Raising an early warning in the ICU: T3

How can ICU clinicians manage the data from all these monitors?

With the Internet’s meteoric rise in the last 20 years—to the point of being available 24/7 in your pocket—technology pundits, psychologists and sociologists have been sounding ever louder warnings about information overload: the constant onslaught of communication, information and media coming at us all the time, and in ever greater volume.

Now imagine you’re a doctor or nurse in an intensive care unit (ICU). For you, information overload isn’t just a daily reality—it’s a necessary one. To make the right decisions at the right time for each patient, you must keep tabs on numerous bedside monitors—in the ICUs at Boston Children’s Hospital, that’s 10 or more for each child.

Melvin C. Almodovar, MD, medical director of Boston Children’s Cardiac Intensive Care Unit (CICU), and his colleagues wanted a better way to assess the patient’s physiologic state and catch crises before they happen. Working with software developer Arcadia Solutions, they built a web-based, portable early warning system called “T3” (for Tracking, Trajectory and Triggering).

T3 doesn’t cut down the amount of information that helps keep patients alive. Instead, it streamlines and manages it—linking data from the child’s monitors and presenting readouts together, in context, on the same screen—matching the way critical care practitioners think. It was introduced last year in Boston Children’s CICU and Medical/Surgical ICU, and Almodovar believes it could have a major impact on how decisions are made and how ICU care is provided.

T3 ICU data management screen detail 2Peter Laussen, MBBS, former chief of the Division of Cardiovascular Intensive Care at Boston Children’s Hospital, worked with Almodovar on T3 before becoming Chief of Critical Care at Toronto’s Hospital for Sick Kids. He notes that currently, doctors and nurses synthesize data on the fly, based on their experience and training, medical guidelines and what they see on a child’s monitors.

“As I stand at a patient’s bedside,” Laussen says, “I’m looking at all these monitors and calculating trends in my head. Now imagine you’re a new ICU doctor or nurse trying to process all of this information. You can see how it can overwhelm.”

The T3 system, which soon launch in Toronto and is being considered by other children’s hospitals, according to the Boston Globe, channels the flood of data by:

  • Tracking and capturing all of the information from a patient’s numerous monitors.
  • Calculating trends in the data and show a patient’s real-time trajectory: Are they getting better? Are they getting worse? Are they responding to care as we think they should?
  • Triggering action to avoid crises, enhance clinical decision making, and make the most efficient use of the resources available.

Laussen further describes T3 in this video:

Modeling future ICU care

Apart from improving intensive care delivery today, T3 could also, through better use of data, inform how such care is delivered in the future.

“The systems we have in the ICU right now only store data for 96 hours,” Laussen explains. “Then it’s lost for us to use to do meaningful analysis. [T3] can permanently store all of that information, giving us a very rich data set for developing new predictive models for care management, which for us in the ICU is like the Holy Grail.”

“Furthermore, the data collected can be analyzed so that we may evaluate the accuracy of our assessments while supporting better decision-making and care plan adjustment through real time, regular analysis of relevant data,” Almodovar adds.

In developing T3, Laussen and Almodovar relied on notions about data management from an industry far removed from the ICU: finance. “T3 should be like the Dow index,” Laussen says. “Each bit of information we are collecting is like a stock. All of those stocks go to make up that single index that we track hour to hour, minute to minute, even second to second.

“If we can do that in the financial industry,” he continues, “why can’t we do it in healthcare? That’s the goal of T3.”