WONDER Healthcare Solutions conducted a pilot study in Erode District, Tamil Nadu at three district headquarters hospitals (Hub) and five PHCs (spokes), where three of the PHCs included tribal populations living in hilly forest areas. Due to overwork and understaffing, we could not get the medical providers to use the system. Therefore, non-medical staff proficient in the use of computers were employed as data entry operators. These staff members were trained to check vital signs of all the patients admitted to the labor and delivery area periodically, using home monitoring kits (e.g., BP apparatus, thermometer, and pulse oximeter), and enter the data into the system. Visual and audible alerts were created according to the pre-set criteria by the WONDER system when the vital sign values were abnormal, which were reflected on a large dashboard which was placed in an area highly visible in the nursing station. The data entry operators were instructed to click on the treatment guidelines and print them and place it on the patient chart, and personally alert the nursing staff for further action, such that treatments were initiated without delay in most cases.

When the alert occurred in the PHC, the same information was transmitted to the central monitoring station at the tertiary care. The skilled provider in the tertiary care was expected to monitor the treatment being provided at the PHC, and, if the clinical situation was not under control, the patient was expected to be transported to the tertiary care after initial stabilization.  In the event of uncontrollable and excessive bleeding, the provider at the PHCs would apply a non-pneumatic anti-shock garment to stabilize and maintain the blood pressure of the patient and transport the patient to the tertiary care, which is usually between 10-20 kilometers away. The information that the patient was being transported would appear on the dashboard at the tertiary care through a flashing ambulance sign which gives enough time for the doctors to assemble the team and get the operating room ready if and when necessary before the patient reached the tertiary care hospital. Though this process was not consistently monitored by the skilled provider at the tertiary care, the PHC staff were able to stabilize and transport the patients based on the protocols included in the WONDER system, since they were trained appropriately at the beginning of the program.

We enrolled and monitored 15,184 patients over a period of two years from July 1, 2017, to June 30, 2019. The results were tabulated and analyzed by established computational and statistical methodologies.

Highlights of the Study

  1. WONDER identified at-risk patients all the time based on pre-set criteria.
  2. It enabled the efficient use of skilled provider services in taking care of the sickest patients.
  3. Once an alert occurred, appropriate treatment was initiated within one hour in 95% of patients and alerts. In developed nations, the target is also one hour, and thus we are already meeting the international standards for treatment.
  4. Maternal mortality decreased by 54.4 % in 2 years. In this study, the number of patients was relatively small and the system was not used to its full potential, and also the learning curve was long. Therefore, we believe that the results could have been better if the program was implemented to its fullest potential.
  5. It was very effective in preventing in-hospital eclampsia thereby reducing serious complications and maternal deaths due to eclampsia.
  6. 15 patients out of 23 patients had eclampsia at home before they came into the hospital. Effective prevention of eclampsia can be achieved by identifying at-risk mothers during the prenatal period and educating them about the warning signs of eclampsia. Thus, there exists a tremendous potential to prevent the overall incidence of eclampsia.
  7. The WONDER system is simple and easy to use by the low-level providers, secure, scalable and economically feasible.

Conclusion

The clinical outcome of the pilot study is very convincing. The WONDER system produced alerts every time there was an abnormal vital sign. The system successfully identified the sickest patients who required immediate care by the skilled providers. It was able to track the time interval between the onset of abnormal vital signs and the treatment, thus indicating how quickly these patients’ critical conditions were addressed and treated, thereby preventing maternal harm and death. The ability of the system made it possible for these patients to be identified and treated early before their conditions worsened. Once a serious red alert occurred, appropriate treatment was given within one hour in 95% of the time, which is the target set by ACOG and other international organizations. There was a 54.4% reduction in maternal mortality during this study period.

Project Details

  • Category: Data
  • Location: Erode, TamilNadu
  • Completed Date: 2017