When Managing COVID-19, “More” Isn’t the Only Answer

Originally published by Jeffery Alvarez

Finding efficiencies in managing COVID-19 may help relieve some of the burden on the nation’s healthcare system

As we watch the impact of COVID-19 unfold across the country, we owe a debt of gratitude to the brave healthcare providers who are on the front lines of this pandemic. Without hesitation, they are courageously caring for patients and giving every hour they can to save lives.

While they are helping the patients, it’s our job to find solutions to the problems they’re facing: the need for more equipment, more tests, and more resources to battle this virus.

As a country, we’ve made some great progress on this over the last week. 

We’ve seen various private-sector corporations rise to the occasion and partner with the U.S. Department of Health and Human Services. Many have shifted their manufacturing services to produce more of the valuable personal protective equipment (PPE) and ventilators our healthcare providers need to treat the influx of COVID-19 patients.

And while thinking about “more” is certainly critical, the time-sensitive nature of this issue requires we go beyond just having more resources. We should also be asking: 

How do we help our care providers increase their efficiency? 

While we look for solutions to address the equipment shortage, we also have an opportunity to find and build up efficiencies. This can enable healthcare professionals to not only do more with scarce resources and treat patients effectively but also protect their own health and safety. This can lead to less traffic in a COVID-19 patient’s room, conservation of valuable PPE equipment, and a reduction in the amount of time patients may need to spend using life-saving equipment such as ventilators.  

One example of finding these efficiencies? Urine. 

How Efficient Urine Monitoring Plays a Role in Managing COVID-19 Patients

When a nurse is monitoring a COVID-19 patient, a delicate process is put in place, which includes measuring how much urine their patient is producing every hour. 

Urine output is a vital sign and an important indicator of a patient’s fluid status and end-organ perfusion. A good fluid balance keeps fluid out of the lungs while providing oxygen to vital organs; helping to get patients off ventilators faster.

And getting patients off ventilators faster is more important now than ever since hospitals in the U.S. and globally are experiencing a shortage of ventilators during the COVID-19 patient surge.

Although urine is an essential vital sign, it isn’t automatically recorded by a device like other vital measurements such as blood pressure, temperature, pulse ox, and heart rate.  

To get the best possible measurement, a nurse is required to gown-up in PPE, enter the patient’s room and “milk” the urine drainage tube so that the urine in the tube drains into the urine bag, then measures it by hand. This entire process takes about 20 minutes, after which the nurse disposes of their PPE only to come back and repeat the process in another hour. 

No alt text provided for this image

This means that one patient could require 24 sets of PPE (gown, mask, visor, gloves) per day, solely for urine output measurement, and at each time, the clinician is put at risk. 

When time and resources are constrained, automating urine output would be more efficient to monitor remotely for COVID-19 patients.

To respond to this challenge, we’ve set up the Frontline Access & SupporT (FAST) program, a loaner program for our Accuryn product.

Accuryn ensures the drainage tube continuously flows (no more milking the line), and automatically measures urine produced, along with intra-abdominal pressure and core body temperature.

These measurements are continuous and can be monitored from outside the ICU room or recorded directly into a patient’s Electronic Medical Record (EMR) without requiring any manual input from the healthcare provider. 

This can help improve favorable outcomes for critically ill COVID-19 patients, potentially decreasing the time these patients require a ventilator, and help reduce the amount of PPE needed for nurses since their exposure would be decreased. 

We’re proud that clinicians at major medical institutions in the San Francisco Bay Area and Atlanta Metropolitan Area are already using Accuryn to help find efficient ways to manage their patients. 

Dr. Michael Connor, an ICU Intensivist shared:

“Accurate, automated, digital urine output measurement is paramount to achieving accurate fluid balances in the critically ill. Improving our chances of survival and favorable outcomes from COVID-19 will require a return to euvolemia, and digital urimeters could make achieving euvolemia much more likely. Additionally, automated measurements of urine output could decrease the need for nursing to physically be exposed every hour for the sole purpose of urine output measurements.”

Every Minute during COVID-19 Counts

As we find ourselves feverishly anticipating how best to prepare for and manage an influx of COVID-19 patients across hospitals nationwide, it’s important that we look for all creative solutions. We need to keep in mind that preparation can involve more than increasing the amount of equipment. It takes time to build up capacity, but building up efficiency is faster with the right treatment approach.

Efficiencies can save our healthcare professionals valuable time and help alleviate some of the pressure they’re currently experiencing as they continue to navigate this new environment.

In the fight against COVID-19, every minute counts. To manage this health crisis together we need to leave no stone unturned and look for answers and solutions in the unlikeliest of places.

Who would have thought that urine could be one of them?

 About Jeffery Alvarez

Expertise is in identifying, defining, and creating significant clinical value through a holistic design thinking approach that delivers high impact products.

Over the past 17 years, Jeff has helped define, design, manufacture, or launch over 22 different medical devices. Including early product development on Auris Monarch Robotic System and Hansen Vascular System. He has led teams through need-finding, definition, development, human clinical trials and commercialization.

Jeff has a BS in Mechanical Engineering from Rensselaer Polytechnic Institute & and MBA from Haas School of Business, UC Berkeley.