Doctors In London Using Mixed-Reality Headsets To Treat Coronavirus Patients, Reducing Need For PPE
by Robert Glatter, MD
With the demand for PPE unrelenting as Covid-19 continues, coming up with creative ways to reduce the need for PPE is always welcome.
One traditional part of medicine involves patient rounds, in which a medical team enters a patient’s room to evaluate progress after admission to the hospital.
However, as a result of the high transmissibility of Covid-19, even this traditional practice is now in the process of evolution. Finding innovative approaches to minimize time and need for direct patient contact with patients requiring PPE would be ideal.
To address these ongoing challenges posed by Covid-19, doctors at Imperial College London are now using mixed-reality (augmented reality or AR) headsets to help reduce the number of persons necessary at the bedside, while at the same time enhancing communication, and ultimately reducing usage of PPE by healthcare providers.
The augmented reality headset used by the doctors is Microsoft’s Hololens 2. It allows the doctor—fitted with PPE and the headset—to enter the patient’s room and communicate and broadcast the patient encounter real-time, obviating the need for a large group of physicians to be at the bedside. The unique feature of the technology employs overlay of holographic images of specific anatomy (via CT, MRI or x-ray images) or sharing of data such as lab results in the person’s screen while wearing the headset.
“At Imperial College London we have been using the Hololens to holographic telemedicine platform in our Covid-19 response since March,” said Dr. James Kinross, Consultant Surgeon and Clinical Senior Lecturer in Colorectal Surgery, Imperial College London who is leading the initiative. “This was started as part of our www.pansurg.org response to the pandemic.”
“It was an attempt to innovate in response to two principal problems—the first was a high rate of staff illness due to Covid-19 and the second was accessing PPE and training all staff in its proper use,” he emphasized.
Kinross explained that “The Hololens 2 system uses a software called Remote Assist 365 which permits bedside multidisciplinary team communication. We deployed this for hands-free, ‘heads up’ distributed video telemedicine in Covid-19 environments. This was because we could simply send one doctor into a Covid-19 environment instead of 4 or 5 that would typically be present on a ward round.”
Kinross explained that there were some operational issues to allow Hololens 2 to be “securely networked into the hospital on the NHS wireless network.” adding that “the next challenge was to ensure we could use the system safely with PPE and that staff would not come to harm.”
One this was achieved, he explained that their team was “able to rapidly innovate during the worst phase of the Covid-19 escalation in London and deploy by the beginning of April.”
But the real payoff would be whether such as system would be able to change hospital protocol for conducting patient rounds. The hope was that such an approach would ultimately help to reduce the number of doctors and time spent at the bedside, reducing demand for PPE at the bedside.
“We prospectively studied its impact and found on average a saving of 50 hours of Covid-19 contact time per clinical team using the Hololens 2,” said Kinross. “We had four teams deployed with the system in the trust. We also found significant improvements in the efficiency of the ward rounds and in the reduction of PPE consumption,” he added.
The results were quite impressive: “On some of the busiest wards there was a saving of 700 PPE items per week per ward,”said Kinross. “Our most junior staff reported significant improvements in communication over our sickest patients and were also able to adapt the system so that we could visualize electronic healthcare records and relevant imaging at the bedside and authorizations reported this was extremely effective.”
Kinross is continuing to expand its applications and is exploring its utility in the operating room for surgery involving the GI tract, expressing his enthusiasm for the device.
“We're now looking into other areas,’ he explained, “where we can use HoloLens because it is improving healthcare without removing the human; you still have a doctor next to your bed, treating you. Patients like it, too. They are interested in this new piece of technology that’s helping them.”
“More importantly we are deploying this as an educational platform for teaching our medical students who cannot currently enter the hospital, The goal is establish a formal trial to establish its true clinical utility,” he offered.