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Articles from 2019 In October

Supplier Stories for the Week of October 27

B&R Industrial Automation, a member of the ABB Group, has worked to help launch the first dedicated global healthcare research hub at the Texas Medical Center (TMC) innovation campus in Houston. ABB’s healthcare research hub will demonstrate solutions for eliminating bottlenecks in laboratory work and addressing the global shortage of skilled medical and hospital staff,  offering the potential to enhance speed, safety, and consistency in laboratories and hospitals around the world, B&R shared in a news release.For instance, B&R's ACOPOStrak intelligent track technology integrates with robots to enable an adaptive machine that automates tasks requiring high variability, precision, and mass customization. The adaptive machine offers flexibility gains in product handling, assembly, and packaging in healthcare, B&R reported.[Image courtesy of B&R INDUSTRIAL AUTOMATION] 

Look Ma, No Hands: FDA Clears Hands-Free Robot for Percutaneous Procedures

Headshot courtesy of XACT Robotics; graphic by Amanda Pedersen Look Ma, No Hands: FDA Clears Hands-Free Robot for Percutaneous Procedures
The XACT Robotic System is based on research originally conducted at the Technion – Israel Institute of Technology, by Moshe Shoham, founder of Mazor Robotics, which was acquired by Medtronic in 2018.

Competitors in the robotic-assisted surgical space would also do well to keep an eye on  Caesarea, Isreal-based XACT Robotics, which just received FDA clearance to sell its first robotic system in the United States. The robot was cleared for use during CT-guided percutaneous interventional procedures.

The wow factor of the Xact robot is that it is the first hands-free robotic system combining image-based planning and navigation with the insertion and steering of various instruments across an array of clinical applications and indications.

“We are committed to redefining the way the entire medical community utilizes robotics, beginning with interventional radiologists,” said Harel Gadot, the company's founder, executive chairman, and president. “Being the first to introduce a hands-free robotic system, we have the potential to provide significant clinical, technical, and economic value while democratizing interventional procedures. Our system’s small footprint and high mobility design will enable care providers to treat a broad range of patient care needs in various clinical sites of service.”

The XACT Robotic System is based on research originally conducted at the Technion – Israel Institute of Technology, by Moshe Shoham, founder of Mazor Robotics, which was acquired by Medtronic in 2018 in a $1.6 billion deal. The company plans to launch the system to select U.S. radiology centers and will debut its technology at the 2019 Radiological Society of North America (RSNA) conference next month in Chicago, IL.

Industrial 5G: Impact on Factory Automation

The roll-out of 5G wireless technology is expected to make an outsized impact on automation and control applications, with its strong focus on machine-type communications and support for the Industrial Internet of Things (IIoT). Unprecedented reliability and very low latencies add to the basic potential of Industrial 5G in manufacturing, even though the main technology building blocks and implementation challenges haven’t been fully resolved.

Industrial 5G Basics

The 5G communications standard offers much higher bandwidth and ability for more data to be sent simultaneously than with 4G or earlier wireless standards. According to Siemens, estimates start at 10 gigabits per second, 10 times more than 4G, along with substantially lower latency of greater reliability than current mobile networks and support for a higher number of connected devices.

5G, 5G networks, automation and control, Siemens, industrial application, factories

New 5th generation wireless networks offer industry enormous potential. Unprecedented reliability and very low latencies as well as the comprehensive IIoT connectivity of Industrial 5G all will make it much easier to create future-oriented applications in industry. (Image source: Siemens)

The basics of Industrial 5G applications include support for three different types of factory communication: enhanced mobile broadband (eMBB), massive machine-type communication (mMTC), and ultra-reliable low-latency communications (URLLC).

Enhanced mobile broadband communications is expected to leverage 5G’s high data rates and enhanced coverage, compared to 4G, to open up wireless applications in areas such as augmented and virtual reality. Possible uses include overlays on smart glasses for assembly line workers.

Massive Machine-Type Communication (mMTC) is designed to provide wide area coverage and enable a huge number of IoT devices (some reports indicate as many as one million devices) to be connected per square kilometer. mMTC communications is intended to offer connectivity that features low software and hardware requirements from the connected devices, and support for low-energy, battery-optimizing operation.

Ultra-Reliable Low-Latency Communication (URLLC) leverages 5G’s high system reliability and reaction times in the low millisecond range. Potential applications are seen in process automation for closed loop control, mobile control panels with integrated safety functionality, mobile robots and motion control.

