Documentation system seeks to improve paramedic-ED patient handoffs

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An automated clinical documentation system is being tested to better facilitate handoffs of patients brought to the emergency department via ambulance.

Vanderbilt University Medical Center partnered with the Nashville Fire Department in a feasibility study as part of a $1.7 million research grant from the Department of Defense.

“The specific focus is how to improve patient care and clinical documentation during transport in military and civilian cases,” says project lead Daniel Fabbri, assistant professor of biomedical informatics in the School of Medicine at Vanderbilt University.

The Automated Sensing Clinical Documentation system includes sensors that are placed on paramedics’ wrists and forearms, which transmit body motion and muscle activity data in real time that is analyzed to let ED physicians and trauma surgeons know what in-transit medical procedures have been performed on patients.

“Administering CPR, intubating someone or applying medication all have some signatures in terms of accelerations of the paramedics’ hands that can be used to infer—by analyzing that data—what procedure they are doing at any given point in time,” contends Fabbri.

According to Fabbri, the system operates entirely in the background and automatically generates patient care records using machine learning that interprets the signals from the paramedic-worn accelerometers.

“Technology continues to advance,” says Joaquin Toon, Nashville Fire Department EMS quality improvement officer. “To think that a civilian paramedic or a military medic’s hand and body movements can generate a medical record or alert the hospital of an incoming patient’s condition is phenomenal. Nashville Fire Department was excited to partner with Vanderbilt Emergency Medicine in this research.”

The system was initially tested earlier this year with two Nashville Fire paramedics who worked over several 12-hour shifts during a 12-week period. Fabbri and his team presented results of the feasibility study at last month’s American Medical Informatics Association annual symposium in Washington.

Going forward, in addition to motion sensors worn by paramedics, Fabbri’s team plans to ultimately leverage data from video cameras as part of the system.

“We wanted to start out with a small study to assess the technology and see what practical issues might arise, and this work with Nashville Fire proved quite fruitful,” adds Fabbri. “Due to privacy considerations, we did not use video, but our initial findings bode well for the feasibility of our project."

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