Non-contact monitoring to support care in acute inpatient mental health.

BACKGROUND: Averting incidents of patient self-harm is an ongoing challenge in acute inpatient mental health settings. Novel technologies that do not require continuous human visual monitoring and that maintain patient privacy may support staff in managing patient safety and intervening proactively to prevent self-harm incidents. AIM: To assess the effect of implementing a contact-free vision-based patient monitoring and management (VBPMM) system on the rate of bedroom self-harm incidents. METHODS: A mixed methods non-randomized controlled before-and-after evaluation was conducted over 24 months on one female and one male acute inpatient mental health ward with the VBPMM system. The rates of bedroom self-harm, and of bedroom ligatures specifically, before and after implementation were investigated using quantitative methods. Qualitative methods were also used to explore the perceived effectiveness of the system and its acceptability. RESULTS: A -44% relative percentage change in bedroom self-harm incidents and a -48% relative percentage change in bedroom ligatures incidents were observed in the observational wards with the VBPMM system. Staff and patient responses gave insights into system acceptability and the ways in which these reductions may have been achieved. CONCLUSION: The results indicate that using the VBPMM system helped staff to reduce self-harm incidents, including ligatures, in bedrooms.

Economic evaluation of a vision-based patient monitoring and management system in an acute adult and an older adult mental health hospital in England.

BACKGROUND AND AIMS: Patients on acute adult and older adult inpatient mental health wards are at an increased risk of accidental injuries and deliberate harm to self and others. A vision-based patient monitoring and management (VBPMM) system was designed by Oxehealth Limited to support ward staff to provide better and more efficient care and to reduce incidents. The VBPMM system uses an infrared-sensitive camera, installed in a patient's room, that works with cleared medical device software to deliver contact-free vital sign and activity insights to clinical teams. Data from two studies undertaken at an English National Health Service (NHS) mental health trust were used to inform an early economic assessment of VBPMM implementation into acute adult and older adult mental health wards. METHODS: A cost calculator was used to compare the introduction of the VBPMM system as an adjunct to standard care versus standard care alone. Observational data were collected at two English NHS mental health trusts. Both compared data pre- and post-VBPMM implementation using a 12-month baseline period. The model estimated cost per occupied bed day, cost per patient, annual cost per average-sized ward, and total cost to NHS mental health trusts across England. Costs were modeled from an NHS perspective over a 12-month time horizon. Scenario analysis was conducted to test the uncertainty of results using statistical significance of key inputs. RESULTS AND CONCLUSIONS: This early analysis indicated that the VBPMM system is likely to be cost saving within both settings examined, with an estimated cost saving of £272 per acute adult mental health patient and £4,591 per older adult mental health patient. This translates to £22.3 and £63.3 million, respectively, across NHS mental health trusts in England every year. VBPMM, therefore, has the potential to augment standard care, leading to positive clinical outcomes and monetary savings.

Economic evaluation of a vision-based patient monitoring and management system in addition to standard care for adults admitted to psychiatric intensive care units in England.

BACKGROUND AND AIMS: Treating patients in psychiatric intensive care units (PICUs) is costly for the English National Health Service (NHS), requiring significant staff time. Oxevision, a non-contact system, providing vision-based patient monitoring and management (VBPMM) has been introduced in some NHS mental health trusts which aims to help clinicians to deliver safer and more efficient care. The objective of this early economic evaluation was to explore the impact of introducing VBPMM with standard care, versus standard care alone on health and economic outcomes in PICUs across England. METHODS: The model uses a cost calculator approach to evaluate the potential benefits of introducing VBPMM, capturing differences in observation hours and critical events such as assaults. Effectiveness data were primarily based on a 24-month observational before and after study undertaken in an NHS mental health trust using VBPMM. Outcomes reported in this study are incremental costs and reduction in clinical events presented as per occupied bed days, per patient, per average ward, and for the English NHS overall. Scenario analysis was conducted to test the uncertainty of results using statistical significance of key inputs. RESULTS AND CONCLUSIONS: The analysis indicates that introducing VBPMM may be cost saving compared with standard care alone. The biggest driver of estimated cost savings was from the potential reduction in one to one observation hours, which may have significant impact in PICUs. Limitations of the analysis include the single center data underpinning the analysis and assumptions made about transferability of clinical data to different sized wards. Scenario analysis was conducted, and the results were robust to statistically significant changes in input parameters. This study suggests that introducing VBPMM on PICUs has the potential to reduce costs and improve efficiency of resource allocation, but results should be confirmed with additional clinical study evidence.

