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Many patients suffer from severe mental problems during or after their stay in the Intensive Care Unit (ICU). This slows down the recovery process and can have long term effects on the patient's quality of life. Mental conditions experienced in the ICU can reach all the way from bad dreams and continuous discomfort to delirium and post traumatic stress syndrome. Early recognition of signs and appropriate management are key to prevent extensive cost for the healthcare system due to effects such as increased mechanical ventilation, increased hospitalization and increased mortality. Despite its importance, mental health is not addressed sufficiently in the ICU.
The main stressors in the ICU which strongly affect the patient's mental condition are pain, anxiety and a lack of decent sleep and rest. To tackle these problems the nurses need to be empowered to precisely assess and address the stressors and indicators for mental degradation. Therefor both the patient and the healthcare professionals need to be able to communicate seamlessly despite the patient's physical condition. These soft vital signs which are not picked up by machines today are difficult to assess.
Sova is a system to monitor the most important aspects of the ICU patient's mental health continuously while allowing patients to communicate any need, discomfort or pain the might experience. All information is visualized for the healthcare professionals. With the information Sova helps the healthcare personnel to get a better understanding of the patient's pain, activity, sleep and mental state. With Sova they can provide a more personalized, humane treatment which takes into account both the physical and mental state.
We talked to healthcare professionals at the hospital in Umeå and conducted interviews with several specialists from Finland, Estonia and Germany, active in the fields of Care, Medicine and Neurology. They provided us with useful insights about Intensive Care Units in general, how patients are being monitored and the role the patient's mental health plays today. Nurses and doctors were continuously consulted.
The mental health of patients in the Intensive Care Units plays a vital role in the recovery time and cost for the healthcare system. Mental problems are very common and can appear at any time, becoming more likely the longer a patient stays in the ICU. Mechanically ventilated patients and long term cases are very likely to experience mental issues.
A very common and bad mental state of patients in intensive care is Delirium. It is a state of severe confusion that is related to impaired cognitive abilities, reduced attention and consciousness. Patients might see halluzinations, get anxious and start acting arational for example by pulling out tubes. In such cases nurses might need to sedate patients further. This can lead to a vicious circle as sedation in itself is also related to a degradation of the mental condition. In general healthcare professionals try to sedate patients as little as possible to reduce their mental burden.
We found out that mental stress - which in the end might lead to Delirium - is strongly influenced by three key factors which are pain, anxiety and deprivation of restful sleep.
The best way to deal with such mental conditions is prevention of risk factors. Our goal with Sova is an early detection of medical problems leading to pain, promotion of good sleep and a minimization of anxiety by keeping a person well oriented and providing them with enough information.
To accomplish the goals two aspects are very important:
The active communication between the patient and the healthcare professionals to articulate the patients needs and discomfort
The detection of negative events and effects on the patient's mental health throughout their stay
Assessing the patient's mental state and recognizing such indicators for a physical and mental degradation which are not visible on the hard vital sign monitors is typically quite difficult and requires experience. Communication with the patient in the Intensive care units can be very difficult as their physical abilities are very limited. In the worst case patients are not able to move or talk. When a patient is not conscious enough to communicate actively, the assessment by doctors and nurses becomes even more important.
Nurses are not present at the patient bed at all times so they can not check on patients continuously but rather get a fragmentary idea on how the patient is feeling and needs they might have. This applies especially in times of the Covid19 pandemic when the number of patients is high and contact to nurses and doctors more limited.
Sova provides a platform for healthcare professionals and patients to communicate more effectively and empowers the personnel to monitor the patient's mental health and indicators for its degradation continuously. It consists of an automatic monitoring system and an interface to support the active communication with the patient.
A sensor on the patients forehead detects brainwaves which gives conclusions on the patient's level of consciousness and sleep patterns. A camera integrated into the screen detects the patients' movements and activity. This way healthcare professionals can tell when a patient might be in pain, have a bad sleep or show signs of unrest. Continuous assessment will allow for an analysis of mental degradation.
An infrared system tracks the patients' eyes to allow them to interact with the display to communicate. Via the interface patients can receive relevant information about their procedures, schedule as well as messages from relatives. They can also point out any needs, feelings of discomfort or pain they might have so the healthcare professionals can react accordingly. This way problems that would have lead to mental stress can be solved early.
The screen is located above the patient's head, either fixed to the room ceiling or to existing parts of the equipment. It can be easily moved into position above the patient's head with in ergonomic handle and a 360-degree joint.
With Sova it will be much easier for healthcare professionals to precisely assess and take into account the mental health of patients. It will promote a more personalized, humane and improved treatment. Mental problems patients experience in the ICU can be reduced and addressed quickly. The recovery will be improved and costs for the healthcare system cut.