SMART: OVERVIEW

Purpose

• Help patients and providers
• Allow dynamic monitoring of simple physiologic signs and location
• Improve communication of patient data
• Allocate resources accordingly
• Experiment with new technologies
• Evaluate in real setting

Components

• Disaster situation: scale-up known processes
• Portable ED, remote management
• Continuous indoor and outdoor location of patients, providers, materials
• Continuous monitoring (2-lead EKG and oximeter) with alerts
• Mobile decision support (case prioritization, additional resource requests, referrals, diversions)

Hardware

• Patient: PDA with monitoring, location device (cricket)
• Provider: PDA, location device (cricket)
• Material: location device (RFID)
• Workstations at ED (Partners)
• Wireless network (802.11b)

3 Phases (Years)

• Development and testing
• Get IRB approval for use in hospital
• Collect control data on utilization and mobility patterns
• Implementation in ED
• Integrate with ED information system
• Hire paramedic for a monitoring station
• Patients in waiting room with chest pain or respiratory complaints
• Evaluation in ED
• Need about 8 patients/weekday 9am-5pm for 50 weeks
• Up to 16 patients/day
• Consider controls here (non-historical)

Outcomes to Evaluate

• Compliance with system
• Accuracy of the monitoring
• System downtime
• Waiting time in ER
• Appropriateness of alarms
• No satisfaction survey will be done

Division of Work

• MIT develops monitoring (alerts), location system, network architecture, and corresponding databases
• BWH does integration with HIS, resource allocation decision support, and evaluation
• Both: ambulance system