By Jessica Kent
- Across the healthcare industry, leaders are increasingly leveraging real-time data analytics tools to advance insights and improve decision-making.
In high-risk care settings, these tools are especially critical. Patients who require a step above standard care often improve or deteriorate rapidly, and providers need solutions that allow them to continuously monitor these individuals.
In the neonatal intensive care unit (NICU), real-time data analytics technologies are just as essential. While the same level of risk exists in the NICU as it does in other intensive care units, clinicians are also tasked with providing care to extremely delicate patients.
“The patients we care for are very different from any other patient in ICU settings, even in pediatrics,” Lance Prince, MD, PhD, chief of neonatal and developmental medicine at Stanford Children’s Health, told HealthITAnalytics.
“The majority of our patients are not in the ICU because of an acquired disease. They are in the ICU because they were either born extremely premature or they were born with some sort of birth defect. We have our share of kids who come in with major infections like anyone else, but the goal of what we're trying to do in the neonatal intensive care unit is to provide unbelievably high levels of support to promote normal human growth and development.”
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Because providers are taking care of patients that sometimes weigh only ounces and have very fragile skin or limbs, they have to think differently about how they’re drawing labs and monitoring babies.
“We can’t put as many tubes and IVs into our patients as physicians who care for adult patients, and we also have to be very mindful of the long-term impact that even a single blood draw can have on a baby. We don't want to give them scars. We don't want to give them recurrent episodes of pain that they have to endure,” Prince explained.
At Stanford Children’s, leaders in the NICU aren’t just trying to miniaturize data analytics tools to fit the needs of their small patients – they’re actively working to find new and effective ways of providing care.
“We've done a lot of work with babies with congenital heart disease, where their oxygenation is abnormal. They have cyanotic lesions, and they can't be as pink as a normal baby would be. But we can still monitor the oxygen delivery that they do have in the bloodstream, and then make decisions about blood pressure control and whether or not we're managing their heart disease in the right way,” said Prince.
“The benefit is that this has now been miniaturized to the point where it works really well on babies, it provides the data in real time, and it's giving us great physiologic information.”
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The fact that these tools deliver real-time information to providers is crucial, Prince noted.
“Our patient population is very distinct. Imagine being in the hospital for months and not being able to communicate with your physician? Babies can't say, ‘Hey doc, I have this pain in my right side and I think something's going on there.’ We have to be able to monitor them in a way that allows us to see these things in real time,” he said.
“We're trying to use machine learning approaches to integrate all the data that we have in the unit and better understand where the forks in the road are for certain patients. Where did they start to do better? Where are they starting to go down the wrong path? That’s where we need to be thinking about novel therapeutics.”
A chief strength of the unit is the multidisciplinary team that works together to care for the patients.
“We deal with every single organ system in the babies. So right away, we're engaging all of the sub-specialists in pediatrics to deal with all the different organ systems. And we're also engaging with the obstetricians and maternal-fetal medicine specialists,” said Prince.
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“We work very closely with them so that we understand what's going on with the mothers, and we also have the perspective of first the fetus and then the newborn about how the pregnancy impacts the baby.”
Additionally, as soon as providers make a diagnosis of congenital heart disease or a congenital heart defect, the NICU includes pediatric cardiologists in care planning and management.
“Cardiologists and surgeons are involved on day one. That way, we're all on the same page. It's seamless. If nothing else, the families feel like they're being supported by everyone,” Prince said.
“We have plenty of spirited discussions, but in the end, everyone brings their unique perspectives and training to the table. It helps the overall continuum of care.”
With the plethora of data analytics tools popping up in every area of healthcare, it’s critical for providers to keep their end-goals in sight, Prince noted.
“There are a lot of people out there developing tools very quickly. The most important thing for us as caregivers is to define the problem we’re trying to solve. What would allow us to provide better care for our patients, and how can technology help us do this?” he said.
“Instead of seeing all the shiny, bright objects of different software packages and programs and what they can and can't do, you have to be very clear about what your core goals are. It might be patient flow, preventing infections, or diagnosing patients faster. There's technology and machine learning approaches that can tackle each one of those issues. But the most important thing is to focus on what exactly you want to accomplish.”
By evaluating the needs within their own organization, leaders in the NICU at Stanford Children’s have made strides in improving overall care delivery.
“We’re trying to let babies be babies while they're in the intensive care unit. If you imagine the perfect environment for a newborn baby, it would be what a nursery would look like at home – it would be quiet, soothing, and comfortable. So, the challenge is, how do we create that within the neonatal intensive care unit while understanding their brain development, their GI tract function, their heart function on a second-to-second basis, in real time?” Prince said.
“We're starting to make some progress there because we can capture the imagination of engineers and computer scientists and ask them how we can do this. Now, we're able to monitor neuro signals, lung development, molecular signals, and biochemical signals. We're able to monitor metabolites from stool, urine, and blood – tiny, tiny drops of blood.”
With the many advancements being made in healthcare every day, it’s only a matter of time before neonatal intensive care units transform. However, the patient will continue to be at the center of every new technology and approach.
“The intensive care unit that we are in today is very different than it used to be, and the ICU of tomorrow is going to be completely different,” Prince concluded.
“It's going to require a lot of engineering and computer science, but we're going to care for these patients in a setting that's nurturing, soothing, and compassionate. It's going to change the way we think about medicine.”
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