Radboud University Medical Center, in the Netherlands, is aiming to transform postoperative care by giving patients more control and easing the pressure on nurses


TV screens with nature scenery and interactive content, as well as mobile tablets, would be provided to postoperative patients in R4Heal's "interactive healing environment" (Credit: Radboudumc/R4Heal)

Skype chats on large plasma TVs, virtual reality gaming and tablets that open windows – it might sound like a five-star hotel room but this is how postoperative care could one day look.

Researchers at a Dutch teaching hospital have developed an “interactive healing environment” to improve the recovery for patients after surgery and ease pressure on nurses.

The single-patient hospital room is personalised based on preferences and continuously-measured needs of the individual to provide a human-centered experience.

It uses technologies including the internet of things (IoT), as well as visuals, sounds, games and smells.

Known as R4Heal, the project is still in the testing phase at Radboud University Medical Center (Radboudumc), based in Nijmegen, with hopes of making it a reality for all patients in the coming years.

Design manager Merlijn Smits told the IoT Solutions World Congress in Barcelona last week: “We will measure pain, stress, sleep and mobility because those four things have been found to speed up the recovery of a patient.

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Radboudumc design manager Merlijn Smits (Credit: LinkedIn/Merlijn Smits)

“By giving the patient a view of a forest scenery on their wall rather than a view outside overlooking another part of the hospital, you can help them feel more relaxed.

“You can then measure how well they’re recovering and adapt to their needs. This is the idea we’ve set up and are now prototyping.”


Challenges facing postoperative care

The need for an innovative approach towards healthcare and, in particular, postoperative care lies in World Health Organisation statistics that say the proportion of the global population aged over 60 will increase from 12% to 22% between 2015 and 2050.

It means the number of people working in healthcare needs to dramatically increase unless technology can assist.

But Smits said it’s important to note that tech should be designed in a way that end users will want to embrace, rather than giving them equipment they will eventually discard.

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Many patients told the Radboudumc team that hospital rooms are often “clinical and cold” (Credit: PxHere)

While conducting research for the project, Smits’ team found that patients wanted more positive distraction to make it feel less “clinical and cold”, greater control over room ambience and increased access to seeing loved ones.

They also voiced frustrations over not being able to move around to perform simple tasks, such as turn off a light or recharge a phone, without calling for a nurse whose service might be required more urgently elsewhere.

Smits said: “We wanted to get an insight into a patient’s needs, when they go to bed, when they wake up in the morning, and what makes them feel stressed and relaxed.

“It’s about getting to know someone and providing better care.”


How the R4Heal project plans to innovate postoperative care

The four-year R4Heal project, which involves Radboudumc and a consortium of Dutch SMEs including Big4Data, Yellow Riders and Relitech, has been running for one-and-a-half years – during which time a prototype has been tested.

The hospital has decided to reconfigure its shared room layout to create 125 individual rooms.

Two rooms have so far been mocked up with a range of new features that will give the patients more of a hotel-style environment but also help nurses prioritise their workload.

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TV screens with nature scenery and interactive content, as well as mobile tablets, would be provided to postoperative patients in R4Heal’s “interactive healing environment” (Credit: Radboudumc/R4Heal)

A large screen facing the bed will help provide positive distraction, believes Smits. It will display a nature setting to give a sense of calmness, videos to remind dementia patients about their lives, personalised care plan and treatment agendas, and Skype interfaces to make video calls with friends and family.

Virtual reality headsets and video games will help with mobility and distraction from pain, while mobile tablets enable patients to alert nurses with specific requests – such as help in going to the toilets or a vase for some flowers – rather than pressing a button for whatever they need.

Smits said: “At the moment, when the patient rings the bell, the nurse doesn’t know how important it is so it actually stops many patients from ringing it at all because they don’t want to waste staff time.

“But having a tablet with different options means the nurses can do their jobs more efficiently and prioritise tasks.

“At the same time, it gives the patient control over their environment to change the temperature, turn off the lights and open windows.

“We want to use screens more. They can give insights such as names of nurses, an agenda so they know what’s going to happen each day, a video call capability with a nurse and, in the future, AI voice assistants.”


How postoperative care patients are monitored in R4Heal project

The mock-up rooms have been equipped with sensors to measure how patients are feeling.

A sensor on the ceiling can monitor what’s going on in the room and can even detect when a patient is feeling uncomfortable.

“If they keep getting out of bed it could be dangerous if they’re at a high risk of falling,” said Smits.

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A team at Radboudumc has designed a prototype of how the “interactive healing environment” will look as part of the R4Heal project (Credit: Yellow Riders)

“So if they’re moving around a lot in the bed, we can direct a nurse there before the patient gets out to prevent the fall.”

By continuously monitoring a patient’s vital signs, it offers a real-time feed of their condition.

Smits added: “In hospitals, a nurse comes around three times a day to take vital signs and it’s shared into a computer.

“Our device is able to monitor constantly so you can check up on the patient a lot better than before.”


Personalising postoperative care

Before the R4Heal prototype is brought into real hospital rooms, demonstrations must first be carried out to both patients and nurses, who will be consulted about their experiences.

Results would then require validation in a scientific study to prove the technology improves clinical outcomes.

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Yellow Riders, which is working alongside Radmoudumc in the R4Heal project, shows how the interactive healing environment could improve patient outcomes and efficiencies for hospitals (Credit: Yellow Riders)

Smits added: “We want to then go one step further and really personalise the experience for the patients and adapt it for individual needs.

“Patients have different lifestyles so how can we manage the technologies to suit those?

“A patient has a completely different need when they’ve just had surgery compared to when they’re nearly ready to go home.

“So we want the type of content on the screens to match the needs of patients. It could include personalised gaming – whereas elderly people might like to do crosswords, it would probably bore a young person.

“We want to create almost like a Netflix ID for patients.”