ECG monitoring is one of the most important vital sign measurements that is carried out in hospital intensive care units. The sensor setup has to stay on the patient's body often for weeks, gets unplugged, cleaned and is part of many daily routines for the staff of an intensive care unit.

Managing the current five-cable ECG monitoring setup can be a real challenge for healthcare professionals, as they spend a lot of time untangling and rearranging these wires. But the multitude of cables attached to the patient's body not only means a lot of effort for intensive care nurses, it also causes a lot of discomfort for the patients and slows down their recovery process by limiting their ability to move unhindered.
Our concept reduces this five-cable ECG monitoring setup to an elegant single-line solution that feeds the gathered data wirelessly into the current system. This sensor-array consists of a flexible cable with sensor-clips that can be arranged freely on the patient's chest and adjusted in length to achieve an optimal fit for every body size or shape. The device is designed to sit on the human skin, its minimal shape makes it easy to clean, intuitive to handle and declutters the patient's appearance in general. The attachment of the sensor-array follows international healthcare standards and can be carried out without applying pressure to the skin or hurting the patient. The head part of the device gets placed in the shoulder area, where a subtle status interface is accessible even when the patient is covered by a blanket and where the battery can be exchanged easily, while the rest of the sensor setup remains in place. The built-in battery powers the sensor-array up to 24 hours and recurring exchange routines can easily be implemented in the shift plans of the healthcare professionals in charge.

Array is a vision for an ECG monitoring setup of a new generation that could be implemented in the current practice of intensive care. It helps to streamline the workflow of health care professionals and improves the patient's comfort during intensive care treatment.

The 10-week project „Future Intensive Care Monitoring '' in collaboration with the global medical technology company Getinge focused on design opportunities within the context of vital sign monitoring of critically ill patients in hospital intensive care units (the so called ICUs). During this project we explored the challenges for vital sign monitoring of different kinds of patients going through different types of therapy and recovery stages in intensive care. The goal of this user-centered process was to come up with a conceptual product solution that could be beneficial for all stakeholders that come together during patient treatment at an ICU.

User-centered design process in dialogue with expert stakeholders
To dive deep into the complex world of intensive care treatment we started the project with an extensive research phase, where we had the chance to visit the ICU department located at Umeå hospital to learn about the critical care environment, to try out relevant equipment ourselves and to find out the daily challenges both for medical staff and patients in treatment. During the project we also worked in constant dialogue with healthcare professionals from this department and with engineers, user researchers and designers from our collaboration partner Getinge, which supported us with their expertise designing products in the medical technology industry. All these collaborative partners helped us to find the right insights during our research and provided us with their feedback and experience to validate our concepts during the later stages of the design process. Through their help and the collaborative research efforts of all students involved, we established a clear picture of the challenges for vital sign monitoring in critical care and were able to find a relevant design opportunity within this field.

Focus area: ECG monitoring in hospital intensive care units
Permanent vital sign monitoring is essential in critical care as patients are often in unstable and life threatening conditions that can change rapidly. To constantly provide the medical staff with updates about the most basic vital signs, the patient's body is always connected to several monitoring devices during treatment in the ICU. Managing the multitude of sensor cables is one of the biggest challenges healthcare professionals are facing on a daily basis, as they have to be untangled constantly and often add discomfort for patients. The cables are also a known cause for pressure wounds and limit patient's ability to move freely, which can have a negative impact on their recovery process.
From all the vital sign monitoring devices in place, the ECG measurement causes the most frustration, as the current setup to measure this value consists of five individual cables. These five cables, the so called leads, get attached to Electrode stickers in specific areas directly on the patient's chest and are connected to the monitoring setup next to the patient's bed. This impractical setup has to stay on the patient's body often for weeks, gets unplugged and reattached during special routines, must be cleaned on a daily basis and is part of many daily workflows of ICU nurses. As the current setup adds a lot of individual cables to the patient, it causes a lot of extra work for the medical staff, negatively affects the patient's comfort and limits their body's ability to move. Our focus for this project was to come up with a new solution for ECG monitoring that genuinely improves the daily work of ICU healthcare professionals and improves the patient's circumstances in critical care.

