UVA Health uses CoMET to fight the pandemic and monitor patients.
CHARLOTTESVILLE – Since July, doctors and nurses at University of Virginia Health haven’t been the only ones monitoring COVID-19 positive patients. UVA has another member on the team, but he’s not on the payroll. And although he’s great at predicting medical emergencies, he doesn’t hold a prestigious degree.
His name is CoMET – Continuous Monitoring of Event Trajectories – and he’s the brainchild of Dr. Randall Moorman, a cardiologist at UVA Health.
Yes, it’s the same Moorman who made headlines 20 years ago. That’s when he discovered that premature babies exhibited abnormal heart rate patterns in the hours leading up to a certain life-threatening diagnosis.
Moorman noted that sepsis, a bacterial blood infection, exhibited warning signs. Unfortunately, the tale-tell symptoms didn’t usually present themselves quickly enough – or in a recognizable pattern – for a medical team to intervene.
“That’s really a four-star example of how you think somebody’s doing okay and then five minutes later, they’re dying in front of you,” Moorman said. “And of course, premature infants can’t tell you they feel sick and so you rely entirely on the things that you measure.”
Taking the various points of monitored care into consideration, Moorman created a device that displayed the readings in real-time. He called it HeRO.
The visual risk display alerted clinicians of infant health declines in real-time, showing patterns.
In the largest randomized trial of its kind, the study found that 3,000 at-risk, low-birth-weight babies across nine hospitals who had a HeRO display at their bedside had an increased survival rate of 20%.
“It was a very gratifying finding,” Moorman said.
Long since, Moorman wanted to offer the technology in adult healthcare situations.
A Desire to Help at UVA
A relentless drive to help all patients with the technology stuck with Moorman.
“I have certainly found myself in the situation of having a patient that I thought was doing well, turn right around and start doing bad,” Moorman said. “And then when you go back and look, sure enough, if you’d known what to look at and how to look at it, you’d have seen something was common.”
Approximately 10 years ago, Moorman started batting around the idea of offering a health pattern monitor for adults similar to HeRO.
“Of course, that’s a whole lot more complicated,” Moorman said. “There are a whole lot more of them. They’re doing all sorts of different things.”
Moorman and his team worked diligently on the project and started making strides. They plugged up the first CoMET monitor in a UVA Health room five years ago and the technology spread to other hospitals.
The monitors displayed data from other sensors already connected the to patient. It pooled together the information from the EKG, laboratory results and vital signs, showing a scope of the patient’s health. The software drew numbers every two seconds and updated models every 15 minutes.
Stable patients’ “comets” are small, yellow and nestle close to the X-Y axis on the monitor. If the risk level rises, the comets grow, turn bright orange or deep red and crawl up and across the screen like plump, shooting stars, indicating cardiovascular instability, respiratory instability or both.
The colorful graphics signal clinicians to employ proactive strategies to stabilize patients’ vital signs before serious medical events, such as sepsis, blood poisoning, respiratory distress or cardiac instability and the need for intensive care unit-level care happen.
“We were working away at this as hard as we could,” Moorman said. “And then came COVID-19.”
The Pandemic Hits
In the weeks after COVID-19 struck, CoMET entered patients’ rooms.
“[COVID-19] is the worst when it comes to leading patients to deteriorate and crash quickly when you didn’t know it was coming,” Moorman said.
While CoMET can’t predict the future, it can alert healthcare professionals of some medical emergencies before they occur.
Jessica Keim-Malpass, a professor in the School of Nursing and Moorman’s research partner, explained how the monitor helped COVID patients.
“For COVID patients, particularly, they can deteriorate really quickly from a breathing problem standpoint,” Keim-Malpass said. “And so one thing that CoMET could do is that instead of giving a breathing tube to the rapidly, kind of, crashing patient in front of you, you could see earlier on, are there signatures that could tell us that this patient really isn’t tolerating this well? And doing, kind of, a safer intubation, where it’s not really so much of a crash situation, but you end up giving the patient therapy much earlier in the course than usual.”
Looking at the monitor, Keim-Malpass noted that the clinician could tell what type of distress the patient was in, as well as whether or not the situation was potentially worrisome.
“Every time a nurse walks by – and this is multiple places in the unit – you can do a quick, two-second look to see, ‘What is my patient doing?’” Keim-Malpass said. “…You’re seeing a barometer of change before you’re able to see it clinically.”
Seeing the monitoring software helping patients battling the coronavirus validated all of the hard work Moorman and his team did.
“I just have always had this feeling for the past year that the reason we were doing all of this work was to get ready for COVID-19,” Moorman said. “Even though, of course, we didn’t know it was coming.”
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A Helpful Tool for UVA
The monitor doesn’t only predict doom and gloom.
“There’s a flipside to the coin here, too. That is, it can tell you when patients have gotten better or when patients are at low-risk,” Moorman said. “If you’re running an intensive care unit and every bed is full and now somebody shows up in the emergency room that you need to put into your intensive care unit, how do you figure out who you move out?”
Utilizing CoMET, doctors and nurses get a quick view of patients in decline, those improving and those remaining stable. It provides an extra factor in determining proper patient care, especially in difficult situations.
A Widespread Appeal
Doctors and nurses aren’t the only ones monitoring CoMET. The display screen appears prominently in the room. The patient and guests – when allowed, due to COVID visitor restrictions – may watch and report upon their real-time health status.
Moorman said the monitor also makes for a great, informative conversation piece.
“It was a great way to have discussions,” Moorman said. “In the neonatal ICU and also in the adult places, if a patient or a family member says, ‘Well wait a minute, this doesn’t look the way I want it to look.’ Then that’s a great way to say, ‘Well, here’s what we’re thinking about. Here’s what we’re doing about it. We’re going to be treating differently in this way. Or we’re going to be doing these tests.’ It’s a great way to let patients and their families know the level of concern that you’ve got about them and all the effort they’re putting into taking care of them.”
In the future, Moorman expressed hope that CoMET could be a standard device in many hospitals.
“I don’t know a good reason why this wouldn’t be very, very widespread,” Moorman said. “We don’t use any information that everybody doesn’t have already. The doctors and the nurses have ordered tests. They’ve measured vital signs. They’re put on EKG leads for a reason: they want to know the information that is there. Why would you not want to additionally, in addition to seeing it yourself, have a computer think it all through, put it altogether and give you some idea of which way the wind’s blowing?”
Over the next two years, Keim-Malpass and UVA cardiologist Jamie Bourque will conduct a random-room CoMET study to determine the system’s efficacy and impact.
Amie Knowles reports for Dogwood. You can reach her at [email protected]