty of Medicine and Health Sciences (FMHS), at Stellenbosch University (SU). The FMHS is a close partner organisation of Tygerberg Hospital and has been instrumental in the conception and funding of the project.
“This is an exciting, innovative example how SU's Faculty of Medicine and Health Sciences is in the vanguard of the fight against the COVID-19 pandemic delivering quality care and improving outcomes. It is also a quintessential embodiment of SU's social impact and relevance," says SU Rector and Vice-Chancellor Prof Wim de Villiers.
“With the impending surge of COVID-19 cases, Tygerberg Hospital's resources will undoubtedly be under huge pressure, and clinicians and nursing staff will face an increased risk of infection," says Professor Nico Gey van Pittius, Vice Dean: Research and Internationalisation, FMHS.
Tygerberg Hospital was the first designated COVID-19 hospital in the Western Cape Province, and is presently dealing with a high service load of COVID-19 infections, including patients needing critical care. Consequently, relatively high rates of infections have occurred among the facility's staff – as of June, more than 200 health workers at Tygerberg Hospital have tested positive for COVID-19.
“Looking after the safety of our staff is a crucial priority for hospital management. This technology will further enable us to reduce the risks to staff members working in the critical care (ICU and High Care) environment, and it is a significant step forward," says Dr Dimitri Erasmus, CEO of Tygerberg Hospital.
Ventilation of COVID-19 patients requires specialised knowledge of ventilation physiology and critical care experience. At Tygerberg, this is only held by a small number of intensive care specialists (intensivists). Tygerberg also services the ICU needs of district and regional hospitals including Paarl, Khayelitsha, Helderberg (Somerset West) and Worcester. ICU care requires continuous updates on patients' vital signs, which, at the moment are being captured onto a paper-based system through a labour-intensive process that also holds a potential risk of infection for healthcare workers at the patient's bedside.
Tygerberg Hospital recently acquired two 'infection-resistant robot nurses', called Quintin and Salma, who are already assisting intensivists with ward rounds in the COVID-19 ICU. The digitisation project will be an expansion of Quintin and Salma's work and will further decrease the risk of contamination and infection, while also increasing capacity, reach and effectiveness of medical and nursing staff.
“The safety of hospital staff is our top priority, and although staff are geared with PPE (personal protective equipment), it is only comfortable to wear for up to 45 minutes. It is cumbersome to put on and to remove, and thus takes up time. In reducing paperwork, nursing capacity will be freed up to focus on providing high-quality nursing care to patients," explains Dr Brian Allwood, an intensivist working in Tygerberg Hospital's COVID-19 critical care wards, and is also one of the leads on the digitisation project. “If paper is replaced by digital record-keeping, it is estimated that the ICU could improve staff infection control by up to 50%."
The new digital system will capture patient and specialist data through the use of cameras, tablet computers, and voice and electronic notes onto a central database that will enable specialists to monitor patients remotely (rather than at the bedside) and thus potentially care for a larger number of patients. With this technology, doctor capacity can also in effect be increased as intensivists can even monitor patients from home, which allows them to continue this critical work while self-isolating or to employ retired doctors with the necessary skills to remotely monitor patients and ventilator readings.
In future, this system could be expanded for monitoring of patients in external or rural hospitals without staff expertise or capacity to do so and could continue after the pandemic.
Another positive spin-off of installing cameras at COVID-19 ICU beds is that it could potentially facilitate video calls between patients and their families. “Patients in COVID-19 wards are completely isolated from their loved ones and can experience loneliness. Video calls with friends and family once patients are stable and on the road to recovery will offer a big boost to patients' well-being and morale," says Allwood.
This crucial project was made possible by a grant provided by the Michael & Susan Dell Foundation. This philanthropic non-profit organisation has committed $100 million to help communities across the world fight COVID-19.
“COVID-19 has created a medical emergency that is requiring healthcare institutions to quickly develop new and innovative ways to keep their staff, patients, and families safe. We're grateful to work alongside our partners as they confront new challenges every day, tirelessly fighting the virus," says Dr Thashlin Govender, program director, Michael & Susan Dell Foundation South Africa.
While the R1.8 million grant from the Michael & Susan Dell Foundation has enabled the critical first level digitisation of the COVID-19 ICU at Tygerberg Hospital, a further R2.9 million is required for the technology upgrade in the ward and the integrated remote teaching and learning platform.