ABG Needle Test

Part
01
of six
Part
01

Critical Care Trends: US

The use of High-Tech central monitoring systems and robotic systems are two trends in critical care treatment in US hospitals.

Use Of High-Tech Central Monitoring Systems

  • Central Patient Monitoring Systems (CPM systems) are an integral part of providing continuous patient care through early warning and data security.
  • CPM Systems allow for easy retrieval of patient data and strategically transports data to one central point.
  • It allows for receiving and consolidating all necessary patient data onto a set of screens or monitors for a more seamless experience within the critical care environment.
  • It also permits easy transfer of patient data across departments while maintaining a comprehensive review.
  • The trend is driven primarily due to an increased need for CPM Systems particularly in hospitals with more than 500 beds.
  • It is seen wherein the U.S. alone approximately 90% of alarms within critical care settings are invalid which heightens the probability for error.
  • One company leading the trend is Nihon Kohden with its recent launch of its NK- HiQ Wireless Patient Monitoring System in the United States.
  • The Monitoring System uses Wi-Fi technology to maintain continuous patient monitoring within a hospital setting. It includes a central station along with bedside, transport and wearable patient monitors and consolidates patient data from admission to the period of discharge.

Use Of Robotics Systems

  • The trend of developing medical robots and their utilization is rapidly increasing within the healthcare field, and hospital robots are now able to greatly assist doctors and nurses.
  • These robots can assist in creating a faster turn-around time on workload and be more precise as they are less likely to have errors.
  • The trend has increased as robotic systems work systematically with health care professionals to ease their burden and allow for greater quality of patient care.
  • Robotic systems work alongside nurses and therapists in taking care of patients.
  • Critically ill patients now have a faster recovery time within hospitals due to their use along with nurses and doctors.
  • The trend has also increased as robotic systems work more efficiently and strategically in inpatient care, and have increased economic efficiency.
  • GE Healthcare is now one of the leaders in not only medical equipment but also hospital robots.
  • The company forecasts that technologies like 3D printing and robotic surgery are the future of healthcare.
  • GE’s Chicago based office mentioned that it will be developing a robotic-surgery assistance device in the future.

Your Research Team Applied The Following Strategy

We conducted this study by looking at sources that provided current medical news particularly of hospitals and their critical care departments. The two trends we looked at were the use of high tech central monitoring systems and robotic systems within the healthcare field and in hospitals specifically.

Initially, we looked for trends in critical care and were able to find information from sources such as Medagadet, Philips HealthCare, and Nicko Hoden. These websites explained what these current trends are and how they are utilized in critical care treatment. They further elaborated on the force behind each trend and the predicted outlook for the future. The companies leading the trend were found on medical news sources such as Medical Device and NS Healthcare.

Finally, we were able to formulate our responses from business sources, medical news outlets and from websites with companies who are leading in these trends.
Part
02
of six
Part
02

Critical Care Trends: China

Two current trends in critical care treatment in Chinese hospital include an aging population creating an unmet demand for critical care treatment and the installation of advanced technology (e.g., CERTAIN).

Aging Population and Shortage of Critical Care

  • At the conclusion of the 20th century, China began entering a society that was aging rapidly, and thus, medical demands were shifting. In the year 2016, Chinese citizens that were 65 and older made up 10.8%, or 105.03 million individuals, of the nation's population, and that figure is projected to increase to about 16% of China's 1.46 billion inhabitants by 2030.
  • In China, authorities have set standards stating that at least three different nurses be in attendance with one Intensive Care Unit (ICU) patient. In reality, many ICUs cannot always satisfy demand, as there are two nurses to a patient in several Chinese hospitals. According to an evaluation issued by the Chinese Journal of Medicine, out of 330 ICU physicians that participated in the study, 83% were forced to turn patients away due to a shortage in beds.
  • As revealed in a report published in Journal Critical Care, ICU beds located in approximately 19,700 of the country's hospitals merely 1.8% of all beds in China, which is significantly lower than leading nations in Western Europe as well as the United States.
  • The Population and Development Institute's (Renmin University of China) Professor Zhan Zhenwu stated, "Most patients in ICUs are elderly, we even say those below 90 years old are young or middle-aged. Given that old people are more vulnerable to critical diseases, ICUs will definitely see bigger shortages as the population grays."
  • Guidelines unveiled in the year 2009 suggested sustaining an ICU occupancy rate of 75%. Nevertheless, the majority of medical institutions are currently at full occupancy as they are unable to refuse patients and ICU patients typically mean more money.

