This new system, which continuously monitors and collects patient data, has recently gone wireless. It is being tested on patients at a hospital in Birmingham, England, but it and similar remote systems may be used in patients’ homes in the future. The more I read on the subject, the more I realized that remote patient monitoring could dramatically change medicine: speed up medical responses and improve health outcomes; remap health care zones; but also maybe transforming the way doctors like me think, in a way that we might not welcome so easily.
Close observation of patients has been a universal duty of all physicians over the years. For millennia, doctors have used their senses to assess a patient’s condition. Even now we doctors are trained to recognize the hard, sugary breath of sick diabetics, the slamming of a glass bottle of a blocked gut, and the feeling of cold, clammy skin when a patient is circulating. stop. But the systematic recording of digital observations is a surprisingly recent phenomenon.
In the late 1800s, instruments were designed to measure a standardized set of health indicators. These are the four main vital signs: heart rate, respiratory rate, temperature and blood pressure. It was just before the turn of the last century that these vital signs, also called observations, were systematically documented for the first time. Through First World War they were used routinely. Studies of these charts revealed that people hardly ever died when these vital signs were normal; hearts don’t stop suddenly. But for nearly a century, the art of interpreting these so-called obs cards was, to the untrained, as mysterious as reading tea leaves.
Then, in 1997, a team based at James Paget University Hospital in Norfolk, England developed an early warning system with which a nurse could quickly turn vital signs into a score. If the score exceeded a threshold, it was a signal to call for medical assistance. Such systems were gradually deployed for adult patients, but it was not clear whether they would work in children, whose physiological responses to disease are different from those of adults.
Heather Duncan was familiar with early warning systems for adult patients in 2000, while working in South Africa as a general practitioner with a keen interest in children’s health. Usually, observations made in a hospital are unrelated to those previously made in primary care clinics. But Duncan tried to link these two sets of data – from the community and the hospital – to create a more meaningful, ongoing story of what was happening to patients. She has taken the trouble to scrutinize the records of her sickest children, tracing their vital signs from the time they were first recorded in primary care until their discharge or death in hospital. “I noticed that kids had cardiac arrests or ICU admissions, and in fact there were missed opportunities where we should have done more,” she recalls.
His nagging feeling that more could be done for these children was later corroborated by the UK Confidential investigation into child deaths, which found that more than a quarter of children in National Health Service hospitals died from preventable causes. In 2003, Duncan completed an intensive care fellowship at the Hospital for Sick Children in Toronto, where, along with Chris Parshuram, a pediatric intensive care physician, she developed the Pediatric Early Warning System, or PEWS, a system bedside scoring designed for sick children.
Duncan now works as a consultant pediatric intensivist at Birmingham Children’s Hospital. I met her on Zoom last October. Duncan worked from home, wrapped against the English autumn in an oversized cream fleece, her hair pulled back in a loose bun and wearing blue-rimmed glasses that matched her eyes. She speaks with a distinguished South African accent and has a calming manner, surely an asset for working in such a stressful specialty. His hospital had adopted the PEWS score in 2008 and saw a fall the number of children who died after suffering cardiac arrest – from 12 in 2005 to no deaths in 2010.