Learning About Industrial 5G

Two websites in particular are helpful in learning more about Industrial 5G and its possibilities for smart manufacturing.

One is the 3rd Generation Partnership Project, which is comprised of seven telecommunications standard development organizations, which provides its members a forum to produce reports and specifications that define 3GPP technologies. 

A second is the 5G Alliance for Connected Industries and Automation, which presents itself as a central global forum for shaping 5G in the industrial domain.

According to a white paper on the 5G ACIA website, “5G has the potential to provide wireless connectivity for a wide range of different use cases and applications in industry. In the long-term, it may actually lead to convergence of the many different communication technologies that are in use today, thus significantly reducing the number of relevant industrial connectivity solutions. Just as there is an ongoing trend towards Time-Sensitive Networking (TSN) for established (wired) Industrial Ethernet solutions, 5G is likely to become the standard wireless technology of choice, as it may for the first time enable direct and seamless wireless communication from the field level to the cloud.”

The white paper provides a comprehensive review of 5G key technologies, primary features and also how the basic 5G system architecture has specific benefits for smart manufacturing. But major challenges also must be addressed in order for 5G’s potential to be realized.  One is that the work of standardization bodies and the manufacturing industry are not fully aligned yet.

Other challenges include:

  • How to develop 5G to support in the manufacturing
  • Spectrum and operator models
  • Safety and security
  • 5G-enabled industrial components
  • Establishment of a common language
  • Transparency of 5G connection in the radio access and core network

The white paper concludes that that efforts to enable Industry 4.0 in manufacturing stand to benefit greatly from Industrial 5G. Key technologies of 5G networks offer important benefits that can be applied to Industry 4.0 deployments but, as great as the benefits of 5G for the industrial domain may appear, challenges of equal magnitude must still be addressed.

Al Presher is a veteran contributing writer for Design News, covering automation and control, motion control, power transmission, robotics, and fluid power.

Volvo Trucks enhances quality with 3D printing technology at its new River Valley plant

Volvo Trucks enhances quality with 3D printing technology at its new River Valley plant

“Volvo Trucks began exploring the use of 3D technology with a prototype approach, identifying opportunities to improve quality in the manufacturing process,” said Franky Marchand, vice president and general manager of NRV. “Several years later, we can now say that 3D printing has become an integral component to our manufacturing processes and culture at NRV.”

Volvo Trucks used 3D printing technology to develop a one-piece diffuser used in the paint atomizer cleaning process, saving the company more than $1,000 per part, as well as eliminating the need for a multiple piece component.

3D printing capabilities have improved quality and precision by printing exact copies from models. The technology effectively eliminates error, increasing the chances of first time through (FTT) production of assembly tools and fixtures, streamlining the manufacturing process and enabling customers to receive end products quicker.

Adam Crowder, manager of Advanced Manufacturing Technology at NRV, is leading a global manufacturing-focused network representing 12 Volvo Trucks’ plants around the world, collaborating to develop new 3D printing applications and techniques for improved manufacturing.

After years of internal exploration with 3D printing technology and fine-tuning, there are now more than 500 manufacturing tools and fixtures in use on the NRV shop floor produced using 3D printing. All of these parts were printed at the Volvo Innovative Projects lab at the Dublin facility. In the state-of-the-art lab, Volvo Trucks primarily uses Selective Laser Sintering (SLS), a 3D printing technology that uses a laser to sinter powdered plastic material into a solid structure that is then rigorously tested and put into use in the manufacturing process.

Using SLS allows engineers to design parts by drawing the end product, putting it in the machine and leaving it to print in a matter of hours during a work day or even overnight, cutting down on the number of hours spent building parts through traditional tooling methods. The use of this technology also increases flexibility in manufacturing, reducing the wait for new parts from vendors by simply printing them in-house. These capabilities therefore reduce inventory expenses as well, eliminating space needed to house traditionally produced tools, driving costs down in end products for customers.

“While the technology has only been in use for a handful of years, it is already proving to be a valuable component of the manufacturing process at NRV, significantly saving production time and parts costs and continually improving quality,” said Crowder.

Volvo Trucks used 3D printing technology to develop a one-piece diffuser used in the paint atomizer cleaning process, saving the company more than $1,000 per part, as well as eliminating the need for a multiple piece component. Spare parts were also produced for the 20 that were created so that they can easily and quickly be replaced should wear occur.