Reducing Falls in Dementia Inpatients Using Vision-Based Technology.

OBJECTIVES: Falls have a significant negative impact on the health and well-being of people with dementia and increase service costs related to staff time, paramedic visits, and accident and emergency (A&E) admissions. We examined whether a remote digital vision-based monitoring and management system had an impact on the prevention of falls. METHODS: Our study was conducted within the Manor dementia inpatient wards at the Coventry and Warwickshire Partnership Trust. Data were retrieved from incident reports before and 22 months after installation of the system. We examined number of night time falls, severity of fall, number of paramedic visits and A&E admissions, and the number of enhanced observations during both time periods. RESULTS: There was a significant 48% reduction in the number of nighttime falls (P < 0.01), a 49% reduction in visits from paramedics (P < 0.2), and a 68% reduction in A&E admissions (P < 0.02). In addition, the data indicated an 82% reduction in the number of moderate severity falls and that enhanced one-to-one observation hours were reduced by 71%. CONCLUSIONS: The study demonstrated that a contact-free, remote digital vision-based monitoring and management system reduced falls, fall-related injuries, emergency services time, clinician time, and disruptive night time observations. This benefits the clinicians by allowing them to undertake other clinical duties and promotes the health and safety of patients who might normally experience injury-related stress and disruption to sleep.

First United Kingdom experience of the novel Osia active transcutaneous piezoelectric bone conduction implant.

PURPOSE: Bone conduction hearing devices are widely used and indicated in cases of conductive, mixed or single-sided deafness where the conventional hearing aids are not indicated or tolerated. This prospective study aims to investigate the surgical and hearing outcomes of a novel active piezoelectric transcutaneous bone conduction device (t-BCD). METHODS: Prospective data were collected from the first 10 patients who underwent implantation with the t-BCD Osia (Cochlear, Australia) (between Dec 2018 and March 2019) in a tertiary referral centre. The main outcome measures include: surgical outcome, free field speech testing with speech recognition thresholds, audiological gain and patient-reported outcomes including the 'Glasgow Benefit Inventory' (GBI) and the 'Client Oriented Scale of Improvement (COSI). RESULTS: The mean length of surgery was 70.6 min (range 50-87, SD = 9.5). Mean skin thickness measured was 5.6 mm (range 4-8, SD = 1.1). There were two post-operative wound infections which settled conservatively. One required revision surgery to thin skin. The average gain in hearing with the implant was + 39.4 dB. Pre-implantation mean unaided SRT was 38.1 dB (SD = 7.8) and the post-implantation mean-aided SRT was 22.7 dB (SD = 4.6) (p = 0.000078). There was improvement in COSI domains. The mean Glasgow disability score dropped from 52% pre-implantation to 20% post-implantation (p = 0.001). CONCLUSIONS: This new active t-BCHD provides excellent audiological gain and improvement in speech recognition. Patient-reported outcomes have also been very positive. The surgery was straightforward with no major surgical complications reported. Further studies will be required to examine long-term outcomes in larger number of patients.

Single-center Experience of Over a Hundred Implantations of a Transcutaneous Bone Conduction Device.

