Adapting smart supportive technology for hospital use: a case report

Abstract

Purpose: Persons living with dementia (PLWD) often have demanding needs, placing burden on healthcare systems and care partners (GBD, 2019). Smart supportive technology is emerging as a solution to improve the quality of life and wellbeing of PLWD, increasing interest in ambient assisted living in facilitating care (Gettel, 2021). However, there is limited research surrounding the customization of deployed systems to each user’s needs, which may lead to higher rates of acceptance (Fares, 2021). This case study explores the personalization of a smart technology system adapted to a hospital setting. Method: A male patient in his late 60s, who is ambulatory and relatively independent, residing on the dementia care unit at Greystone Village Retirement, Ottawa, Ontario, Canada, participated in this study. The patient suffered from both dementia and a significant psychiatric diagnosis. A bed pressure sensor and motion sensors were installed in the room. The bed pressure sensor was placed under the mattress to indicate bed occupancy. One motion sensor was placed on the wall of the bedroom to detect movement in the room. A contact sensor for the doorway was intended to be installed to indicate room exits. Starting at 10pm, alerts would be sent to a phone kept in the nursing station if the patient was detected to be out of bed for a defined period of time or had left the room during the night. Weekly meetings with staff at the facility were held to assess their level of satisfaction with the technology, and to consider any points of improvement. The facility staff also kept reports on each alert that was received, the action(s) taken, and noted if there were any false alerts. Results and discussion To adapt the technology around the patient’s environment, the door contact sensor was replaced with a second motion sensor. Since the facility leaves patient doors open overnight, the door contact sensor would not indicate room exits. Instead, a second motion sensor was placed in the closet. As the patient was relatively independent, the second sensor would sense when they would attempt to access the closet to get ready for their day, presumably prior to leaving the room. Following staff feedback, the timing for the overnight alert was adjusted from 12 to 7 and finally to 10mins after the patient was detected to be out of bed. Staff reported satisfaction and are working to integrate the new technology into their workflow in unanticipated ways. For example, the staff would automatically go to the medicine room when the alert went off, as the patient typically required his as-needed medication at that time. The increased success and acceptance of the system after adjusting it to suit the user’s specific needs suggests that adaptation of smart technology to a patient’s unique behavioural considerations and staff care needs is important for clinical use. Future digital solutions should aim to customize their systems to the individual user, rather than implementing a 'one size fits all’ approach, to optimize the usefulness of the system.