Source: NG HEALTH VENTURES, LLC submitted to NRP
DEVELOPMENT OF A PROSPECTIVE MOBILE AUTOMATED VIDEO MONITORING SYSTEM TO REDUCE RISK OF FALLS IN RURAL CRITICAL ACCESS HOSPITALS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
Reporting Frequency
Annual
Accession No.
1012701
Grant No.
2017-33610-26735
Cumulative Award Amt.
$100,000.00
Proposal No.
2017-00743
Multistate No.
(N/A)
Project Start Date
Jun 1, 2017
Project End Date
Jan 31, 2019
Grant Year
2017
Program Code
[8.6]- Rural & Community Development
Recipient Organization
NG HEALTH VENTURES, LLC
151 N 8TH ST SUITE 300
LINCOLN,NE 68508
Performing Department
dba Ocuvera, LLC
Non Technical Summary
The development of a cost-effective fall prevention system for rural Critical Access Hospitals (CAH) represents a significant opportunity. Patient falls are a common, costly, and serious problem in hospitals and care facilities. CAHs have greater pressures on them over typical urban hospitals due to their typically smaller number of beds and occupancy, older population demographics, smaller operating margins, shorter patient stays, and intermixing of patients of various demographics and with various diagnoses. These challenges present barriers to implementing a cost-effective fall prevention system. The proposed project aims to overcome these challenges faced by CAHs by introducing a mobile intervention system that is effective and flexible, allowing ease of use and integration. The goal of the proposed project is to implement and demonstrate the feasibility of a mobile Automated Video Monitoring (mAVM) system to reduce the risk of injurious falls among adults age 65 and over in CAH settings by detecting unassisted bed exits before they occur. To create the mAVM system, we propose to take a video monitoring system, mount it on a mobile cart unit made for use in hospital settings, and deploy it to CAH rooms to monitor and gather data from patients at a higher risk for falls and fall-related injuries. The data obtained in this step, in the form of 3D video footage of real patients in rooms during their stays at CAHs, will be analyzed in order to gain a better understanding of the specific behaviors that precede and indicate dangerous fall situations. This knowledge will be tremendously valuable to the public good in helping develop this and other technologies that prevent dangerous fall situations, decrease injury, increase overall quality of life, and decrease the overall cost of hospital care. Then, we will use this data to customize an automated video monitoring component and test feasibility of this approach by deploying the prototype mAVM intervention in CAH rooms, using the data collected previously as a comparative baseline to demonstrate the effectiveness of the intervention. Critical Access Hospitals provide rural communities with access to healthcare. In addition, these hospitals provide economic benefit in the form of skilled jobs to rural communities across the United States. Hospitals everywhere are experiencing pressures due to increasing healthcare costs, an aging population, and a shortage of healthcare workers. These problems are often intensified for rural CAHs due to the demographics of the smaller, older communities that they serve. The proposed project will enable the business, Ocuvera, to modify its existing, promising solution to meet specific needs of CAHs. As a result, CAHs will be able to reduce specific healthcare costs related to falls and provide the same level of patient monitoring found at larger facilities elsewhere. These benefits will assist CAHs and their rural communities in continuing to exist, prosper, and become more self-sustaining.
Animal Health Component
33%
Research Effort Categories
Basic
34%
Applied
33%
Developmental
33%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
72360102090100%
Goals / Objectives
The major goal of this project is to demonstrate the feasibility of a mobile Automated Video Monitoring (mAVM) system to reduce the risk of injurious falls among adults age 65 and over in Critical Access Hospital (CAH) settings. An mAVM system is intended to detect risky patient behavior that could lead to an unattended bed exit and alert hospital staff before an unattended bed exit occurs. Project objectives include: (1) Development of a prototype mAVM using a mobile cart and the Ocuvera Automated Video Monitoring system. (2) Design and implementation of an efficacy study to track statistics on unattended bed exits with and without an mAVM system in CAHs. (3) Statistical analysis of the resulting data on unattended bed exits with and without an mAVM system.
Project Methods
Efforts include:(1) Develop a prototype mAVM system. Milestones for this effort include: develop optimal algorithm parameters for computer vision algorithms when mounted on a mobile cart in varying room configurations to best balance false positive and false negative alarms for older adults; determine all hardware components for testing; integrate preliminary computer vision algorithms and hardware with a mobile cart for an end-to-end system capable of consistently alerting hospital personnel to indications of unattended patient bed exits.(2) Conduct a study to compare the prototype mAVM intervention to baseline rates of unattended bed exits, falls, and fall-related injuries among adults at high risk for falls and fall-related injury. Milestones for this effort include: establish a baseline rate of unattended bed exits using 3D camera recording systems deployed to 2-4 hospital units; deploy the prototype mAVM to the units; run the prototype mAVM intervention continuously for at least 1200 cumulative patient days with at most 1% downtime; enroll at least 100 patients and at least 50 older adults identified as high risk for falls. Statistics about system performance, including the number of bed exits and falls predicted, detected, and prevented, with patient demographic and diagnostic information, will be collected from the system and reports by nursing staff.(3) Conduct a statistical analysis of the results produced by the study. These analyses will include: a longitudinal analysis comparing rates from baseline to post intervention; an efficacy analysis determining sensitivity, specificity, and positive predictive value of system performance as judged by an independent panel of experts, including nurse response behavior and rates of injurious falls; and a comparison of these validity indices across our two populations of interest (younger adults less than 65 years and older adults). Milestones for this effort include: completion of these analyses and reduction of unattended bed exits by at least 25% among younger adults and 50% among older adults.Evaluation: Success of this project will be the development of a prototype mAVM system and the completion of the efficacy study and from it obtaining significant and meaningful results that demonstrate the degree of effectiveness of the prototype system.

Progress 06/01/17 to 01/31/19

Outputs
Target Audience:Target audience include rural critical access hospitals in Nebraska, their staff, and their patients. Ocuvera systems were deployed to 7critical access hospitals. An initial period of data collection recorded patients, while a subsequent period of intervention alerted nursing staff to risky patient behavior. Staff were trained on system usage. After completion of the study, hospitals were given aggregated performance indicators. Changes/Problems:One main major change resulting from this project comes from the conclusion that mobile carts, while useful for their mobility, pose an obstruction in hospital rooms. The change is that the mobile unit design has changed from being cart-based to being wall-mounted. This allows for a significantly smaller footprint and entirely removes the trip hazard introduced from mobile carts. Another major change was the use of seven study sites instead of the anticipated two to four, because critical access hospitals were collecting video at a significantly slower pace than anticipated. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? (1) Aprototype mobile AVM was successfully developed using a mobile cart. (2) A study was conducted with the Ocuvera system at sevencritical access hospitals. Of the seven, four of the facilities could utilize mobile cart systems while three could only accomodate fixed systems because of the obstruction posed by the mobile cart. As a result of this study, Ocuvera developed a new mobile wall-mounting system to have a mobile system without a cart. Data was collected from approximately 138 patients during a baseline stage and 129 patients during a subsequent intervention stage with alerts shown to nursing staff. (3) Pre/post analysis was conducted for the data collected. The analysis, as well as interviews with hospital staff, uncovered two distinct uses for the Ocuvera system: for observation and for fall risk reduction. Two hospitals used the system's video monitoring capabilities to observe patient movements, allowing nurses to let patients who were of lower fall risk to have more mobility and independence. These hospitals saw an increase in unattended bed exits. Five hospitals used the system as intended, to reduce fall risk and intervene when a patient appeared to be attempting to get out of bed without assistance. Preliminary analysis indicates that unattended bed exits were reduced at these five hospitals by over 90%.

Publications