Clinical engineering


safety and savings “as a dual aim”. “I think we hide a lot of our capabilities under a bushel,” Prof. Scott exclaimed. “We need to get out there, engage with our executives, and think about how care is moving out of the hospital into patients’ homes. Many of us are in hospital- based services, but our communities need us; they need the skills we offer… “We should redefine our service specifications and the skillsets we need. Yes, we need competent engineers. Yes, it’s a challenge in developing them. But we need far more open and advanced career pathways for clinical technologists – we need new roles. We need to be advocating for what we can bring to the party,” he concluded.


The future of the digital ecosystem in acute care Michael Wilkening, Vice President, Strategy and Business Development, at Draeger Medical, delivered a presentation on the ‘future of the digital ecosystem in acute care’. “We are using more and more software-


based technology inside the medical devices, but also outside the medical devices – there’s a paradigm shift going on,” he commented. In the past, discussion around patient safety and performance in clinical applications has primarily focused on the medical device itself. Now the focus is on connected devices. Hospitals are facing a “perfect storm” of


challenges, he warned. An ageing population is placing increased demands on health services, with patients presenting with multiple morbidities. This is resulting in a longer length of stay. At the same time, we are seeing staff shortages – not just in clinical engineering, but also nursing, while the cost of healthcare delivery is also rising. Technology must have a key role to play in tackling these challenges, going forward. However, Michael Wilkening identified the


lack of interoperability of proprietary systems, in terms of medical device connectivity, as a significant barrier that must be addressed – if we are to maximise the opportunities in the future. “If we look at ICUs today, our patients are


surrounded by 50-100 medical devices...The survival rate is much higher today, but it comes at a price and that price is complexity,” he commented. Research shows that >80% of all critical


incidents are related to loss of situational awareness due to missing perception or comprehension. The complexity of information is resulting in medication errors. In addition, alarm fatigue is a major issue for both staff and patients. Prolonged ICU stay can result in delirium and cognitive dysfunction. In the


of this cognitive load. Assisted decision making would involve the collection and consolidation of data by central computers, while the next step would be to implement close control with AI. However, the current situation is that hospital


Lawrence Barker


IT infrastructures consist of several different systems and interfaces, which need to be adapted to each other. There are a plethora of proprietary interfaces and protocols, which presents challenges and, historically, there has been resistance to the standardisation of networks among manufacturers, for commercial reasons. Bi-directional, standardised and secure medical-device interoperability is a prerequisite for the “Internet-of-Medical-Things”. Michael Wilkening highlighted the importance of the ISO/IEEE 11073 SDC (Service-Oriented Device Connectivity) standard as the foundation to enable “true, bi-directional communication between devices.” He outlined how this standard could


transform patient monitoring into a hardware- agnostic, software-based system and serve as the essential prerequisite for safely implementing advanced applications like remote monitoring, smart alarms, and supporting the implementation of artificial intelligence in high- risk clinical settings.


He explained that the application of Richard Scott


ICU, delirium occurs in up to 80% of critically ill patients, leading to prolonged hospital stay by 5-10 days, while 50% of all ICU patients still have cognitive dysfunction 12 months after discharge. Alarm complexity is resulting in stress and discomfort – 771 alarms occur in average per day around each ICU bed. More than 80% of all alarms are clinically irrelevant and 50% are not even noticed, due to alarm fatigue. We are also missing opportunities for


remote patient monitoring capabilities leading to increased infection risk. At least 90,000 healthcare workers were infected during the COVID-19 pandemic and 260 nurses died. A lack of patient monitoring also leads to


increased perioperative morbidity and mortality. With 4.2 million deaths, post-operative mortality is the third leading cause of death worldwide; 53–70% of surgical adverse events occur outside operating theatres and over 50% on the normal ward. “At present, clinicians have to observe a number of different medical devices, gather the information in their head, interpret it, make a decision, then act on it. That’s a huge cognitive load in stressful situations,” he pointed out. The goal is for technology to take away some


interoperability in critical care units could be used to provide date/time synchronisation across all the medical devices. In addition, lung ventilation could be optimised through the interoperability of lung monitoring, the patient bed and the ventilator, for example. “If the lung monitor sees that the patient’s left lung is poorly ventilated compared to the right, what would you do clinically? Probably tilt the bed…So why not send a message to the clinician and propose to adjust the bed accordingly,” he commented.


It could also automatically adapt the ventilation settings to better ventilate the left lung and support: l Close-loop controls, e.g. FiO2 based on SpO2 or PaCO2 based on etCO2


l Protocol-based weaning including sedation information


l Remote access and control from outside the patient room


He described a scenario where patient data could be seen at a glance on one combined display outside of the room, leading to less patient disturbance and reduced infection risk. “There is an opportunity to collect the data


from all the medical devices in real time and do something smart with it,” Michael Wilkening continued. “Clinicians don’t want to look at 10


December 2025 I www.clinicalservicesjournal.com 23


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