HTN recently attended the virtual opening ceremony of Chelsea and Westminster Hospital NHS Foundation Trust’s two new critical care units, where digital and tech innovations have been combined with smart design, green space and art installations, to improve patient experience and create a more bespoke environment for recovery.
The virtual tour of the trust’s new intensive care unit (ICU) and neonatal intensive care unit (NICU) guided online guests around the state-of-the-art features, as a way to thank donors to the hospital’s official charity, CW+.
Four years in the making and planning, the project took just two years to fund and the first phase of the adult ICU was fast-tracked to help treat more patients during the initial stage of the COVID-19 outbreak. The development has given the trust a 45% increase in capacity, with space for 2,000 people per year across both units.
As part of the trust’s innovation in critical care, extensive research was undertaken – and patient feedback incorporated – to ensure that the technologies would help patient brains, bodies and senses to rest and, therefore, heal more effectively.
Elaine Manderson, Lead Nurse in Critical Care, said: “With the support of our charity, CW+, our critical care units incorporate the latest innovations and digital solutions that can be personalised to help reduce anxiety, pain and stress.
“I’ve seen first hand the difference that these redevelopments have already made for our patients and their families at end of life.”
During the first wave of the pandemic, she said, the extra capacity made “a huge difference…the new environment helped patients and our staff – the light, the space, the new technology all made a huge difference at that time.”
“We are also constantly collecting and analysing data from the build, to help us evaluate the environment, so that we can build an evidence-base and an ideal blueprint that we can share with our institutions and across the NHS.”
On the clinical side, additions to help staff gain greater insight into patient conditions and improve the environment for rehabilitation include eye-tracking technology, which the trust calls a ‘first-of-its-kind delirium recognition system’.
According to the trust, nearly one third of patients who are admitted to an ICU develop delirium, including up to 80% of those who are ventilated. This can mean the affected patients have an increased rate of mortality, length of stay, and the potential for long-term cognitive impairment. However, Chelsea and Westminster’s new technology uses artificial intelligence (AI) to track the movement of patients’ eyes, to help determine whether they are about to go into, or are already in, a state of delirium.
The new ICU has also integrated the latest digital innovations and technologies – often including ideas from our own staff @ChelwestFT, whose ideas are brought to life with support from our #CWInnovation programme.
— CW+ (@cwpluscharity) June 29, 2021
Sensium sensors in the ICU also allow staff to remotely monitor patients’ vital signs and physiological responses, including measuring heart rate, breathing rate and temperature every two minutes, allowing for more efficient tracking. While, staff stations for clinicians and nurses to record or work with patient data and vital signs, are specifically located on the right-hand-side of patient beds, leaving space for families and loved ones to comfortably interact or sit by the patient, on the left.
But innovations are also available to assist before admission stage, as clinicians have co-developed an AI algorithm with the company Sensyne to provide ICU staff with “near real-time risk prediction” for COVID-19 patients, which predicts not only the risk of ICU admission, but also the likelihood of the need for mechanical ventilation and potential in-hospital mortality.
In line with the trust and CW+’s ethos around applying arts and digital to improve patient outcomes and healing, the innovation does not stop with the clinical. Much thought has gone into the design and layout of the units – with a focus on bright, light, spacious and quiet spaces with rooftop views out over the London landscape, and smart screens that can offer privacy between rooms rather than curtains, for improved infection control.
The ICU also incorporates a series of customisable and personalised innovations to help patients and families create an environment that’s more conducive to recovery. This begins with focusing on the senses and working with ideas as simple but fundamental as lighting, temperature, air quality and sound.
Leigh Paxton, Matron of the ICU, was one of a host of staff members that helped guide the audience around the new spaces, explaining what the new innovations would mean for both clinicians and patients.
“The rooms have been designed very much with the patient as a focus,” he said, “each room is individually heated with air conditioning, bespoke lighting…we also have smart glass doors…”
In-room lighting can be adapted to suit patients’ moods and personal tastes, to help improve circadian rhythm by controlling day and night cycles, while Airthings technology measures temperature – which can also be controlled from a patient’s bedside – as well as air quality, CO2 levels and virus risk.
As part of a collaboration with Imperial Health and Sonitus Systems, the ICU is also now home to digital sensors that monitor sound levels, as part of a project that is believed to be the first research study of its kind in the UK.
Linking the holistic side of recovery into the units is the RELAX Digital programme, which uses TV screens in patient rooms to show family photos and videos, relaxing pictures, moving imagery and installations to distract patients, and “bring the outside world into our hospitals” – something which proved particularly important during the height of the pandemic, when visiting restrictions were in place.
The in-room media screens in each ICU room also enable patients to engage with the trust and charity’s Arts in Health programme, which includes screenings and recordings of live musical and dance performances or movement-based exercises, as another way to improve the clinical environment through the use of music and sound technology. Streaming services and mobile device technology also provide easy access to music and more choice and control for patients.
“That’s personalised to each patient,” said Leigh, “and with that it helps aid the recovery, the length of stay and the general wellbeing post-discharge.”
Away from the technology, the hospital has also installed a ‘Sky Garden’ by the ICU, based on its own research that showed nature can improve healing. The garden can be used by both patients and staff, and can be utilised as a space to aid physical and psychological recovery.
Over in the NICU – the second busiest maternity unit in the UK – meanwhile, critical care’s younger patients can also benefit from sensory lighting for play, while the space was re-developed to be able to care for another 150 babies a year and houses new state-of-the-art incubators that provide cot-side space based on family feedback.
Speaking about the project’s tangible benefits, Trystan Hawkins, Director of Patient Environment at CW+, said: “Something like sleep is really difficult in a hospital…over the past couple of weeks I’ve been looking at the data we’ve been getting from the old unit compared with the new unit.
“In our old unit, at night, decibel levels were around 88 decibels, in the new unit they are around 50. This is really good news as, for sleep, it needs to be around 50. Just walking through the unit as well, it is so different, it’s much quieter, more like a library…I think we’ve really achieved that in the design.”
On what’s next for the development of the spaces, he added: “In many senses, the journey is just starting – we’ve created the physical environment but now we’re going to be learning about ‘what does it actually do?’ in terms of the clinical outcomes, the effect that is has on people.
“Evaluating the impact, hopefully showing a reduction in the number of patients developing delirium, will be things that we’ll be doing over the next couple of years – as well as sharing the learning that we’ve created here with other hospitals within the UK and further afield.”