Thursday, December 17, 2015

Future of Healthcare Scenario: The Importance of Established Medical (and Circadian) Rhythm

By Cara Ann Cama
HCA:507.90 Organizational Innovation, Creativity & Change Management in Healthcare
Post University

Linda scanned her fingerprint onto the visual TimePad to clock out and Terapio4, her robotic nurse assistant, retreated to the nurses’ station to await its next assignment. The night shift was about to begin. The hospital floor was silent with the exception of the occasional squeak from a Terapio tire. Linda took one last visual scan of the periphery as she yawned in exhaustion and hopped into her Ford InstaTraveler to head home.

Terapio4 met with its fellow robotic health assistant models to prepare for room rotations. Once assembled together, the captured EMR records from the prior shifts streamed from the database within the Terapios via iCloud network into online patient charts. Red flags for urgent patient matters popped up instantly on all of the on-call staff’s tablets for review. A few minutes later Terapios dispersed to administer medications, assist in patient mobility training, take vital signs and track patient urine output levels.


Linda removed the cafpatch from her arm to cease administration of caffeine into her system. Her limbs and eyes instantly grew heavy as the fatigue set right in. She stretched her arms up high and relaxed with a deep sigh. As she rubbed her knuckles into her bloodshot eyes, she headed over to the REMopedic. Linda placed the sensors on her forehead to register the necessary sleep cycle based on her cognitive function level and stepped into her pajamas. The double shift she had just worked drained her mentally and physically. Terapio4 was a great assistant, but the complete dependence on nurses for medical procedures and patient relations placed a lot of stress on Linda.

Before hopping into her REMopedic, she asked Siri for her social updates. A holographic screen appeared before her with touch sensitive applications. Linda selected an option that opened up to a live video streaming of the hospital floor she worked on . Patient dissatisfaction lights outside the doors were all off, indicating the Terapios were in control and on top of everything. She pushed away the hologram and snuggled herself into her REMopedic capsule to begin her circadian rhythm. The tanning bed-like structure folded over and an aerosol mist of melatonin filled inside. Linda’s muscles began to stiffen and her heart rate increased as her blood pumped faster within her. Her lungs caught an automatic and soothing rhythm as she entered into REM sleep. The expedited alternations between REM and deep sleep allowed for all the necessary biological benefits of sleep to occur in only half the time. REMopedics were staples in health care provider’s homes— especially nurses struggling to keep up with the demands of a physician-less world.


An elderly patient from Brazil entered the hospital with complaints of fever, body aches, and a rash. Terapio4 approached the patient with attempts to register the patient, but being unfamiliar with the technology differences from her country, she could not communicate.  Terapio4 attempted to comfort the patient, but the 65-year-old patient hit the machine with her cane and began to scream. Terapio retreated to the nurses’ station and tele-contacted all on-call professionals for assistance.

Linda’s tablet lit up with red flags and vibrated until it fell from the bedside cabinet onto the floor cable unit disconnecting the REMopedic. The sleep cycle was disrupted mid-REM and a bright light entered the unit waking Linda suddenly. Groggy and irritable, Linda was confused with what was going on. She pushed open the REMopedic and grabbed her head as a migraine shot through her frontal lobe. Linda grabbed the used and practically empty cafpatch from the night before and placed it on her arm. She began to focus a little and scanned the room as her eyes met the still vibrating tablet. Her eyes sore from lack of sleep, she opened her holographic video stream of the hospital to see multiple Patient Dissatisfaction lights illuminated. Linda quickly dressed and ported back to the hospital.


Terapios scattered from room to room to assist and reassure patients that there was no threat and the screams from the Brazilian patient were not of concern. Linda was met by Terapio4 with a debriefing on the patient. Linda quickly approached the patient who was now visibly shaken and wrought with concern. Attempting to comfort the patient, Linda held her hand and escorted her into a private room to talk. The patient calmed down and was able to tell Linda about her symptoms of fever and body aches. The pounding headache still resounded within Linda as she attempted to evaluate the patient.

Linda was used to dealing with apprehensive elderly patients and accounted the chaos to unfamiliarity with the changes in technology. Looking forward to heading back to sleep, she diagnosed the patient with Influenza, and suggested rest and Tylenol.  Too exhausted to port back home, Linda opted for an empty on-call room. She rested her eyes for a brief nap.

Several hours later Linda awoke feeling recharged. She freshened up and reviewed her cases from the night before. Terapio4 greeted Linda and alerted her that the Brazilian patient was still there. Curious, Linda decided to check in on her. She peaked into the waiting room to find the patient stiff, cold and shivering. Linda extended her hand to the patient and as she went to shake her hand, she noticed a large rash on her wrinkly forearms. Linda asked if the rash was new and the patient told her no, but it was getting larger.

Sleep deprivation resulted in Linda failing to elicit the rash symptom. Paired together with her recent travel from her home country of Brazil, the patient was actually suffering from a case of Dengue fever. Now a serious exposure risk to the hospital, and a heightened carrier risk via Terapio4, this patient should have been quarantined immediately. With her limited cognitive abilities and depressed immune system due to insomnia, Linda, too, contracted the infectious disease.

Medicine requires a rhythm and established structure for all patients. Addressing patient concerns through comprehensive medical interviewing exhausts the chief complaint and any other patient concerns. However, nothing can be done for others if providers are not caring for themselves first. Providers have a personal responsibility to ensure they receive adequate amounts of sleep as to not put the lives of others in danger.

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