Arrival of New Technology and Challenges

  • The following technologies both are driven by the lack professionals or expertise regarding critical care treatment in Chinese hospitals. There were only 1,365 ICU physicians in Beijing, or just 1.5% of all physicians the city.
CERTAIN
  • In March 2019, Ambient Clincal Analytics and Bringspring Meehealth revealed a breakthrough clinical decision support system named CERTAIN that comes with diagnostic checklists that are evidence-based, which is currently available in hospitals throughout the nation. This technology was developed utilizing Mayo Clinics and Ambient Clinical Analytics' licensed technology. Throughout the last five years, it was evaluated in about 30 nations and adapted to the requirements set by the Chinese medical system.
  • CERTAIN is capable of aiding clinicians in the area of acute and critical care. It is also able to "guide, time and document real-time intervention" and enable clinicians to bestow their expertise, establish professional expertise, and collaborate to construct a medical knowledge graph.
TENCENT HEALTHCARE
  • The company behind the mobile application WeChat, which has over 1 billion active users, currently offers a wide range of healthcare service, such as permitting users to consult with their doctor, schedule medical appointments, buy over-the-counter drugs, and pay their hospital bills.
  • Currently, Tencent is developing online electronic medical records with artificial intelligence. According to Alex Ng, the Tencent Healthcare's vice president, the technology will help patients as well as doctors. For example, it will provide alerts if the patient is in need of urgent critical care.
  • Tencent Healthcare is collaborating with various Chinese municipalities to create a health database, and the hospitals in these cities are "contributing to a regional health-information system" while having the information in their own servers.
CHALLENGES
  • Even though many hospitals are being equipped with state-of-the-art life-sustaining technology, in areas such as the Zhejiang Province, several country-level institutions are unable to afford those types of technology (e.g., Extra Corporeal Membrane Oxygenation), and they lack the medical staff to operate them.
  • For example, at an 11-bed ICU in local hospital located in Dancheng County, out of the four physicians, three of them lack any experience in critical care medicine training.
  • A study found that enteral nutrition feeding in Chinese intensive care units was suboptimal. According to the study, "patients requiring intensive care unit (ICU) admission are at increased risk of death," and throughout the catabolic stage, nutritional assistance can result in a positive nitrogen balance, along with the prevention of weakness, the failure of various organs, and death.

Research Strategy:

Our research began by searching through medical papers and articles. However, most of the published papers were old or behind paywalls. After extensive research, we found more recent articles and research papers on intensive care units where critical care treatments take place and used interchangeably in many articles. From there, we were able to find current trends and challenges in Chinese hospitals.

To provide a full insight, we searched for the most recent technologies used in critical care treatments in China, which lead us to CERTAIN and Tencent Healthcare, as both are addressing and solving current challenges that Chinese hospitals are facing. From there, we were able to address the second issue, lack of professionals, which is also connected to first trend.
Part
03
of six
Part
03

Critical Care Safety Requirement Trends: US

Two trends in safety requirements for critical care treatment in US hospitals include environmental design and a BSN nursing workforce.

ENVIRONMENTAL DESIGN

  • The 1999 Institute of Medicine report revealed that hospitals in the US are not as safe as they are portrayed to be, especially as hospitals fail patients more frequently than they should.
  • While errors are bound to occur in any part of the hospital, the intensive care unit (ICU) is more easily affected due to the critical conditions of patients, the intensity of their care, higher medication prescriptions, and the intricacies of multidisciplinary decision-making by the critical care team.
  • As such, the ICU faces a higher risk of adverse events, defined by the unexpected harms that affect patients during their medical care.
  • From the over five million patients that are admitted yearly into ICUs in the US, almost all of them are victims of preventable adverse events, thus emphasizing the need to cultivate a culture of safety through environmental design.
DRIVERS
  • The marketplace for ICUs has become more competitive as the US population is growing older. As such, there is an increasing need for ICU beds and larger operating environments. This trend is thus promoting "the need to understand the role of environmental design in making bigger ICUs safer for patients, families, and staff."

