Changi General Hospital partners Respiree to advance patient care through smart remote monitoring of vital signs

Potential for wearable medical sensor to maximise and improve productivity gains

Singapore, 8 November 2022 – As part of continual efforts to enhance patient care, Changi General Hospital (CGH) is partnering Respiree, a medical technology spin-off of A*STAR, to develop a wearable medical sensor to accurately and remotely monitor patients' vital signs. When deployed, the device has the potential to save up to 12 hours of the time spent by nurses on vital signs monitoring daily in a general ward.

Comprising a sensor patch and a finger oximeter, the medical device can be easily attached to a patient's chest and finger respectively, and is linked to a central system via wireless monitoring once activated. With the seamless collection of vital signs data, nurses will be able to view and check the data of all patients within the ward at any time, presented through the dashboard at the nurses' workstations in the ward.

This reduces the time spent on taking vital signs at patients' bedside, and allows nurses to focus on other critical clinical duties or spend more time caring for patients with more pressing needs. Moreover, patients are able to have uninterrupted rest. Typically, in a 40-bed general ward, up to three minutes is spent on vital signs monitoring of each patient, with the monitoring frequency ranging between one to eight-hours.

One of the vital signs measured by the wearable sensor is respiratory rate. Clinically validated by CGH, the wearable sensor has had more customised parameters such as oxygen saturation level and heart rate added over the course of development to meet hospitals' clinical needs. Besides the ease of use in wider clinical applications, the system has the capability to flag out any abnormal variation of vital signs so that early investigations and interventions can be carried out.

"Although respiratory rate is generally a significant predictor of deterioration, assessment of other vital signs in totality is equally crucial when identifying at-risk ward patients. In delivering enhanced and safe care for our patients, CGH is actively involved in the development and validation of the wearable sensor. This ensures that the medical device can provide the accuracy that is expected for vital signs monitoring, and meet the stringent clinical and patient safety standards for use in hospital settings," said Dr Aza Taha, Consultant, Department of Respiratory & Critical Care Medicine, CGH.

Vital signs monitoring is a common practice in hospitals, and plays a key role in determining a patient's health and clinical outcomes. As part of safe care, the surveillance of the vital signs, including heart rate, respiratory rate, oxygen saturation, blood pressure and temperature, is carried out regularly to track changes in patients' clinical status. Trends in vital signs data provide early warning of potential clinical deterioration.

Ms Png Gek Kheng, Chief Nurse, CGH added, "Clinical research and innovation are the bedrock of CGH as a smart and caring hospital. We will continue to pilot and incorporate well-tested innovations in evidence-based practices to assist nurses in their work and transform care delivery. Through the continual review of nursing processes and streamlining of work such as the automation of vital signs monitoring, our nurses can be freed up or upskilled to focus on higher level care, and take on more complex tasks or procedures."

The wearable sensor's accuracy and usability were earlier validated in a study conducted between April 2018 and January 2019 for close to 100 warded patients with respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD) and pneumonia. In 2020, the sensors were trialled on about 100 patients at CGH's COVID-19 isolation facilities over a period of three months.

These pilot trials tested the reliability of the sensors and feasibility of deployment in clinical settings. It was found that the performance for the respiratory rate measurement met the set requirements by the United States Food and Drug Administration, which was to compare devices to clinician-scored end-tidal carbon dioxide monitoring. 12

"The integration of clinical workflows is a vital step towards the translation of medical devices into practice. In collaborating with CGH, we seek to develop a medical device with a system that works well for the clinical team while ensuring data integrity. Our focus now is to ensure that its use will be made seamless and closely integrated with the nursing, patient and administrative workflow so that it can be deployed on a larger scale within the Hospital," said Dr Gurpreet Singh, Founder, Respiree Pte Ltd.

The team is currently validating the temperature sensor to be included in the wearable medical sensor as an additional parameter for vital signs monitoring. In addition, algorithms based on artificial intelligence are being developed and validated to predict likelihood of a patient deterioration and allow for early intervention to enhance critical care. Once proven, these algorithms may be considered for wider clinical application in the observation wards and emergency department at the Hospital. In future, the technology has the potential to monitor vital signs of patients post-discharge in the comfort of their homes so that care can continue in the community setting.

The development of the wearable sensor is one of the projects that CGH, Respiree and A*STAR is working on following a funding of $1.35 million from National Research Foundation Central Gap Funding in 2021 to develop an AI-based clinical support system for disease management.

CGH nurse putting on wearable medical sensor for mock patient

CGH nurse checking on the vital signs dashboard

1 Singh, Tee, Trakoolwilaiwan, Taha & Olivo (2020). Method of Respiratory Rate Measurement using a Unique Wearable Platform and an Adaptive Optical-based Approach. Intensive Care Medicine Experimental

2 Respiree RS001 Wearable Biosensor, Use-case and Validation Summary, Whitepaper V2-June 2022.