Introduction
Robotics is frequently regarded as a crucial enabling technology for tomorrow’s society. This study looks at how robotics and intelligent medical devices (IMD) are used in intensive care. The demand for advances in ICU management is driven by the demographic prediction that more elderly patients will need to be treated with fewer healthcare professionals. The anticipated workload/manpower disparity in medicine may be reduced with the help of robotics, one of the important enabling technologies for the twenty-first century. It would be ideal to research how to use robotics in the intensive care unit in a way that benefits patients and is acceptable to the team providing care. For these new technology to be introduced to the ICU, financial viability is crucial. The paper summarizes the state of the art of robotics for the ICU on the background of real-life practice in a large Intensive Care Unit in a Swiss University Hospital (University Hospital of Basel – UHB).
Methods
It starts with a concise presentation of current medical practice in the ICU, complemented by an engineering view on technologies suited for ICM and the challenges associated with their use.
Monitoring & Diagnosis
Because of the immediate vital risk of patients in the ICU, sensing and monitoring technologies are particularly critical.
Infrastructure and support activities
Telemedicine may reduce ICU length of stay and, potentially, mortality. Robotics and IMD in the ICU is not yet as prevalent as in surgery or patient rehabilitation. Stringent requirements for device quality, testing and certification may be part of the reason. The BAM (Bed Aligned Map) system using a set of cameras was studied for estimating patient agitation state and sleep position. Data integration is key for deriving treatment strategies. Along with monitoring and sensing individual variables, data integration is key for deriving treatment strategies. An ICU physician may encounter up to 200 variables per patient. She/he needs to process this data and make upon it. Consequently, clinical information systems (CIS) are needed to summarize, integrate and store the data over time, examine trends, and put the information in context with other data relating to the patient, with drug and their interactions, and with the environment. Trends and events collected in CIS are not only used for monitoring the patient but to some degree also yield important information on the quality of the acquired medical signals. Detecting patient-critical events while avoiding false positives reliably are key features because frequent false alarms lead to alarm fatigue, hence endangering patients. An ICU physician may encounter up to 200 variables per patient. Clinical information systems are needed to summarize, integrate and store the data.
Economic Viability
The largest economic impact of utilization of robotics and automation in the ICU is the shortening of the time devoted by nurses and other personnel for an ICU patient without compromising the quality of treatment. In this study, we will examine the economic potential of the suggested technologies in order to promote cost-efficient high-quality future medical care. Medicine preparation is one of the most time-consuming tasks in the ICU. Latest statistical analyses of medical decision-making models show that the initial health-status of the patient does not affect the treatment’s success, therefore it is worth to invest into moribund patients. This implies that introducing advanced technology for treating patients is economically viable.
Robotics and IMD aiding the ICU
The ICU patient is usually connected to a large number of devices used for monitoring and treatment. Most of them are managed manually. Current concepts (Internet of Things, IoT) and technologies enable automated computer control of the treatment devices that are connected to the patient. Sensor-equipped IV lines may contribute to fluid flow monitoring and early detection of line-associated infection that is still a significant source of morbidity in ICU patients. The monitoring and treatment devices that are connected to the CIS and CTS may be incorporated into closed loop control systems.
Robots in ICU
Robots in the ICU can be used in interventions, nursing, rehabilitation and services. Robots’ roles in medicine have been discussed expansively in the last 30 years. Patient treatment robots are mostly in development. These robots are summarized The robots and robotic systems in the tables above were developed directly for use in hospitals and the medical industry. Robotics systems from other fields can be also applied in the ICU. Automated storage combine with courier robots can be used to deliver rapidly consumables and equipment to the patient’s bed and to save time for the nurses.
Economic aspects of robotics and IMD in
ICU
ICUBetter medical diagnosis and treatment by robotics and IMD in the ICU requires an initial financial investment. In this section we estimate costs that might potentially be saved by introduction of automation and robotics based on real-world data from the ICU of the UHB. To identify opportunities for use of robotics and automation in the ICU and explore its potential economic impact, we analyzed all hospitalizations of patient in the medical ICU of the UHB in the year 2018. To find scenarios where robotics and IMD in the ICU may have the largest impact, we analysed the task distribution of nursing. The total patient treatment time period in UHB ICU in 2018 was 76,146 hr, valued as 10,680,972 CHF. A total number of 2,318 cases were treated in 2018 averaging 32.85 hours and 5,834 CHF per case.
Assuming that introduction of infusion preparation and medication sorting systems might save half of the preparation time, such automated processing could save 596,300 CHF per year. Setting up diagnostic and treatment devices could be improved by automation and courier robots, but estimating time savings is difficult. Cleaning robots may have a role and might be particularly valuable in reduced hospital antibiotics-resistant pathogen transmission or highly susceptible patients. Manual handling of blood tests is time consuming, with an estimated workload reduction for nurses and lab technicians of 66% corresponding to savings of 454,373 CHF. Robots aiding patient positioning in bed and moving them out of bed are in development worldwide. Another example for saving time by robotics is implementation of robotic storage system also known as automated warehouse in the ICU.
To estimate whether it is effective to implement a robotic storage system in the ICU we analyzed the current needs for bringing items to the patients. We assume that the time to bring an item from storage to the patient is 2 minutes. A total of 82,806 minutes per year is spent on bringing items from the warehouse to the patient’s bed, in terms of economic value this action costs 245,105 CHF. Based on interviews with experienced ICU personnel we estimate that implementing an automatic storage system could save a minute in bringing an item to the patient. Such a system could save 41,403 minutes (50%) of working time translating to savings of 122,553 CHF in a year.
Conclusion
Our conclusions regarding robots and intelligent medical devices in the ICU are as follows:
1. According to the economic analysis the most feasible automation processes are: patient supervision, medicine preparation and test handling.
2. Robotic currier tasks (test handling, automated storage, medicine distribution) are technologically solved and are ready for application in the ICU.
3. For emerging technologies, the most important task for the ICU is the development of integrated CTS (Clinical Treatment Systems) and connecting them to the CIS.
4. Artificial intelligence will play a significant role in aiding ICU personnel in various roles.
5. Direct handling of patients by robots is immature and will require additional R&D to be beneficial for the ICU.
6. Automation of cleaning is feasible and its main benefit in the ICU is infection prevention.
Source: Kosa, Gabor; Morozov, Oleksii; Lehmann, Angelika; Pargger, Hans; Marsch, Stephan; Hunziker, Patrick (2022): Robots and Intelligent Medical Devices in the Intensive Care Unit: Vision, State of the Art and Economic Analysis. TechRxiv. Preprint. https://doi.org/10.36227/techrxiv.19664388.v1.
