Cardiac Rehabilitation
Arlington Memorial Hospital
I played a key role in designing and developing an experimental audio system for a Cardiac Rehabilitation Center at Texas Health, Arlington Memorial Hospital. This system allows RNs to control and monitor educational audio tracks that patients hear as they exercise. This system consists of a Window-based server that communicates simultaneously with 16 iPod touch clients. The project was a success and is still in use today.
Documents and Resources
Overview
Heart patients who have undergone a procedure are often prescribed sessions of therapy by their heart physician. The initial therapy involves exercise and education, as the first step in their recovery process. The cardiac rehabilitation facility at Arlington Memorial Hospital is authorized, and has the capability to provide this valuable service.
New patients are evaluated by a staff RN after receiving them from hospital admissions. Each patient is checked for weight, hip and waist measurements, blood pressure and current mediations. Each patient is attached to the heart monitor that they will use during the rehabilitation cycle and are shown the data monitoring system. An appropriate exercise regime and education program is then designed for each patient consistent with individualized goals.
Cardiac rehabilitation has proven to be successful in rehabilitation and as a key motivator for patients to adopt a healthy lifestyle that includes appropriate post rehabilitation exercise, diet, and prevention education. A great deal of individual motivation has its beginnings with the professional staff of nurses and physical therapists and a format program of education as an integral part of each session.
Patients are scheduled for sessions three days per week (Monday, Wednesday, Thursday). They are placed in one of five time slots each day, and their rehabilitation sessions usually extend over three months. Each class has a capacity of sixteen which gives the program a total capacity of eighty patients. That limit could be expanded by adding additional time slots if required.
Each session every patient begins with an interview as to doctor visits, medication changes, changes in physical well being and any problems or questions they may have. Blood pressure and heart rate are checked at arrival, during exercise, and at rest after cool down. Each individual has their heart monitor attached and has specific exercises to accomplish. As patients begin their exercise, a member of the volunteer staff will give them headphones and a player programmed with one of their prescribed audio education recordings. Wednesday sessions include one of ten classroom programs following exercise. The professional staff of Arlington Memorial teach these classes.
Graduates of the cardiac rehabilitation program are encouraged to move to the next phase of improved lifestyle by enrolling in the Arlington Memorial Fitness Center program where they will continue to improve under the watchful eye the same RNs and therapists they now know.
Improving the Education Program
The education of patients is accomplished in three distinct ways. First and foremost is the consulting that each patient receives from the staff RNs in each scheduled session. Every Wednesday there are classes taught by hospital professionals in addition to the regular exercise. Finally, each individual is given an audio program to listen to while exercising. The latter is facilitated by audio lessons that are programmed in compliance with the individualized plan that was developed during the initial evaluation.
The audio system consists of players, headphones, and a selection of sixty-nine specific lessons that run from approximately six to twenty minutes in length. That totals a maximum of 11.98 hours of recorded lessons that may be available for selection. The system and lessons have been purchased from an outside supplier (Intervent). The only soft spot in the three pronged education strategy appears to be in the Intervent system.
It is crucial that patients be educated and motivated. Any system impediment that would cause a patient to refuse or miss important information detracts from the already outstanding success of the rehabilitation program. While the Intervent system is generally acceptable to most patients, there are definitely reasons to consider potential improvements. The specifics that follow are based on patient comments, experiences of staff, and operational difficulties.
Some patients simply do not understand the audio which is narrated by an individual with a distinct accent.
More often than would be desired, patients find the lessons too generalized and boring.
There are delays in getting programmed audio lessons to exercising individuals, as each player must be manually programmed to a specific selection out of the sixty-nine lessons available.
There is no way to monitor what the patient is listening to, or if to check if they are listening at all.
The audio programs are fixed in time with no apparent way to modify or update information, or to insert some motivational audio.
The players are showing their age, and require maintenance attention that taxes an already short time interval to deliver audio to those who need it.
The problems with the existing Intervent system could be overcome with existing technology and a new approach to the recording of audio content. The following specifications are offered for comment and preliminary design. A final specification will be generated and studied for the optimum trade off of cost and desired functionality.
Hardware and Software Objectives
Make available from existing technology a small receiver/player that can be worn by patients in or attached to their heart monitor pouch. Provide non invasive ear pieces as an integral part of the system worn by the patient.
Store all educational content in a single computer and have the ability to select and transmit different lesson content to as many as sixteen receivers at any time.
Select, start and stop lessons via the central computer. A screen matrix should show selected lessons by individual patients and indicate status. There would be features for control and patient monitoring, including the ability to select and listen to any running audio.
Provide system security and privacy.
The memory storage for audio content should accommodate fifteen hours of lessons. The number of lessons will be seventy or less. CDs may be used.
Provide equipment to record and modify lessons.
Improving Audio Content
A system that incorporates all the innovations outlines above will accomplish little if the audio content is not markedly improved. The patient must be motivated and eager to hear his or her lesson of the day. Content must be rescripted to make it more specific to Arlington Memorial Hospital and to the goals of the cardiac rehabilitation to gradate patients who have been educated about prevention, exercise, healthy eating, and specifics related to their individual needs and goals.
The audio needs not only a new voice, but new voices. The recorded content should be professionally done using a mix of male and female voices. One might also consider a future availability of lessons in several languages, with English as the default setting.
Next Steps
This document is being used for comment as to feasibility and suggestions for change. Existing hardware and software would be preferred, but suggestions for new design are acceptable and welcome. When your responses are received and evaluated, a procurement specification will be created and submitted to the hospital for consideration. Donations are always appreciated.