Additional examples of 3D printed parts in use at Volvo Trucks include:

  • Roof seal gauges
  • Fuse installation platens
  • Drilling fixtures
  • Brake piston gauges
  • Vacuum drill ducts
  • Brake valve fitting gauges
  • Hood drilling fixtures
  • Power steering adapter holders
  • Luggage door gap gauges
  • Luggage door pins

“The NRV facility is dedicated to exploring these new technologies to further improve efficiency and quality in our manufacturing and deliver the best products to our customers in a timely manner,” Marchand said. “Thanks to the collaborative effort of the entire team around the globe, we are able to accomplish that goal through 3D printing. We plan to continue to advance this technology to benefit our customers, saving them time and money.”

New Form of Printing Produces Curvy Electronics

Researchers already have come up with numerous ways to make electronics more flexible. But until recently, creating electronics with a specific three-dimensional (3D) curve has remained an elusive endeavor.

Scientists at the University of Houston (UH) and the University of Colorado Boulder have collaborated to change this scenario with the development of a new printing process that they said can produce 3D curvy electronics on various scales.

Curvy Electronics, University of Houston, University of Colorado Boulder, conformal additive stamp printing
A team of researchers led by University of Houston engineer Cunjiang Yu has reported a new way to manufacture curvy, three-dimensional electronics. (Image source: University of Houston)

The breakthrough paves the way for contact lenses with integrated sensors and electronics to monitor health and improved vision as well as other types of next-generation wearables, optoelectronics, telecommunications, and biomedical applications, researchers said.

The new manufacturing method is conformal additive stamp printing, or CAS printing, which researchers invented when they couldn’t find a way to adapt existing printing techniques to their ultimate goal, said Cunjiang Yu, Bill D. Cook Associate Professor of Mechanical Engineering at UH.

“We tested a number of existing techniques to see if they were appropriate for manufacturing curvy electronics,” Yu, also a principal investigator with the Texas Center for Superconductivity at UH, said in a press statement. “The answer is no. They all had limitations and problems.”

Creating the Curve

Indeed, existing manufacturing technologies—such as microfabrication, don’t work for curved electronics because they are inherently designed to produce two-dimensional, flat electronic devices, Yu said.

However, next-generation demands for devices such as smart contact lenses, curved imagers, electronic antennas, and hemispherical solar cells will require fabrication techniques for curvier shapes ranging in size from millimeters to centimeters with a high degree of accuracy, he said.

“Electronic devices are typically manufactured in planar layouts, but many emerging applications, from optoelectronics to wearables, require three-dimensional curvy structures,” researchers wrote in an abstract for a paper on their work published in the journal Nature Electronics. “However, the fabrication of such structures has proved challenging due, in particular, to the lack of an effective manufacturing technology.”

CAS printing is a rather simple but effective technique for this purpose, according to researchers. It works like this: Researchers inflate an elastomeric balloon and then coat it with a sticky substance to use it as a stamping medium. They then use this object to apply pressure to a pre-fabricated electronic devices to pick up the electronics and then print them onto various curvy surfaces, they said.

In their work, researchers used a manual version of a CAS printer to create a variety of curvy devices, including silicon pellets, photodetector arrays, small antennas, hemispherical solar cells, and smart contact lenses, they said. They also designed an automated version of the printer that should facilitate scaling up production, researchers said.

Another paper featuring the team’s research also is published in the journal Nature.

Elizabeth Montalbano is a freelance writer who has written about technology and culture for more than 20 years. She has lived and worked as a professional journalist in Phoenix, San Francisco and New York City. In her free time she enjoys surfing, traveling, music, yoga and cooking. She currently resides in a village on the southwest coast of Portugal.

What Medical Device Designers Can Learn from a Heinz Ketchup Bottle

What Medical Device Designers Can Learn from a Heinz Ketchup Bottle
An MD&M Minneapolis speaker used the original Heinz Ketchup bottle as an example of why investing in design is so important to product development.

If you've ever tried to get ketchup out of a glass Heinz bottle, you are probably familiar with just how real that struggle is.

At MD&M Minneapolis 2019, Brian Mullins, director of design and development at Kablooe Design, used the original Heinz Ketchup bottle as an example of why it's important to invest in the design of a product.

"This bottle you see here ... it's really good at holding ketchup, but what they didn't really think about was how to get the ketchup out of the bottle," Mullins said. "There's a process involved. First you have turn the bottle upside down, then you might have to hold it at about a 45-degree angle, then tap on the 57 [on the neck of the bottle], then you get out a knife and start trying to pull out the ketchup, then you give it a shake, and the final step of the process is to clean off your shirt."

