How well can a device monitor patients?

Winner master’s thesis prize FHML: Tom Den Ridder


Patients recovering from surgery or who have been admitted to a general hospital ward via the Accident & Emergency department may deteriorate suddenly. To monitor these patients, nurses make rounds to check their heart rate, breathing rate and blood oxygen levels. Prize winner Tom Den Ridder (25, currently working as an Intensive Care Unit doctor at MUMC+) studied whether it’s more effective to monitor patients using special equipment.

“We’re looking for a kind of intermediate step between the ICU and general hospital wards”, says Den Ridder. “Patients in the ICU are continuously monitored. This requires specialist equipment and someone who knows how to interpret the readings. Nurses on general hospital wards check heart rates, respiratory rates and blood oxygen saturation levels every four, six or eight hours, depending on the ward and the patient. If these vital signs deteriorate, the patient may be suffering from an infection or sepsis, for example. Sometimes this means they will need surgery again or have to be transferred to the ICU.”

Previous research has shown that this kind of deterioration is not as sudden as it seems at first glance. “There’s a trend in patient vital signs in the preceding hours. You can miss this trend if you only check vitals every few hours. We tested devices that monitor heart rate, respiratory rate and oxygen saturation. If these vital signs reach a certain threshold, an alarm sounds. This means the nurses don’t have to continuously monitor the devices.”

They tested a small device worn around the wrist to measure oxygen saturation and a sticker placed on the chest to measure heart rate and respiratory rate. “The system caught on to the fact that the patient’s condition was deteriorating before the staff did. Nurses continued to check patient vitals to make sure the readings of the devices were reliable.”

Den Ridder could only make a preliminary analysis of the data; the project was prematurely terminated due to COVID-19. “But I do think it can make a difference for high-risk patients ­– those who have just undergone major surgery or are very ill, but not ill enough to be admitted to the ICU. ICU admission can be avoided by responding earlier.”

Den Ridder hopes he will be involved again if the project is restarted. “But it’s still unclear if and when that may happen. Fortunately, I can do research in my current job as well; I’m allowed to devote 30 per cent of my time to research. I only started two months ago. Before this, I spent a year working in the Accident & Emergency department. I will probably work together with Anaesthetics on pain relief and sedation. I became a doctor to be directly involved in patient care, but I think it’s important and interesting to also be involved in research.”

Every year during the Dies Natalis, special attention is paid to the students who wrote the best bachelor’s and master’s theses. Although the event was cancelled due to COVID-19, 27 lucky students (18 bachelor’s theses and nine master’s theses) were awarded a cash prize of 500 euros and a certificate. Observant selected eight theses. Their stories will be published on this website in the coming weeks. 

How well can a device monitor patients?
Tom Den Ridder
Author: Cleo Freriks

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