Our mission at Birmingham Women’s and Children’s NHS Foundation Trust is to provide world-class clinical care and training; pioneering new research and treatments, in partnership with others, for the benefit of children in the UK and worldwide.
Our team is critical in this process and we have built a culture where everyone – from support staff to the Trust Board – is aware of the research going on. Staff are able to reassure patients and their families that their contributions are going to make a difference, not just to engage them during the process but to build their confidence in research being a part of their future and of generations to come. The RAPID study is an example of how the research we carry out has the potential to make a difference across the world.
What is the RAPID project?
The RAPID (Real-Time Adaptive and Predictive Indicator of Deterioration) project was a ground-breaking research study undertaken at Birmingham Children’s Hospital to detect and allow early response to clinical deterioration in sick children.
Our Trust, together with Aston University, Birmingham University and Mclaren, partnered with Isansys Lifecare to use the Patient Status Engine, a state-of-the-art patient monitoring platform, to monitor and care for children more effectively.
The technology was used to monitor children and babies continuously in real-time; helping to identify deterioration more quickly so timely treatment could be given. The project focused on the development of the new personalised self-learning early warning score – the RAPID Index, which has the potential to save hundreds of young lives.
"This is the first time this technology has been used in this way, anywhere in the world."
Dr Heather Duncan, Principal Investigator and Clinical Lead for the RAPID project
The Trust is now working on RAPID2, the next phase of this world-leading study, which will pave the way for the introduction of this technology as standard care, not only in Birmingham Children’s Hospital but potentially for children in hospitals everywhere.
The RAPID2 study will test wireless monitoring and an updated RAPID2 Index (R2I), as routine care, in a larger group of children.
RAPID1 followed two smaller studies, which proved the technology’s potential. Young Lives, an initial study of 3,000 children in intensive care at Birmingham Children’s Hospital funded by the Health Foundation Shine programme, showed that cardiac arrests could be predicted using advanced analysis of their vital sign data.
A second study of 40 patients showed that data could be captured using wireless sensors, allowing children to move around wards without getting wires tangled and pulled off.
Why is the RAPID project so important?
Detecting deterioration fast
Being a parent or carer can be overwhelming. Besides everyday issues of care, we know there are also concerns about a child’s health and wellbeing. We all hope our child will never have to face serious illness but this is the reality for some. When this happens, support from everyone around you is crucial.
We know when a child gets ill and is admitted to hospital they can deteriorate quickly and that signs of this can sometimes be missed or not acted upon because existing monitoring methods do not provide the accuracy required in paediatrics, nor can they provide the continuous monitoring necessary to detect the more subtle signs of deterioration.
Continuous monitoring with new methods, such as Artificial Intelligence, will detect deterioration much faster than normal observations; alert clinical teams more quickly allowing more effective treatment.
Freeing patients from wires and cables
Currently, when a child or baby has their vital signs measured continuously, they are attached by cables and wires to a bedside monitoring unit, which means they are unable to move from their bed meaning, for example, simple trips to the toilet require assistance from our healthcare staff.
If continuous monitoring is not required vital signs are measured every one to four hours.
In both cases, observations are documented on an Early Warning Scoring chart. The accuracy of this routine process is limited by how often the child’s vital signs are measured and assumes that children of a certain age show the same signs of deterioration.
Wireless, continuous monitoring provides more effective data and means that patients don’t need to be wired up to machines in hospitals to have their vital signs checked. The smart patches used in the RAPID study allow children to move and play or be cuddled and fed by parents and families. Additionally, the new technology provides real-time, accurate data meaning more patients can be monitored at one time. This information is transformed into personalised smart alarms, reflecting that no child is the same.
What happened during RAPID1?
More than 900 families participated in the RAPID1 study. Children and families strongly preferred the freedom of wireless monitoring, using advanced technology and valued seeing the trends at the bedside. The study confirmed that the RI detected deterioration more often and earlier than the current early warning system. RAPID1 showed that it is safe to test wireless monitoring and the RI in routine patient care.
What do we want to do during RAPID2?
The RAPID2 study will test wireless monitoring and an updated RAPID2 Index (R2I), as routine care, in a larger group of children. Our aim is to identify children needing early treatment and the impact on avoidable cardiac arrest and death.
Other aims include engaging with parent and patient opinions, reducing false alarms and determining whether the system is value for money. The study will run over 28 months in eight wards selected in random order.
“Wireless monitoring and the R2I could save nursing time and help us to see clearly, and in good time, when children are getting sicker. The technology could enable nurses and doctors to reduce avoidable cardiac arrest and death.”