It's an example of a company making a great product but not putting a lot of money or forethought into the user experience. That was until 2000 when Heinz introduced its EZ Squirt collection of a variety of kinds of ketchup in an easy squeeze bottle with an inverted design.

"This is quite a novel innovation that Heinz did," Mullins said, referring to the new and improved bottle. "And they invested in the design and catered to the user needs. They actually paid an individual who invented a nice little silicon valve that holds the ketchup in. "When you squeeze it, it allows the ketchup to come out and when you let it go the valve seals."

At MD&M Minneapolis, Mullins shared secrets to solving the five hardest design problems in medtech, using the Heinz example to address the first "secret", which is investing in design.

1. Invest in Design

Before going to the management team to ask for funding, Mullins said you need to be able to identify good design. "You can't be asking for funding if you don't really understand the value and what it really comes down to is pleasing your customers and making sure their needs are met," he said.

But how do you convince the management team to invest those dollars in design when you're also competing with other departments that are also asking for funding?

"I like to say 'what's going to happen if we don't [invest in design]? Who's going to come around and better understand their end-users and make that impact? And then you're going to lose market share, so what happens if we don't? It's starting to trend up, most companies understand the value of design and they are investing in it," Mullins said.

2. Focus on Human Factors and Usability

Any good product designer should know the importance of understanding their target user's needs in order to create a product driven by human factors and usability. Mullins said it's also important to not only be empathetic to the user's needs but to make sure you're not inadvertently reflecting your own thoughts and feelings on the user.

3. Consider Manufacturability

Another tricky challenge in product design is figuring out how to bring manufacturability into the conversation without restricting the innovation and the designer's creativity.

Mullins encouraged designers in the audience to engage with vendors early and often, beginning with the ideation phase. "You might not be showing them a concept, you might just say 'tell us about your company and tell us about what your capabilities are so we know if we need to adapt to that capability and design towards it," he said.

It's also important to start getting manufacturing quotes as early as possible so you don't get too far along in the process before finding out it's going to be too expensive to manufacture.

"I do have clients say 'do not think about how this could be made' but I feel like that's not a good way to design because while it is a good idea to push the boundaries a little bit, it's just a reality if they're going to make anything they need to know how it's going to be made," he said.

4. Pivot for Greater Impact and Outcome

Things don't always go according to plan so the fourth secret Mullins shared is being able to pivot when things go wrong.

"The idea here is to take calculated risks. If you have to pivot, try to look into the future and understand what the risk is. Maintain the core technology if possible," Mullins said. 

Also, he added, don't forget to keep the user needs in mind as you pivot, and if by pivoting there is a new group of users, you need to go back and record those needs through another usability study.

5. The Wow Factor

"Some of our clients have a great network of key opinion leaders that they involve in our R&D meetings," Mullins said. "These are primarily end-users that are leaders in the space and they provide feedback while you're developing."

Make sure you involve these key opinion leaders early because sometimes people won't want to speak up about a potential problem with a product if they can see that you're too far into the development process, he said.

"If you're developing a product you need to have an understanding of what [the key opinion leaders'] needs are," Mullins said. "And there's going to be one need somewhere that's going to give you that competitive advantage and that's going to be the wow factor."

Medtronic is Moving Toward a Fully-Implantable LVAD

Pixabay Medtronic is Moving Toward a Fully-Implantable LVAD

Medtronic is developing a fully-implantable left ventricular assist device. The Dublin-based company announced Tuesday it had received breakthrough device designation for the technology.

Current LVAD systems, including the HVAD Medtronic inherited when it acquired HeartWare International for $1.1 billion in 2016, are connected to a driveline cable that extends outside the body to a controller. This is then connected to power sources (AC or DC adapter, batteries).

Medtronic’s new LVAD is being designed to be fully implanted inside the body. News of the development of the new LVAD system comes a little more than a year after Medtronic won approval for a less-invasive implant approach of its HVAD system.

FDA’s nod would allow for the HVAD to be implanted through thoracotomy, a small lateral, surgical incision between the patient's ribs on the left side of the chest. Approval for the implantation was fueled by data from the LATERAL prospective clinical trial, in which 144 patients, with end-stage heart failure who were eligible for a heart transplant, were enrolled at 26 centers in the U.S. and Canada.

The technology isn’t available anywhere.

It hasn’t been smooth sailing for the HVAD. A month after Medtronic acquired HeartWare FDA designated two of HVAD’s recalls as Class I. A year later, Medtronic expanded the recall, and initiated a new recall of a driveline splice kit used to repair the HVAD's driveline once an electrical break has been identified.

