Dr Hoi Shu Yin, Chief Nurse, Tan Tock Seng Hospital, Singapore
By Sean Nolan
Women in GovTech Special Report 2021.
In my role as Chairperson of the hospital Fall Prevention Committee, a team of nurses and I collaborated with a local start-up to develop a patient monitoring system, named PreSAGE, for falls prevention in single and isolation rooms in the hospital environment. The system uses thermography, proprietary machine learning, predictive algorithm and image processing techniques to predict bed-exit situations and triggers advanced warning to facilitate early intervention. The system was developed based on four design principles: (i) non-contact, (ii) non-intrusive, (iii) automated continuous monitoring and (iv) privacy-preserving.
Following development of a prototype, our team evaluated the system in a proof-of-concept study conducted with 80 patients. A total of 11,573 hours of images were recorded and the development of a predictive algorithm enabled an alarm trigger to allow a 15-second lead time for staff to intervene, before the patient assumes a standing position from the bed. The predictive capability of the system led to achieving high sensitivity and specificity scores. We had also conducted a survey after deployment, whereby staff shared the ease of use of the system and their perceptions of improved surveillance facilitated by a live monitoring dashboard. There was a 34 per cent reduction in falls rate and a 67 per cent saving in manpower hours.
Beyond TTSH, PreSAGE has been scaled and deployed as a fall prevention measure in both public and private hospitals, nursing homes and residential homes in Singapore and overseas. The system has also clinched the Asia Pacific HIMMS-Elsevier Digital Outstanding ICT Innovations Award in 2019, shortlisted as a finalist in the SG:D Techblazer Awards 2020 and in 2021, awarded Runner-Up in the Innovative EHealth Solutions (Public Sector) category under the 2021 WITSA Global ICT Excellence Awards.
What was the most impactful project you worked on this year?
Amidst the pandemic, our nursing team observed that in an isolation room, alarm sounds emitted from within are inadvertently lowered (and sometimes inaudible) when room doors are closed. This could potentially delay our responses to a critical situation. Solutions such as sound amplifiers and baby monitors were considered, but assessed to be less suited for the healthcare environment due to the need to maintain our patients’ confidentiality and privacy.
We prototyped a Bedside Alarm Recognition (BAR) solution with an industry partner to address this gap. BAR is a solution that leverages on proprietary audio signal processing and machine learning techniques to recognise a range of medical equipment audio alarms while filtering human conversations and ambient noises in real time. Once the BAR device successfully recognises an audio alarm in the patient’s room, it relays the information to an external unit which includes both audio and visual indicators to alert the nurses for timely intervention. We have trained the system to recognise the most common type of alarms triggered from medical devices used in our acute wards and intensive care units and are currently evaluating its proof-of-value.
What is one unexpected learning from 2021?
Recently I had borrowed an e-book from the National Library Board titled “Atomic Habits”, authored by James Clear. James alluded that to truly gain any sustainable change, it is critical that we focus on the “how” of achieving our goal than the goal itself. It is not uncommon that we often achieve the goals we desire in the short term while eventually losing the gains in the long run as the system needed to sustain the gains has not been established. Hence in his words, James asserts, “we do not rise to the level of our goals, but rather we fall to the level of our systems.”
Another interesting insight is the power of tiny gains. Often, we think we need to take big steps to result in significant changes. But here, James explains the compounding effect of making a 1% improvement every day. When you take small step and improve by 1% daily, you will be 37.78 times better than when you first started after a year.
What’s your favourite memory from the past year?
I was packaging my old books when I flipped the pages of one and found a note written by my son many years ago, when I think he was 4 (he is 15 now). It says, “Mummy, I love you”. I felt blessed and fortunate.
What’s a tool or technique you’re excited to explore in 2022?
We hope to stack up the capability of the PreSAGE system, probably crossing with other technologies to build a healing environment where monitoring patients’ vital signs can truly be contactless and non-intrusive while enabling anticipative and timely care.
What are your priorities for 2022?
I will like to focus on building an even more positive work environment for our nurses and nursing staff by strengthening our leadership and management practices, building a culture of collective leadership, developing pathways to support staff professional and personal development and addressing issues of burnout, workplace aggression and incivility. Through innovation and digitalisation, we hope to also achieve more by doing less.
Who are the mentors and heroes that inspire you?
Many from my workplace have shaped my thinking and work ethics. Whenever I visit the wards and speak to my nursing staff, I feel inspired by their dedication and professionalism. Ground engagement energises me.
What gets you up in the morning?
Thinking about what else can I do to make things better.