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More time for clinical care: KU evaluates robotic systems in hospital wards

The "Jeeves" service robot already supplies hotel guests with drinks and snacks that they can order. Being adapted to the clinical routine, it is now also intended to give clinical staff more opportunity to devote time to the actual care for patients.
© LMU Klinikum The "Jeeves" service robot already supplies hotel guests with drinks and snacks that they can order. Being adapted to the clinical routine, it is now also intended to give clinical staff more opportunity to devote time to the actual care for patients.

The application of robotic systems for an improved recovery process of intensive care patients as well as the relief of nursing staff from non-specialist activities that can be taken over by service robots are the focus areas of two projects, which are scientifically accompanied by Prof. Dr. Inge Eberl (Professor of Nursing at the KU). The sub-projects at the KU are funded by the Federal Ministry of Education and Research with a total amount of more than 580,000 euros over three years. The projects are respectively coordinated by the LMU hospital in Munich.

The joint project MobiStaR (acronym for: Mobilization of intensive care patients through a new standard in adaptive robotics) addresses a topic that is very common in intensive care medicine: Clinical studies show that severely affected intensive care patients undergo the best possible rehabilitation process if they receive early mobilization three times a day for 20 minutes. To date, however, they have to be transferred to a special therapy device for this together with all their monitoring equipment, on which they can be secured in place and erected. Their legs are then moved according to a normal motion pattern. This stimulates blood circulation, prevents thrombosis, stimulates the sense of balance and maintains muscular mass.

"However, this form of early mobilization requires a high staff attendance and is associated with risks for intensive care patients in their unstable condition. For this reason, only some of the affected patients are currently being mobilized early at all," explains Professor Eberl. This has considerable consequences for the healing process, the burden on relatives and not least for the costs incurred by health insurance companies and the insured. A possible remedy could be a modular system developed by the technical partner Reactive Robotics in a preliminary project, which was also already supported by the Federal Ministry of Education and Research. This system eliminates the time and staff-consuming transfer to a separate therapy device: The new device is simply being attached to the nursing bed, so that fewer staff members are required to operate it. The new MobiStaR project builds on the knowledge gained during the development of the prototype. "The focus of the project is not on technical development, but rather on the integration of robotics into everyday clinical practice, in order to enable better dissemination in the nursing practice overall," explains Eberl. The project is the first in Germany of its kind that uses this type of mobilization robot in a clinical pilot project in an intensive care unit.

"A general aim is to adapt technology to the needs and processes of good nursing and physiotherapy practice in intensive care units – and not the other way round, i.e. adapting the quality of care to current technical opportunities," says Eberl. This is also in line with a statement issued by the German Ethics Council, which emphasized in March that robots can support but not replace nursing care workers. The reflection of nursing, therapeutic and medical processes – also seen in comparison to conventional therapy – shall contribute to making the use of robotics in clinical nursing a permanent feature. To this end, many fundamental questions of nursing management and the nursing practice must be approached: Is the robot really perceived as a relief by those involved? What are the inclusion and exclusion criteria for its use? How do you deal with patients who are unable to give consent, or who have limited ability to give consent? Are there measurable results in the healing process that speak in favor of using the system? The evaluation of such questions regarding first use of the prototype forms the basis of the sub-project located at the KU.

The project REsPonSe (acronym for: robotic system for relieving the nursing staff of service activities) is not concerned with intensive care medicine, but with everyday life in normal wards. This project addresses the fact that, according to various studies, highly qualified medical nursing staff nowadays only have the opportunity to care for patients directly in 15 percent of their working time. Instead, much time is lost on unnecessary walking distances (21 percent) and other non-nursing activities (25 percent). Professor Eberl, who is a registered nurse herself, says: "Most walking distances are caused by spontaneous and often undifferentiated patient requests." It is precisely the nursing staff who play a key role in the care of the patients and the coordination of highly complex measures. With conventional systems, where patients ring a bell to call a nurse, the nursing staff only find out about patients’ concerns when they ask them after they arrive at the beds. For this reason, software solutions have been developed that allow patients to specify their wishes and needs already from the bed via a smartphone app – in addition to the emergency button that is still available. Their specified request is then forwarded in accordance with different allocations of responsibility – be it a request for a drink, help with going to the toilet, or assistance for being able to move around.

The "REsPonSe" project will now also integrate the "Jeeves" service robot into these request systems that were already looked into by the Munich university hospital. The robot was developed by Robotise GmbH and is currently already being used in hotels. There, guests can order drinks or the left-at-home toothpaste online and then have the service robot bring the items to their room. The products are stored in several drawers, which can also be cooled or heated up depending on the type of product. "Within the framework of this research project, we want to adapt two existing systems to the needs of a maximum care clinic, test them in everyday practice and evaluate their acceptance among staff and patients," says Professor Eberl. In addition, the project will investigate whether the use of robots has an influence on the walking distances that nursing staff cover during the day. In addition, the project partners hope that the benefits of the project will give staff more opportunities to interact with patients and their relatives. In a first step, the researchers now want to carry out a survey among caregivers and patients about the purposes for which they can imagine using the autonomous service robot, in order to derive corresponding application scenarios.