Our process: Prototype iteration & expert user validation
For us and the experts involved in this project it was obvious that we had to reduce the cable chaos to improve the current situation of ECG monitoring. As this was a very tangible design challenge and the human body a challenging product environment to design for, we quickly realised that only thinking and sketching wouldn't be sufficient in this project. So we decided to work very hands-on, building a lot of prototypes of different product architectures, cable arrangements and adjustment mechanisms to find innovative approaches for a new ECG monitoring setup. We tested each iteration on medical dummies (and ourselves) to emulate the patient's body and to quickly assess the performance of our prototypes in a realistic environment. But what was even more important, at the Umeå hospital we got the chance to show our prototypes to the healthcare professionals to let them test and evaluate our ideas. Checking back with their expertise we could validate our prototypes and adapt our concepts to their workflows and the intensive care environment. In total we built and tested over 25 different prototype iterations during this project and rated them based on four functional attributes: product architecture, patient comfort, cleanability and handling. This way we were able to get from a large pool of promising ideas to one proven concept direction - the Array.

Concept details: Single-cable ECG monitoring solution
In this final concept direction we managed to replace the current five-cable ECG monitoring setup with an elegant single cable sensor architecture that houses five separated wires inside. This sensor-array gets placed on the patient's chest and feeds the monitored data wirelessly into the current system so that it can be displayed next to all the other vital signs on the patient monitor. A small receiver plugged into the already existing setup enables this wireless data transfer on an encrypted protocol.
The sensor-array consists of the head which houses the battery, the antenna as well as a subtle light interface and a flexible cable with sensor-clips that can be arranged freely on the patient's body. This device is designed to sit on the human skin, its minimalist shape makes it not only easy to clean, it also simplifies daily routines for caregivers and declutters the patient's appearance.
The attachment of the device follows global intensive care standards and even guides the healthcare professionals during this routine using colour coded light feedback on each clip. They start by simply snapping the head on the first electrode in the shoulder area, where it is accessible for the medical staff even when the patient is covered by a blanket. The head's omnidirectional shape allows potential movement and a groove on the backside helps guiding ICU nurses while finding this electrode's pin - so that it is possible to feel the correct position and place the head without looking. After placing the head, the medical staff can attach the other leads with clips on the remaining electrodes. The clip's spring-loaded scissor mechanism helps to fix them in a gentle way without applying pressure to the skin or even hurting the patient. As soon as all the leads are in place they transmit the monitored ECG data to the patient monitor, where it's visible for the ICU staff. Excess cable can be managed in length by sliding it into the designated holders on the clips and if one sensor detaches by accident the healthcare personnel gets notified. With a nicely arranged cable setup the device provides more comfort for the patient and ensures an optimal fit for each body shape or size.
As soon as the sensor is in place the medical staff can always check battery and connection status by simply touching the head of the device. The appearing light interface offers a subtle status feedback without causing disturbance for the patient. The battery can power the monitoring device up to 24 hours and recurring exchange routines can easily be implemented in daily shifts in ICUs. As the battery is placed on the front of the device, it can be flipped out and exchanged easily, while the overall setup remains placed on the patient's body. During cleaning or special treatment nurses detach the ECG-array and place it in the charging dock which can be mounted next to the patient's bed. The charging dock is designed to be very flexible and sturdy, it houses the exchange battery and works as the designated storage area for the sensor array when it's not in use.

Summary: Improvement for all the stakeholders

In the critical environment of intensive care medicine small details can make the difference, so we designed a holistic concept that offers a feasible vision for the future of vital sign monitoring. Our product system consisting of the sensor-array, the receiver and the charging dock addresses all the challenges that come with long-term ECG monitoring in intensive care units and can be implemented in the current infrastructure and the daily routines of the ICU staff. The Array is an ECG monitoring setup of a new generation, it helps to improve the daily workflow of the healthcare professionals as they spend less time untangling cables and offers more comfort and better flexibility in movement for patients in order to speed up their recovery process. Furthermore it is a carefully designed medical device that declutters the patient's appearance in order to shift the focus from machines, cables and wires to the human being treated in critical care.