BSN NURSING WORKFORCE

  • Nurses are required to make critical decisions when taking care of sicker, frailer patients, making care in the hospital setting much more complicated, as the care delivered in such a setting involves the incorporation of sophisticated, life-saving technology, as well as complex information management systems.
  • As such, more hospitals require nurses that are bachelor of science in nursing (BSN) graduates due to their extensively higher levels of preparation for evidence-based practice, as well as their research skills and abilities in teamwork, collaboration, and practice.
  • They are also better equipped to use a broad range of technological tools that improve care quality and effectiveness. When there is no staff shortage, nurses that hold a baccalaureate degree are more preferred for employment in a critical setting.
DRIVERS
  • The implementation of technology in healthcare has become a global trend. This trend is closely associated with the rise in technology in society and has led to the development of technology and information systems.
  • Nurses continuously encounter the application of such treatments in their everyday work. It is thus changing how nursing care is conceptualized and delivered. As such, critical care nursing, which incorporates a high knowledge and use of technology are valued more than nursing that features less technology such as personal care treatments in nursing homes.
  • More healthcare organizations in the US require more BSN nurses for hire in entry-level positions. Teaching and children's hospitals, as well as those recognized by the American Nurses Credentialing Center Magnet Recognition Program, favor BSN-prepared nurses for entry-level employment.
  • The Tri-Council for Nursing put out a consensus policy statement, requesting for a more highly educated nursing workforce on the basis that BSN-nurses deliver safer and more effective care.

RESEARCH STRATEGY

During our research, we utilized a 2016 source that is older than Wonder's standard two-year timeframe for sources. However, we used the article as it provided some useful insights for drivers of the trend that was highlighted in the article by National Center for Biotechnology Information (NCBI). Also, we used this source since trends are generally established over a particular period.
Part
04
of six
Part
04

Critical Care Safety Requirement Trends: China

While there is no publicly available information detailing trends of safety requirements in critical care treatment in Chinese hospitals, available data shows the Chinese health care system is State run. Therefore, very few details about the process and implementation of safety requirements is made public.

Helpful Findings

  • Patient safety is a core issue in healthcare services. Both hospitals and the Chinese government have expended substantial efforts to strengthen patient safety climate and improve patient safety performance.
  • According to an article In Oxford Academic that outlines the main goals of the reform of public hospitals in China, policy directions will focus on efficiency and quality moving forward. A major emphasis will be on achieving safety and quality for lower costs through integrating quality improvement and safety standards in all systems.
  • China's central government announced a series of health care reforms in 2008 that the country has instituted over the past decade. The goals of the reform included establishing a basic, universal health system that can provide safe, effective, convenient, and low-cost health services to all of China's more than 1.3 billion citizens, and they affected many facets of health care delivery: health insurance, primary care, hospital management, medications, and public health.
  • According to a study published last week, the government of China should establish standards for the staffing of nurses during different periods and in different departments in large hospitals in order to improve patient safety for critical care. The rational allocation of nursing resource would enhance efficiency, improve nursing quality, and maintain patient safety in critical care.

Research Strategy

Research did not identify any trends regarding safety requirements in critical care treatment in Chinese hospitals. This is most likely do to the centralized and highly controlled planning and implementation of health care policy by the Chinese Communist Party.
The first step in our research included the China Ministry of Health and additional Chinese government health publications with the intention of finding trends related to new codes, standards, required training or education of safety requirements in critical care treatment in Chinese hospitals. However, after exhaustive search, we were not able to find any related or helpful findings for trends in safety requirements in critical care treatment in Chinese hospitals. Secondly, medical health industry sources, medical peer review journals and research publications, such as BMC, Health Management, International Common Health Fund, and Research Gate were searched. However, only some studies and expert opinions that focus on how China should act to improve safety regulations for patient care are present in the potential sources. Also, due to lack of publicly available information, there is no perceptible trend in China's safety regulations for hospital critical care. However, studies and research show that China needs to improve hospital safety regulations in general.
Finally, the research parameters were expanded to safety requirements at any level of care, critical or otherwise, in Chinese hospitals. The thought being it may be possible to identify trends in the larger health care sector, which would apply to critical care. However, only an overview of the Chinese healthcare, news about their healthcare reform form 2008, and the role of the government has in helping citizens with healthcare costs was present.

Part
05
of six
Part
05

ABG Perceptions: US

The limited data available on consumer perceptions around the arterial blood gas (ABG) test was mostly related to the pain associated with the test. Although those insights are provided below, a research strategy has also been provided to outline the detailed steps taken to uncover additional relevant information on the procedure, including details on awareness and safety perception, since these details were not found in the course of the research.

