Beating sepsis with wearable sensors – the future Dr Meera Joshi is the 2020 Isambard Kingdom Brunel Award Lecture winner for Engineering, Technology and Industry. This Award is in recognition of her cutting-edge work and committed public engagement efforts. Full details of the 2020 Award Lecture winners can be found here: www.britishscienceassociation.org/news/introducing-our-2020-award-lecturers Written by Alan Barker, freelance writer Mortality rates from sepsis can be as high as 25%. Spotting the signs early is critical to improving a patient’s chances of survival. Meera Joshi is working on a project to provide vulnerable patients with wearable sensors – and the results so far have been dramatic. How did you become interested in developing this technology? I’ve always been interested in how tech can help healthcare. I’m a surgical registrar; I do about 350 operations a year. Throughout my training, I’ve seen how fast some patients deteriorate as a result of infection. A common cause is sepsis. At the moment, nurses use the National Early Warning Score, or NEWS. They use NEWS charts to monitor vital signs: heart rate, respiratory rate, blood pressure, oxygen saturations and temperature. These are paper-based? Yes, mostly: the kind of chart you might see at the end of a patient’s bed. They’re usually handwritten by nurses and the practice of handwritten observations recorded on paper hasn’t changed for centuries. It’s the first thing a doctor looks at when assessing a patient. It’s absolutely fundamental to understanding a patient’s physiological condition. Patients are monitored maybe every four to six hours – more frequently if they’re seriously unwell. Sadly, there are still delays in identifying patients with sepsis, and subsequently delays in treatment, which can be very dangerous. For every hour’s delay, the risk of death rises by almost 8%. We need to catch sepsis – and escalate a response – more quickly. We’ve been looking at electronic monitoring and wearable sensors. We have fitness apps on our mobiles, of course… Absolutely, and some of them can be better than the tech in hospitals. But they’re not designed for medical monitoring, and they don’t have the safety and security approvals you need: CE marks, FDA approvals, things like that. My PhD supervisor Professor Ara Darzi sent me to spend some time at Google Deep Mind in the early stages of my PhD. Subsequently, I spent a lot of time with companies that make wearable technology and this became the focus of my research. I got really valuable support from the Royal College of Surgeons, and from the charity CW Plus. I couldn’t have done this work without that. Which companies did you look at? Lots of companies are fighting for this space: lots of fancy marketing, saying the technology can do all sorts of things. But a lot of it is clunky; it’s just not user-friendly. We came across Sensium, who make a patch: a lightweight wearable device that attaches to a patient’s chest via electrodes. Importantly, this had approvals to be used in hospitalised patients. How did you test it? We set up a big trial with a cohort of 500 acutely admitted hospitalised patients – medical and surgical – and we put the sensor on them within 24 hours of entering hospital. Then we measured how quickly the sensor picks up changes compared to nursing observations. And what did you find? We certainly found that alerting electronically can improve outcomes. The tech is reliable, but we also need to think about how easy it is to use, and how medics can use the data most effectively. The human factor element is as important as the technology. How does the tech work? The sensor monitors heart rate, respiratory rate and temperature every two minutes, uploads packets of data to a bridge – a bit like a Wi-Fi hotspot – and then sends it to a server. We had to engineer the wards where we ran the trial, so that data could be uploaded in real time, wherever patients were. That took time, and we had to test everything for blind spots. How do the nurses get the alerts? Algorithms in the system decide when to send triggers to a smartphone-type device carried by the nurse – later, on our trial, we gave them iPods. You need quite a few readings to generate a trigger and we needed to find out how often a nurse should be alerted. We don’t want to bombard staff with alerts, waste their time and cause alert fatigue; but we do want to pick up the really sick patients. The algorithms can analyse the data and tell you whether it’s registering something serious. Has this device got other applications? We picked up irregular heartbeats, signs of respiratory conditions, really useful stuff. And now we’re moving towards remote monitoring, outside hospitals. We’ve just completed a COVID-19 trial. We engineered a hotel near Heathrow, putting sensors on travellers coming through. Normally, they’d just be left to quarantine with an occasional call from a nurse; this system gave the nurses real-time data. Are you looking at other devices? We’re looking at devices that monitor blood saturation levels – oxygen levels in the blood, which is a really important indicator for COVID-19. That work is in its early stages. What about the future? I really think remote monitoring and wearable tech is the way forward, both in hospital and in the community. It can also help doctors who are working across multiple sites. We have all this data available and we need to harness it, make it meaningful and useful to the people who use it. I’ve got great visions for this work. Imagine being able to click on a dashboard, wherever you are, and see everything about a patient’s operation and how they’re getting on. Our work is just one part of a very big jigsaw, but it’s a really crucial part. Alan Barker is a writer, trainer and coach specialising in communication skills. He has been working with the British Science Association since 2015. Alan’s webinar, Storytelling for Scientists, is on the 3M YouTube channel.