Internet of Things for hospital patient flow management

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< Project Overview >

Introduction

A number of challenges exist in the creation of a system to map the status of healthcare across wards, departments and whole hospitals. Such an IoT-based system would inform better management decisions and more effective resource utilisation.

This project investigated barriers preventing effective IoT adoption in hospital settings by starting at the Emergency Department.  A proposed infrastructure to facilitate improved patient flow and overall operational efficiency in hospitals was produced.  We worked in close collaboration with our clinical partners at the Oxford University Hospitals to survey barriers to the implementation of IoT from the perspective of clinicians, nursing staff, hospital managers, and patients.

Project aims

This project attempts to investigate two key barriers related to the application of IoT in health and wellbeing. Firstly, identifying barriers that prevent effective IoT adoption in hospital settings, so enabling these to be effectively addressed in future and thereby greatly derisk the adoption of IoT solutions. Secondly, understanding the concerns related to privacy and confidentially in this sensitive environment, so ensuring future IoT solutions can address barriers related to trust and uncertainty. Identifying and addressing these barriers is vital to progress research and applications of IoT in hospital settings. Data-driven solutions aimed to optimise patients’ flow will provide a potential cost-saving for the NHS and improve the overall patient experience.

What was done?

Although numerous engineering challenges exist in developing a system to map the status of global healthcare across the entire hospital, this work aimed to determine the exact barriers that exist, which would prevent clinicians, patients, and healthcare entities from accepting and adopting the proposed IoT infrastructure. With the support of this project, we collaborated closely with our clinical partners over the last year to conduct a thorough investigative study to identify these issues across an exemplar hospital, namely the John Radcliffe (JR) Hospital in Oxford. We conducted a literature review of previous related work in this setting both within and beyond UK healthcare settings. This was followed by a case study analysis at the JR Hospital in Oxford, where a fact-finding study was carried out through carefully designed surveys and interviews with clinicians, hospital managers and patients at the Emergency Department.

Results

Through careful implementation, the project identified critical thematic barriers that limit IoT adoption in global Emergency Departments.

The project’s outcome includes drafting an updated literature review (currently under review) and a summary of the findings from the surveys for the key stakeholders. Beyond the academic output, we believe a crucial output of this project is the increased awareness and interest that it could draw from the clinicians, especially during a particularly demanding time in 2020. Despite limited resources during the pandemic (or perhaps because of it), there was a heightened awareness of the potential of digital health and the facilitating role of IoT. As such, the project was approved as an official service improvement project of the JR Hospital Emergency Department, which will ensure that the work will continue beyond this project.

Impact

This project has managed to activate and establish a “digital emergency medicine network” in Oxford.

A new working group, involving both clinicians from the JR Hospital Emergency department and researchers from the Oxford University Biomedical Engineering Department, was established to support ongoing interest and enable future collaborations. The group is currently working on a joint research proposal to continue the collaborations of this project.

Furthermore, this group also established a new collaboration with a research group at Cambridge University. Finally, the learnings of this work and newly established group have been invited to contribute to a series of talks and teaching of the Primary Care Health Science’s new MSc in Applied Digital Health.

Next steps

Our immediate dissemination activities include publications of both the literature review (currently in review) and the initial survey results.

As part of the ongoing service improvement project at the Emergency Department, the clinical staff will roll out another iteration of the survey to compare the pandemic’s impact. Prototyping of a proposed solution will continue until the end of June, and discussions have started with OUI regarding the future format regarding patenting and spin-out.

Finally, the newly established working group plans several virtual (and physical) events over the coming months to continue stimulating interest and awareness in this area.

Lessons learned   

What went well?
The immense pressure on healthcare systems worldwide due to the ongoing pandemic greatly enhanced the overall awareness of the importance of digital health innovations. One of the successful outcomes of this project was facilitating and encouraging a conversation between the relevant stakeholders. By taking a needs-led approach, the engineers could listen and understand some of the core systemic issues that often go beyond purely technical solutions.

What could have been done better?
Having realistic expectations during a pandemic! The most important lesson here was that even without limited human resources during a pandemic, realistic expectations would avoid many frustrations.

What would have been useful?
Overall limited support (both clinical and administrative) due to the pandemic made progressing work within the Emergency Department a challenge. Compounded with restricted administration support from the university due to the COVID lockdowns, some of the processes were delayed in rolling out.

Pitch-In’s role

Pitch-In provided an excellent opportunity to investigate the barriers related to IoT adoption. As a machine learning researcher, it is rare to get the opportunity to investigate the upstream barriers of IoT applications that influence data streams. Specifically, by bringing together the end-user (clinicians) and the designer (engineers), it has been possible to elevate and educate both parties.
Our clinical partners understood the potential applications of IoT, which have enabled them to identify possible problems in their workflows that could benefit from IoT solutions. This would greatly enhance the long-term adoption of any solutions rather than technology-push solutions proposed by engineers that do not address a real clinical need.

Project leads

Professor David Clifton – University of Oxford

Heloise Greeff – University of Oxford

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