Uses of ABG Test

  • The test is commonly used for breathing and lung issues including "asthma, cystic fibrosis, or chronic obstructive pulmonary disease (COPD)."
  • Additionally, other conditions that may require a check of blood oxygen or acid levels in the blood include "kidney failure, a severe infection, specific toxic ingestions, complications of diabetes (DKA), or under-treated sleep apnea."
  • Our research also found that the procedure is sometimes required of patients undergoing gastric bypass surgery for weight loss.

Feedback from Forums

  • A forum chain from 2012 on a thread about gastric bypass surgery had a few people discussing their familiarity with, and experiences with, ABG testing. There were only eight people on the chat and, of those people, seven were familiar with the procedure. Of the people that had previously had it done (six), one had it while under anesthesia so didn't remember the experience; two people considered the test extremely painful; and three people didn't think it was that bad as long as there was a strategy to deal with it (blowing out when the needle goes in or squeezing someone's hand).
  • Another chain in a forum on obesity and gastric bypass surgery asked for people's opinion on the pain level associated with the test. There were about ten people on the chain and since the original poster was asking about people's experience with the test, everyone on the chain was familiar with the test. There was a wide range of opinions on the pain level including, "It hurt, but I've had worse pain from all kinds of other things;" the pain is " is fairly short-lived;" "It hurts like h*ll!!!!!!;" "many have said it wasn't nearly as bad as they anticipated;" and "It hurt when the needle went in for 5 seconds and then, the pain went away to just a little ache..."
  • Some more recent forum posts, from 2017, only had four posters, and three were familiar with the test. The two who had previously had it done described it as very painful.
  • None of the posters on any of these forums mentioned anything about the safety of the test.

Insights from Scientific Studies

  • One study examined whether the pain and anxiety experienced by a patient was different when a 23 G needle was used for the ABG procedure instead of a 25 G needle. The results showed that the 23 G needle allowed for faster sampling, and did not increase the pain or anxiety experienced by the patient.
  • In studies, patients who had previously had an ABG test reported higher levels of pain than those who had the procedure for the first time.

Research Strategy

Our research found very limited data on patient attitudes and perceptions around the ABG test. We began our search by examining websites designed to inform patients about medical procedures and conditions including Healthline and Verywell Health. Our hope was that in addition to reporting on the procedure itself, these sites would also report on the patient experience and possibly provide links to other relevant sources. While this search did not allow us to find details on the patient experience with the test, we did determine that the test was most often used in emergency settings which allowed us to further hone our research.

Since ABG testing is commonly used on patients with breathing issues, our next strategy was to look for online forums for conditions such as asthma and emphysema, as there was an increased likelihood that these patients had experienced the test and would be able to provide the necessary insights. This led us to sites including the Asthma and Allergy Foundation of America, the American Lung Association, and eMedicineHealth. Unfortunately, a deep scan of these forums did not uncover any comments regarding ABG testing. We then expanded to search for any general forums that discussed ABG testing and did find some limited comments that have been included.

Next, we examined research studies that had been completed on ABG testing to see if there were any on the patient experience. We did find one study that examined whether the pain and anxiety experienced by the patient was different based on needle size, and another that examined whether the use of an ice pack can lower patients pain perception of the procedure. Limited insights from those studies have been included.

Since most of the strategies employed so far were focused on the patient experience, we also tried to determine if there were any statistics on the procedure that would help provide some data on people's familiarity with the procedure and whether it is considered safe. This led us to a study on how the incidental data gathered during ABG and other tests is utilized, and a study on how ABG test results relate to patient prognosis for patients with acute heart failure. Unfortunately, there was no information found on the population's familiarity with the test.

As a final strategy, we attempted to compare the number of site visitors to a page with information on ABG testing to pages with information on other medical procedures that range from common to obscure. Our thought was that the number of visitors would provide an indication of how many people may be familiar with the procedure compared to other procedures which would at least provide a comparison point, if not exact data on familiarity. The site we chose for ABG testing was the WebMD page on the procedure. Analytics sites that we attempted to use for this process were SimilarWeb, SEMRUSH, and Alexa. SEMRUSH only provided free data for the main website, SimilarWeb did not have data on the site, and Alexa required a subscription to access the required data. Therefore, this was not a successful strategy.