OBJECTIVE: To assess outcomes with a novel passive transcutaneous bone conduction device (t-BCD). STUDY DESIGN: Prospective data collection and patient review. SETTING: Tertiary referral center. PATIENTS: Patients who underwent implantation with the t-BCD between November 2013 and September 2016. INTERVENTION: Implantation of BAHA Attract. MAIN OUTCOME MEASURES: Surgical outcome, patient reported outcomes including the "Glasgow Benefit Inventory" and the "Client Oriented Scale of Improvement" for adults and the "Speech, Spatial and Qualities of Hearing scale" (SSQ-12) for children. RESULTS: One hundred five patients were implanted. Numbness superior to the incision was commonly noticed. Four patients (3.8%) developed skin tenderness and redness that settled with conservative measures. Among those patients who had a conversion from a percutaneous Bone Conduction Hearing Device (BCHD) to the t-BCD (n=15), 1 (0.9%) developed seroma and 2 (1.9%) developed skin dehiscence at the edge of the implant magnet. Significant improvement in Client Oriented Scale of Improvement and Glasgow Benefit Inventory scores with a global satisfaction of 84% and 77.4% was observed for those previously aided and unaided respectively, with use of the device. A 22% improvement in SSQ-12 mean score was observed in the pediatric population. CONCLUSION: This is the largest single-center series reported on this t-BCD. The complication rate is small but caution is required in patients of conversion from a percutaneous BCHD. The patients' satisfaction is high and the need for aftercare is minimal. Cost-effectiveness evaluation of these devices, development of core outcome sets and well-designed, prospective trials to compare the different BCHDs should be the focus of future research.

Initial UK Experience With a Novel Magnetic Transcutaneous Bone Conduction Device.

OBJECTIVE: To assess outcomes with a new transcutaneous bone conduction hearing aid. PATIENTS: Patients that underwent implantation with the transcutaneous bone conduction device between November 2013 and May 2014. INTERVENTION: Hearing rehabilitation using the BAHA Attract. MAIN OUTCOME MEASURES: Quality of life measures using Glasgow benefit inventory (GBI) and clinically oriented scale of improvement (COSI). Audiological outcome using word discrimination score. RESULTS: Ten patients were implanted. Significant improvement in GBI and COSI scores comparing preimplantation and postimplantation. An increase in word discrimination scores at 30 dBA, with an increase from 0% unaided to a mean of 50% with the magnetic transcutaneous bone conduction aid and at 50 dBA with an increase from a mean of 31.7% to 88.3%. However, the word discrimination score increase at 30, 50, and 60 dBA was not statistically significant (p = 0.25; Wilcoxon). CONCLUSION: There was a high level of satisfaction with the device with significant increases in GBI and COSI scores in patients who were previously aided with an acoustic aid. The absence of daily skin hygiene appealed to patients.

A randomized controlled pilot study comparing aqueous cream with a beeswax and herbal oil cream in the provision of relief from postburn pruritus.

Postburn itch is reported to affect up to 87% of the burn population. Although treatments for postburn itch are multimodal, they remain consistently ineffective. However, recent anecdotal evidence from several outpatients at a tertiary referral hospital suggests that a cream combining beeswax and several herbal oils may be effective in the minimization of postburn itch. The aim of this study was to test the efficacy of beeswax and herbal oil cream against the standard treatment of aqueous cream in the provision of relief from the symptoms of postburn itch. A randomized controlled trial compared two groups using a visual analog scale, frequency of cream application, itch recurrence after cream application, use of antipruritic medications, and sleep disturbance to determine the effect of itch severity and duration. Fifty-two participants were enrolled in the study (84% male) with a mean age of 35 years (SD = 16) and mean burn TBSA of 7.2% (SD = 7.7). Study results found that the beeswax and herbal oil cream reduce itch after application more frequently than aqueous cream (P = .001). In addition, when managed with beeswax and herbal oil cream, participants found that their itch recurred later (P ≤ .001) and their use of antipruritic medications was lower (P = .023). Findings of this study suggest beeswax and herbal oil cream to be more effective in the minimization of postburn itch than aqueous cream. Given this, a larger study examining the efficacy of beeswax and herbal oil cream appears warranted.