Boston hospital tests tracking system in emergency department setting

Brigham and Women's Hospital in Boston is testing ultrasound tracking and wireless technologies to monitor the vital signs and location of patients while they are in the emergency waiting area.

Under a six-month pilot test that will end in October, the hospital is outfitting patients complaining of chest pain and shortness of breath with waist packs containing a personal digital assistant with four protruding wires.

Three of those wires are connected to the patient's chest to form an EKG tracing that will be fed into the PDA, said Thomas Stair, MD, an emergency physician and research director for the emergency department at Brigham and Women's. The remaining wire is connected to a pulse oximeter clipped to the patient's finger that has a tag that transmits ultrasound waves to sensors the hospital has installed in the waiting room and nearby areas, including bathrooms.

The waist pack monitors patient's heart rates and oxygen saturation, wirelessly transmitting those data to a central station monitored by emergency personnel.

Should a patient's condition deteriorate as he or she awaits treatment, emergency personnel will be alerted and will be able to pinpoint the patient's exact location in real time via the ultrasound tags, which transmit ultrasound waves as the patient moves throughout the emergency waiting area, Dr. Stair said.

Because it has 10 waist packs, the hospital is able to monitor up to 10 patients at a time, Dr. Stair said, estimating that patients will wear them for about an hour on average.

He expects that 500 to 1,000 patients will participate in the trial, which is being funded by a $3.1 million grant from the National Institutes of Health.

The project, called SMART -- Scalable Medical Alert and Response Technology -- is a joint effort of Brigham and Women's and the Massachusetts Institute of Technology's Computer Science and Artificial Intelligence Laboratory.

A key goal of the project is to determine whether the technology can be used to improve monitoring of patients not only while they are in the emergency waiting area but also after they are admitted to the emergency department, Dr. Stair said.

"We're trying to develop a more intelligent system," he said, explaining that it's difficult for now to track emergency patients because the emergency department gets crowded and busy, particularly in the afternoons and evenings. Another problem that occurs is that patients admitted to the ED are wired to a monitoring system that produces too many false alarms, he added.

A second goal is to develop a monitoring system that "scales up" so that the hospital could more easily respond to a large disaster.

"We're trying to develop day-to-day approaches and equipment that scale up easily in an emergency so if some other patients show in the emergency department it's not a big crisis. We can just scale our [daily], ordinary operations a lot more efficiently," Dr. Stair said. "We do know that it doesn't work very well to have new people learning new equipment and procedures at the very worst time."