Although there is no definitive data indicating this is true, the general lack of discussions and information on the procedure may indicate that the public is not very familiar with the procedure.
Part
06
of six
Part
06

ABG Perceptions: China

There was not much information on the Chinese consumer perceptions around the arterial blood gas test. However, the research team provided some useful information on the subject: the Chinese market for blood gas and electrolyte analyzers reached $170.5 million in 2017 and is expected to grow exponentially because of "rising healthcare expenditures and increasing patient awareness in the country." Below is an overview of the findings as well as an explanation of the research methodology.
  • According to Market Study Report, the Chinese market for blood gas and electrolyte analyzers reached $170.5 million in 2017. It is expected to grow exponentially because of "rising healthcare expenditures and increasing patient awareness in the country."
  • At 2.07% of the GDP, the R&D spend in China was comparatively higher than the global average.
  • According to Grand View Research, the blood gas and electrolyte analyzers market in the Asia Pacific region is expected to grow at a faster rate than in other regions because of "the presence of high unmet clinical needs coupled with rapidly rising healthcare expenditures and patient awareness levels in countries such as India and China."
  • According to another report, blood gas and electrolyte analyzers market in China is likely to grow at a 9.6% from 2019 through 2021 and add about "$498.3 million in terms of addressable opportunity for the picking by aspiring businesses and their astute leaders." The global growth is estimated at 6.5%.
  • According to China Med Devices, the Chinese blood gas/ electrolyte analyzer market in 2017 was about 900 million yuan (about $130.3 million) with an annual growth of between 20% and 25%. Import brands have a monopoly in the country.
  • According to IIVD, Radiometer, Werfen, Abbott, Roche, NOVA, Siemens, Comley, Perlong, and EDAN account for 28%, 24%, 16%, 12%, 9%, 6%, 1%, 1%, and 1%, respectively.

RESEARCH STRATEGY

Our research was conducted in both English and Chinese languages. To determine the Chinese consumer perceptions/attitudes around the arterial blood gas test, the research team began by searching through the public domain for the general awareness among consumers and whether they trust or view it as safe. Our initial research entailed searching through local, regional, and international media resources. We also expanded our research to industry-focused resources including China Med Devices, and market research resources. Our intention was to find readily-available information that was already compiled from studies, surveys, or expert analyses. From this strategy, we found global reports from Market Study Report and Grand View Research that indicated that the blood gas and electrolyte market in China was growing exponentially because of increased patient awareness. There were also several other market research reports that indicated that the Chinese market for ABG products was the largest in the Asia Pacific region and was expected to grow at a greater CAGR than the global average. However, all reports were behind paywall and we could not access them without purchasing/subscribing.

Next, the research team decided to explore consumer forums as well as review sites in the hope that we would find consumer feedback regarding arterial blood gas testing in China. We first searched for China-based health/medtech-focused review sites and identified several, which we explored. We only found one review from IIVD that had some information on ABG products. However, this site had conducted a poll to determine which producers of ABG analyzers were considered top among consumers.

Having identified the top ABG analyzers in China, we decided to carry out a more targeted search by focusing our research on finding consumer perceptions around these devices. We did this by searching through the public domain for any reports of surveys. Again, our efforts were fruitless. Our attempts to find any information from the companies' were also unsuccessful, probably because most companies focus on providing financial information rather than consumer perceptions. We have, therefore, provided useful information as available from our research.
Sources
Sources

From Part 02
Quotes
  • "China had entered an aging society by the end of the last century. As age increases, health status and medical demands change correspondingly. According to the “2017 China Statistical Yearbook Compiled by National Bureau of Statistics of China (http://www.stats.gov.cn/),” people aged 65 and over accounted for 10.8% (150.03 million) of the total population in 2016 in China; by 2030, the population is predicted to be 1.46 billion, and 16% percent of Chinese citizens will be aged 65 and over."
Quotes
  • " So if you call an ambulance, both the ambulance driver and the receiving hospital will already have a very clear idea of who you are as a patient—your medical history and your medical needs—even while you’re still en route to the hospital. It’s not just that your electronic medical record (EMR) will be available online; it’s that, with AI, the EMR will be tailored and curated to the setting, which will result in faster and more accurate care. For example, in an ambulance, what the ambulance worker really cares about is whether the patient has a medicine allergy, is on certain medications, or has a medical condition that will require immediate critical care"
Quotes
  • "There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery."