Predictive analytics takes center stage in the fight against Covid-19 and the critically ill
Clew Medical's Gal Salomon discusses Covid-19 and how the pandemic has revealed vulnerabilities in healthcare systems around the world
ICUs are currently being challenged on multiple fronts including resource limitations, infection control, protection of healthcare workers (HCWs), and adaptation of services to a rapidly evolving pandemic situation. These demands combined with decreased revenue generation from elective procedures has placed a profound strain on health systems both logistically and financially.
One area that may assist in the current environment is real-time prediction models. Rarely used in American healthcare, such models may offer an opportunity to change practice and enhance efficiency in the operation of clinical enterprises. As an overall response, predictive models have been proposed to support healthcare authorities in the early planning of resources, personnel, ICU, and hospital bed capacity.
In the ICU, predictive markers of patient deterioration enable clinical decision support to facilitate resource utilization and enhance patient outcomes. Given the complexities associated with Covid-19 treatment, such models may enhance patient interaction, ICU staff capacity, and virtual ICU care.
Reducing the frequency and duration of times that staff enters the rooms of patients with Covid-19, is generally thought to reduce healthcare worker exposure. Predictive models of decompensation may be a key element in ensuring appropriate and timely interaction with patients while still having adequate time to conform to the best personal protective equipment practices.
Predicting and upgrading capacity
In general, most American ICUs are equipped to withstand an approximate 20% surge in demand. However, in the face of the pandemic, a significantly higher ICU surge capacity has been needed and critically ill patients may need to receive care outside of a traditional ICU, depending on available resources. It is now becoming common for critically ill patients to be cared for in locations that were previously anesthesia recovery areas or general wards. At the same time decisions on timely discharge to step-down care areas have become exceptionally important in effectively managing ICU resources and ensuring availability.
Although such logistic decisions may provide increased physical capacity for the critically ill, they do little to address critical shortages in competent manpower. With such shortages of human resources, in extreme situations like those recently seen in New York City, intensivists and ICU nurses may have to take up a supervisory role, with non-critical care HCPs providing direct care to patients.
Redeployment of resources
Tele Critical Care has come to the forefront in the pandemic as a beneficial tool that expands the reach of experts in critical care and allows skilled critical care physicians and nurses to work in areas from which they are geographically remote. Tele Critical Care solutions can act as a significant workforce multiplier.
Determining deterioration or improvement and planning accordingly
In cases of Covid-19 critical illness, patients have progressed rapidly to acute respiratory failure, acute respiratory distress syndrome, and septic shock. Early identification of risk factors for critical illness can facilitate rapid access to the ICU when required. For patients with mild and moderate illness, general isolation and medical treatment are required. ICU-care is not needed unless their condition worsens. Awareness of early deterioration is a vital tool in helping to reduce mortality and alleviate the shortage of medical resources.
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By closely observing patients in areas with lower levels of staffing and then triaging them to ICUs only when requiring critical care treatment, ICU resources can be dedicated to those patients that truly need them. This is a different model of operation compared to many facilities where patients that are at risk are admitted to the ICU for monitoring.
What about predicting deterioration?
A model of close observation outside of the ICU introduces profound risk to patients and the institution if not implemented correctly.
Failing to recognize a significant deterioration can result in further deterioration and/or cardiac arrest; therefore, early recognition of decompensation is important as early intervention may avoid intubation. It is not only the respiratory parameters that need monitoring in Covid-19 disease. Intensive hemodynamic monitoring should be considered for patients with Covid-19 as there have been multiple case reports of patients suffering profound hemodynamic collapse. The etiology of such events is not clear as some cases appear linked to embolic phenomena and others appear linked to profound myocardial depression.
In the event of a 4-hour advanced warning of respiratory failure for a patient, it is possible to prepare. A patient can be transferred to an ICU, receive a trial of high flow nasal cannula and self-proning in addition to optimization of volume status and medical therapy. Such interventions may eliminate the need for invasive mechanical ventilation, likely reducing ICU length of stay and morbidity associated with mechanical ventilation. One could likely see similar interventions in the event of such a warning regarding hemodynamic compromise.
To conclude, The Covid-19 pandemic has brought the vulnerability of healthcare systems and how they can be rapidly overloaded in excess of the available ICU bed and ventilator capacity sharply into focus. Additionally, Covid-19 has highlighted the significant shortage of Intensivist and qualified and experienced ICU nursing staff. The possibility of predicting which patients will decompensate to require critical care therapy hours ahead of time offers the opportunity to intervene early and minimize the need for maximal critical care support. The Covid-19 outbreak has accelerated the implementation of such technologies, for the benefit of both patients and medical teams.
Gal Salomon is CEO at Clew Medical.