Monitoring rapid progress….
28 May 2010
The medical electronics market is an arena that demands the ultimate in both specialist functionality and industrial reliability, but strong partnerships and extensive experience can pay dividends as LiDCO and Display Solutions have shown in producing a monitor to optimise patient care both during and immediately post-surgery with a result of shorter hospital stays.
Well positioned in a market that grew by 30% in twelve months, Terry O’Brien was probably in the minority of UK CEOs thinking that 2009 was a good year. Heading up the medical equipment supplier LiDCO, he saw his company’s ‘LiDCOrapid’ acute care monitor chosen for a major trial to gauge the effects of continuous patient monitoring-driving protocolised therapy both during and immediately post-surgery. The trial is believed to be the largest of its type to date and will take up to 18 months to complete. But LiDCO’s is no overnight success story, the combination of Dr. O’Brien’s medical background married to an entrepreneurial zeal for how commercial solutions can pave the way for good healthcare delivery driving its position where over 60% of UK hospitals have LiDCO equipment.
Previous research carried out in randomised trials has shown that improved monitoring and protocolised therapy can drive a reduction in post-operative complications in high risk surgeries by up to 40 per cent and enable patients to leave hospital, on average, 12 days earlier than those patients treated with the use of conventional care. In today’s under pressure National Health Service as well as delivering better patient care, it also equates to good business sense as everyone knows hospital beds- especially in intensive care- are costly.
By harnessing technology developed in consumer electronics and then adapted to meet the very specific demands and culture of healthcare LiDCO has been able to produce the first cardiac monitoring product to enable operating theatre teams to see the total picture of changes and reactions of a patient’s cardiovascular system on one monitor; Dr. O’Brien takes up the story: “You ask what clinicians want from their equipment and they will universally agree it has to be easy to use, quick to set up and simple to integrate with existing equipment. With the ‘LiDCOrapid’ we can give surgeons and anaesthetists the ability to monitor and view real-time the patient’s various vital signs parameters simultaneously. This provides the earliest warnings if fluid or drugs levels need to be adjusted. It’s the first time all this inter-dependent information has been available on one machine with a graphical user interface (GUI) specifically designed for surgery. The ability to run this software and present a more evolved GUI is thanks to the increased capacity available from the processor, coupled to the strong partnerships with our suppliers to develop a panel PC that fits the exacting demands of the surgical applications we are addressing.”
From a technical perspective, the immediate challenges of designing the LiDCO rapid were to produce a machine small enough for use within the limited confines of an operating theatre or Intensive Care Unit, powerful enough to deal with the information and display required yet not producing too much heat to impact on reliability or safety. Not least, the unit also needs to be robust enough to deal with frequent moves within the hospital from one care area to another.
Display Solutions is one of LiDCO’s two suppliers of the panel PC for use as the host for the LiDCOrapid software and Martin Whitehead, Systems Manager for the Huntingdon-based company is the man responsible for meeting the challenges of producing a streamlined product: “One of the main elements to factor in was as a piece of critical care equipment, it needed to be powerful yet unobtrusive - big enough to be easily viewed but with as small a footprint as possible. Most equipment in an operating theatre is within an arms reach so the display doesn’t need to be huge. In terms of powerhouse, we were looking for the optimum trade-off between cost performance and heat-dissipation.
“Because the Real Time OS used in the application is QNX that also brought its own restrictions – the newest hardware is not yet fully supported - but the upside of QNX is you don’t have to accommodate the baggage and bloatware found with Windows.”
Working together with Taiwanese technology specialist Avalue, with who Display Solutions has already successfully produced a number of high-profile systems, Whitehead opted for an Intel Celeron M600 together with Avalue’s DTP 1201 which gave him the optimum, performance reliability, cost and availability solution. Practical considerations were also paramount: “The power supply had to be taken into account - we didn’t want a brick (adapter) for staff to trip over - it wouldn’t have been too user-friendly in an operating theatre! So we took that component inside to leave a single plug in cable and a unit that takes literally a minute to set-up and begin monitoring. Specific features also had to be factored in, including a card reader which enables a cost-effective per patient revenue model. Further, a sensitive dimming control had to be incorporated to acknowledge the unit’s usage at night in ICUs or other areas where high levels of brightness is distracting.”
Display Solutions was able to deliver the first prototype into LiDCO HQ just four weeks after getting the go-ahead from agreement. This involved incorporating all the customisations required including the internal medical PSU, card reader, anti-bacterial covers, backlight dimming, QNX approved components, and additional com ports for archiving etc. Whitehead acknowledged it was a tight deadline but a not uncommon achievement for the company: “Four weeks from receiving a customer’s specification is easily achievable for us, with the DTP 1201 we knew the Avalue engineers could achieve the targets we set.”
While QNX and Celeron M600 might have games developers thumbing through modern history manuals, in the medical arena it has opened up revolutionary possibilities. Looking beyond LiDCOrapid, the company continues to explore and develop practical methods with its partners to improve care: “The trend these days is for nurses, who are on the wards 24/7, to take responsibility for fluid and drug monitoring,” O’Brien continued. “Sometimes a life threatening event can occur in the patient and if it takes a consultant a number of minutes to reach a patient - that’s potentially too long a time. We can offer all grades of staff simple to interpret screens that mean quicker response times and therefore better monitoring. We already have plans to produce the ability for the data and GUI of the screen to be ported to locations remote from the ward, in order to allow real-time monitoring irrespective of location of clinical staff thereby enabling instant diagnosis.
“You may not have seen one of our units yet, but I am aiming to ensure that this sort of advanced monitoring becomes a standard of care available to patients in all hospital,” concluded the LiDCO chief.
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