The biggest competitor to the medtech giant’s LVAD technology is Abbott Laboratories’ HeartMate. Abbott inherited the HeartMate device through its $25 billion acquisition of St. Jude Medical. The St. Paul, MN-based company obtained HeartMate through its acquisition of Thoratec in 2015 for about $3.4 billion.

At one point Thoratec once tried to acquire HeartWare but backed off because the deal was challenged by the Federal Trade Commission.

Facebook Makes Its Healthcare Debut

Facebook Facebook Makes Its Healthcare Debut
Facebook is working with U.S. health organizations to offer a tool that connects people to health resources and checkup reminders. People can use this new tool to find affordable places to receive care, set reminders to schedule tests, mark when tests are completed, and more.

Cristin Moran, CEO of Growth Science, said it best last week at MD&M Minneapolis when she said almost every industry is interested in healthcare. We've already seen Apple, Amazon, Microsoft, and Google make power moves in healthcare, so it should come as no surprise that Facebook has now made its healthcare debut.

The social media giant announced this week that it is developing products and partnerships aimed at connecting people with healthcare resources, starting with a new Preventive Health tool for U.S. consumers.

Facebook said it is working with U.S. health organizations to offer the new tool, which is designed to connect U.S. consumers to health resources and provide checkup reminders. The company said its initial focus is on heart disease and cancer, as well as the flu. The resources available in the tool are provided by the American Cancer Society, the American College of Cardiology (ACC), the American Heart Association (AHA), and the Centers for Disease Control and Prevention (CDC).

“Heart disease is the number one killer of men and women around the world and in many cases, it is 100% preventable," said Richard Kovacs, MD, president of the ACC. "By incorporating prevention reminders into platforms people are accessing every day, we’re giving people the tools they need to be proactive about their heart health.”

Here's How Facebook's Preventive Health Tool Works

In the United States, people can search for Preventive Health in the Facebook mobile app and find out which checkups, such as cholesterol tests or mammograms, are recommended based on the age and sex they provide. Reminders for flu shots will also appear at the appropriate time of year. 

The tool allows people to mark when tests are completed, set reminders to schedule future tests and tell loved ones about the tool to increase awareness of preventive care. People can also learn more about each checkup and find affordable places to receive care.

And so far, healthcare organizations seem to be on board with the idea of the social media platform's involvement in the industry. 

“We’ve contributed our content and resources to the Facebook Preventive Health tool to empower Americans to take the first step to know about and take action to lower blood pressure, blood sugar, and cholesterol, each of which has been shown to increase the chance of a longer, healthier life and reduce the likelihood of a heart attack or stroke," said Eduardo Sanchez, MD, chief medical officer for prevention at the AHA.

Richard Wender, MD, chief cancer control officer at the American Cancer Society, said that one of the main reasons people don’t get screened for cancer is that they don’t realize their own risk. "We hope this program will help by building awareness about important recommendations from expert organizations," he said.

Most of the preventive measures recommended by the health organizations Facebook is working with, such as blood pressure tests, are free of charge with insurance coverage, but the company acknowledged that many people do not have insurance. To help people get affordable care, Preventive Health offers a way to find Federally Qualified Health Centers near them. These centers are located in underserved areas and provide care to everyone, regardless of their ability to pay.

People can also use Preventive Health to find convenient locations that offer flu shots, such as grocery stores, pharmacies and urgent care clinics.

“Flu vaccines can have wide-ranging benefits beyond just preventing the disease, such as reducing the risk of hospitalization, preventing serious medical events for some people with chronic diseases, and protecting women during and after pregnancy. New tools like this will empower users with instant access to information and resources they need to become a flu fighter in their own communities," said Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases, CDC.

Facebook said it plans to work with additional organizations to include more resources and expand to other countries.

Privacy Matters

Facebook said it took privacy and safety into account from the beginning. For example, Preventive Health allows you to set reminders for your future checkups and mark them as done, but it doesn’t provide Facebook or its partner organizations with access to consumers' test results. Personal information about a consumer's activity in Preventive Health is not shared with third parties, such as health organizations or insurance companies, so it can’t be used for purposes like insurance eligibility, the company noted.

The social media giant also said it will not show people ads base on the information they provide in the new tool. But the company reminded its consumers that other actions they take on Facebook could inform the ads they see, for example, liking the Facebook page of a health organization or visiting an external website linked to from the Preventive Health tool.

