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Intelligent Emergency Department: Validation of Sociometers to Study Workload

  • Mobile Systems
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Abstract

Sociometers are wearable sensors that continuously measure body movements, interactions, and speech. The purpose of this study is to test sociometers in a smart environment in a live clinical setting, to assess their reliability in capturing and quantifying data. The long-term goal of this work is to create an intelligent emergency department that captures real-time human interactions using sociometers to sense current system dynamics, predict future state, and continuously learn to enable the highest levels of emergency care delivery. Ten actors wore the devices during five simulated scenarios in the emergency care wards at a large non-profit medical institution. For each scenario, actors recited prewritten or structured dialogue while independent variables, e.g., distance, angle, obstructions, speech behavior, were independently controlled. Data streams from the sociometers were compared to gold standard video and audio data captured by two ward and hallway cameras. Sociometers distinguished body movement differences in mean angular velocity between individuals sitting, standing, walking intermittently, and walking continuously. Face-to-face (F2F) interactions were not detected when individuals were offset by 30°, 60°, and 180° angles. Under ideal F2F conditions, interactions were detected 50 % of the time (4/8 actor pairs). Proximity between individuals was detected for 13/15 actor pairs. Devices underestimated the mean duration of speech by 30–44 s, but were effective at distinguishing the dominant speaker. The results inform engineers to refine sociometers and provide health system researchers a tool for quantifying the dynamics and behaviors in complex and unpredictable healthcare environments such as emergency care.

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Acknowledgments

The authors would like to thank all the volunteer actors that participated in this study and Kelly Herbst and Kyle Koenig for their administrative and technical support. This work is funded in part by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

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Correspondence to Kalyan S. Pasupathy.

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This article is part of the Topical Collection on Mobile Systems.

Appendix

Appendix

Emerency department handoff mock scenario #1

NURSE #1: (Directions: Nurse is talking casually (small talk) with the parent while the Doctor and Resident conducting a handoff, nurse asks questions): Are you all from Rochester? How long have you lived here? You have any other family members here? What daycare does you daughter go to? Were any of the kids at the daycare sick?

PATIENT PARENT #1: (respond to questions nurse asks)

NURSE #2: (Directions: Enters Room after NURSE #1 ask Patients the second question): Hey I’m heading home, just wanted to give you a quick summary of the patient in room #3.

PATIENT PARENT #1 & PATIENT PARENT #2: (Engage in a casual conversation after NURSE #1 was interrupted by NURSE #2)

NURSE #1: Great. I wish I was heading home.

NURSE #2: Well, the patient’s name is Jason Caper and he is 3-month old full term baby who was born via normal spontaneous vaginal delivery. His Apgars were 8 and 9 at 1 and 5 min respectively. Both the pregnancy and delivery were uncomplicated. He had been doing very well until 2 days ago when he developed a cough.

NURSE #1: Was anyone in the home sick?

NURSE #2: Mom says that her 4-year old daughter had something similar a week ago. Yesterday Jason wasn’t very interested in breastfeeding and developed a fever. This morning Mom noticed he was breathing faster than normal so she brought him in to the Emergency Department. We diagnosed him with RSV bronchiolitis.

NURSE #1: What is the plan?

NURSE #2: Jason will be kept NPO because of respiratory distress. He has an IV in place and is receiving maintenance IVF. He may need a bolus if his capillary refill doesn’t improve.

NURSE #1: You mentioned respiratory distress?

NURSE #2: Yeah, He’s on CRM and pulse oximetry. He’s currently on 2 l high flow nasal cannula with an FiO2 of 30 %. If his FiO2 increases above 40 % or his work of breathing worsens, he will need to be transferred to the ICU.

A nasal swab for RSV is pending. If the x-ray comes back and it looks like pneumonia then we will have to consider starting antibiotics.

NURSE #1: Any other labs pending?

