By Guye Biron Halpern
Each year in the United States, some 1.5 million patients are transferred between acute care hospitals. The transfers occur for a range of reasons such as access to specialty care, expert opinion, or patient choice. In general, the number of transfers has been increasing in recent years.
Several studies show that inter and intra hospital transfers and especially transport of ventilated patients can be rife with risk such as a deterioration of physiological parameters, displacement and malfunctioning of tubes, and, most notably, equipment malfunction or misuse. Transfer patients are also more complex requiring high levels of care and resources.
As a result of these issues, medical professionals must weigh in the risk of transfer when deciding whether to move a patient. Theoretically, these added risks can prevent a patient transfer even when it is in the best interests of the patients.
In order to improve patient outcomes and medical professional quality of life, the medical community must find ways to reduce the risk associated with transfer.
Medical Equipment and Transfers
One challenge point for transfers is the medical equipment that must travel with the patient. Almost half of transfer cases that lead to adverse events are due to equipment failure or accidental disconnection. Beyond having detrimental effects on patient care, the cost of equipment failure to hospitals can be enormous.
Common issues surrounding equipment failures include disconnections, power failures, monitor failures, failure to use or setup the device correctly. That these issues arise despite the devices often being designed to support patient transfers suggests that portability is often prioritized over ease of use and functionality.
It is important to consider where the designs for portable equipment are falling short and how best to design our medical equipment so that transfer decisions can be made for solely medical reasons. Ultimately, the goal of every developer of portable medical equipment should be to raise the performance of those devices until they are indistinguishable from their non-portable counterparts.
Case Study: Portable Mechanical Ventilation Design
Ventilators and ventilated patients present particular difficulties for patient transfers. This point is problematic for the medical community as it responds to the COVID-19 pandemic that has created a heavy reliance on ventilators.
Due to the size of many ventilators, patients who require ventilation must be accompanied by portable manual or mechanical ventilators. Manual ventilators struggle to meet the precise standards of ideal ventilation. Even when they can deliver effective ventilation, the requirement for human control makes them inconsistent and labor intensive.
As a result, the MedTech community began to develop mechanical ventilators that could meet patient needs during transfers. However, as the design emphasised portability, ventilation capabilities were reduced.
For example, portable ventilators may struggle with larger patients due to lower or less accurate tidal volume delivery.
As more time has passed though, the medical technology community has been able to replicate more advanced ventilation technologies within portable ventilators. Some of this has been made possible by harnessing general advancements in technology such as smaller but powerful batteries and compact high-performance turbines allow models to be lighter and more portable.
At the same time working to use parts that require little to no maintenance as well as materials that are suited to the environments pushed ventilators from big and cumbersome to small and nimble. For instance, effective filters which only require changing every 300 working hours enables a small design as there is no need to constantly open the device to maintain it.
Transferring sick patients has its own inherent risks which will never fully be removed. With each advancement in design however, medical professionals can focus more on the medical merits of transfers without having to assess the risk of outside factors such as equipment failures.
As transfers increase in number, the MedTech community must set itself to produce the highest quality robust portable medical equipment to support patients and doctors.
Guye Biron Halpern is VP Products and Clinical Research at Inovytec Medical Solutions. He has over 10 years of experience in the public sector, with extensive operational and managerial experience, including managing stressful and emergency situations, integration of cross-disciplinary product design and development and product-market fit.