App Update Helps Patients Breathe Easy in the Event of a Misplaced Inhaler

App Update Helps Patients Breathe Easy in the Event of a Misplaced Inhaler
Images of the Find My Inhaler App and Propeller Health sensor courtesy of Propeller Health

Even when patients with asthma or COPD are symptom free, losing an inhaler is probably one of their worst nightmares.

To help patients quickly locate one should a loss occur, Propeller Health has updated its app to allow users to "ring" the sensor on the lost inhaler. Propeller Health's battery-powered sensor transmits data on medication use and location to the Propeller app via Bluetooth.

The app, which tracks medication use, health patterns, and even environmental forecasts that may affect asthma or COPD, also includes the “Find My Inhaler” feature, which can track multiple inhalers. With "Find My Inhaler," Users would navigate to their list of “sensored” inhalers within the app and tap “Find My Inhaler” for the missing inhaler. The sensor’s last known location would be shown on a map, and users could then press “Ring Sensor” to activate the sensor’s chime function.

“We heard from our users that it’s easy to misplace an inhaler, whether it’s in a purse, down the side of a chair or in a coat pocket,” said Greg Tracy, chief technology officer of Propeller Health, in a news release. “This update to Find My Inhaler is intended to make it quick and easy for users to find their inhaler with the same tool they use to manage their condition every day.”

If the sensor is within Bluetooth range of the user’s smartphone, the two devices should be able to communicate. If they are further apart, the sensor’s last known location would be displayed on the map within the app. Interference from other sensors should not be an issue, a company spokesperson told MD+DI. The sensor battery life lasts about a year.

Propeller Health is a wholly owned subsidiary of ResMed.

AI Beats Out Clinicians in Triaging Postoperative Patients for ICU

Pixabay AI Beats Out Clinicians in Triaging Postoperative Patients for ICU

How good is artificial intelligence in decision-making? Not bad according to findings from a pilot study that was recently presented at the American College of Surgeons Clinical Congress 2019.

Findings from the study show AI in the form of a machine-learned algorithm correctly triaged the vast majority of postoperative patients to the intensive care unit in its first proof-of-concept application in a university hospital setting.

As it stands now surgical teams typically rely on clinical judgment to decide which patients need postoperative intense care because there is no single set of fixed criteria to make the determination. The result is that clinicians typically over-triage, meaning if they are in doubt, they err on the side of caution and send a patient to intensive care. However, over-triaging may result in admitting a patient to the ICU who doesn't need to be there.

"In those cases, the patient may be unnecessarily exposed to multidrug-resistant bacteria and have an increased overall length of stay. On the other hand, under-triaging means a patient that should have been in the ICU is sent to a recovery or step-down unit, and the opportunity for quick rescue of a deteriorating condition is delayed because monitoring is not as intense," Marcovalerio Melis, MD, FACS, an associate professor of surgery, New York University Langone Hospital System, New York City, and coauthor of the pilot study, said in a release.

The resulting algorithm included 87 clinical variables and 15 specific criteria related to the appropriateness of admission to the ICU within 48 hours of surgery. Admission to the ICU was considered appropriate if one of these criteria was met. The criteria included: intubation for more than 12 hours, reintubation, respiratory or circulatory arrest, call for rapid response or code, blood pressure below 100/60 mHg for two consecutive hours, heart rate below 60 or above 110 bpm for two consecutive hours, use of pressors, placement of a central venous line or Swan-Ganz catheter, echocardiogram, new onset of cardiac arrhythmia, myocardial infarction, return to the operating room, blood transfusion requiring more than 4 units, or readmission to the ICU after a prior admission.

Researchers prepared a questionnaire to prospectively ask clinicians how they would evaluate the need for intensive care for each patient.

AI correctly triaged 41 of the 50 patients in the study (82%). Surgeons had an accuracy triage rate of 70% (35 patients), intensivists 64% (32 patients), and anesthesiologists 58% (29 patients). The number of incorrect triage decisions was lowest for AI (18%), followed by 30% for surgeons, 36% for intensivists, and 42% for anesthesiologists.

The rate of undertriage was similar for AI (12%) and surgeons (10%); the rate of overtriage was much lower for AI (6%) than for the clinicians whose rates ranged from 20% to 40%. Further, AI achieved a positive predictive rate of 50% and negative predictive rate of 86%.

Although the algorithm in this study clearly outperformed clinicians' judgment, it is the first step. The surgical researchers plan to apply the algorithm to other populations of patients and include other demographic and clinical features.