NURSE #2: Yes, Blood gas, CBC, blood culture, and urine culture are also pending

NURSE #1: Just to recap before you depart. Jason is 3-months old, was doing well up until 2 days ago when he developed a cough. He developed a fever yesterday and begin breathing faster than normal, we diagnosed him with RSV bronchiolitis this morning and we are now waiting for all the pending labs that include Blood gas, CBC, blood culture, urine culture and nasal swab for RSV. Jason should be kept NPO because of respiratory distress. He has IV in place and he may need a bolus if his capillary refill doesn’t improve. If his FiO2 increases above 40 % he will need to be transferred to ICU

NURSE #2: that is correct; here are my notes for future references.

NURSE #1: See you tomorrow.

>> > WHEN THE NURSE WALKS IN THE ROOM ED DOCTOR AND RESIDENT STARTS HANDOFF BELOW < <<

ED DOCTOR: (Directions: outside the room or near the door) Hey, I’m Dr. Phil. I’m the lucky one who was called in because Dr. Penn is sick. Is there anything that I should know about your patient? We kinda need to make it quick because I hear another admit is coming in and I’d like to grab some breakfast before that patient comes.

RESIDENT: Morning Doctor, not a problem. Here we have Jennifer Jones, who is 1 year old, Jennifer was admitted this earlier this morning after her parents brought her in to the Emergency Department because she “couldn’t keep anything down.”

ED DOCTOR: How long has she been sick? Vomiting?

RESIDENT: She started vomiting 3 days ago and then developed diarrhea last night as well. They describe her diarrhea as very foul smelling. Her emesis is nonbilious and nonbloody. Dad says that he had a “stomach bug” a week ago but it was nowhere near this bad. In the Emergency Department, she did eagerly eat a cherry popsicle.

ED DOCTOR: okay, so what allergies, PHM, history, exams?

RESIDENT: (Directions: speed through this summary quickly): sure Doctor,

ROS: She’s had a diaper rash from the diarrhea.

Allergies: NKDA

PMH: She was born at 35 2/7 weeks gestation via C-section for breech presentation. She was on Zantac for GERD for approximately 3 months.

Social History: Abby lives with her parents and 2 siblings (2 and 5 years old). No smoking in the home. There are 2 cats and 1 dog in the home.

Exam:

Vitals: Weight 8.3 kg T 37.4 HR 130 RR 35 Sat 98 % on room air

General: well appearing infant, clinging to her mother

Skin: no rashes or lesions

HEENT: AFOSF, PERRL, clear tympanic membranes, clear oropharynx, MMM (doesn't appear dehydrated)

Resp: Breathing comfortably on room air, clear breath sounds bilaterally

CV: RRR, 1/6 systolic murmur, pulses and perfusion are normal

Abdomen: Soft, NT/ND, no masses or hepatosplenomegaly

Extremities: Capillary refill is brisk, no clubbing or cyanosis

Neuro: Normal reflexes and tone

ED DOCTOR: Are there any labs? What are the plans?

RESIDENT: The following labs are pending: Electrolytes, CBC…..her symptoms are consistent with viral gastroenteritis.

ED DOCTOR: …and the plans are again?

RESIDENT: Differential diagnosis also includes bacterial gastroenteritis. Abby will be encouraged to drink pedialyte. If she doesn’t drink 8 oz every 4–6 h then an IV will need to be placed. An electrolyte panel is pending.

ED DOCTOR: Just recap before you depart, Jennifer started vomiting 3 days ago, diarrhea last night, doesn’t appear dehydrated, the labs that are pending includes Electolytes and CBC; the fact that she has be vomiting for 3 days and 1 day of diarrhea is consistent with viral gastroenteritis. She should drink pedialyte and if she doesn’t drink 8 oz every 4–6 h then an IV will need to be placed. Is that correct?

RESIDENT: Correct, have a good day.

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Yu, D., Blocker, R.C., Sir, M.Y. et al. Intelligent Emergency Department: Validation of Sociometers to Study Workload. J Med Syst 40, 53 (2016). https://doi.org/10.1007/s10916-015-0405-1

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