Infusing Technology Into Hospital Beds

From the perspective of robustness and safety, battery backup, and eased CPR release, the new hospital beds provide for fast responses to emergencies under power-failure conditions.

Hospital beds provide extra comfort and relief to patients. They are a root-level requirement of a hospital, so much so that the value of the hospital is calculated on the number of beds it is equipped with. Special hospital beds are packed with additional features and facilities which help in supplementing relief to the patient during a surgery as well as in the recovery period. The key features of hospital beds such as adjustable side rails and height along with operating buttons for electronic devices make them more patient friendly and furnish ambient comfort.

Recent scientific achievements and technological advances have brought forward a massive display of new or updated beds, enabled with highly-developed embedded-control functions and interactivity. From the final decade of the twentieth century, hospital beds have particularly been affected by this surge, taking on new forms and functions, while accommodating to established properties. The past 15 years have also brought forward changes to conceptual frameworks, concerning the product design and manufacturing processes (standards), as well as the patient (perspectives on patient-care environments and accessibility). Currently, hospital beds come with a lot of inbuilt features like a pre-loaded setting for performing CPR on a patient, movement capability of the bed on all axis, and emergency bed light. Bed stretchers, which were used earlier to move a patient from wards to OTs, ICUs, and for investigations, are now becoming obsolete and are being discontinued. The hospital bed itself comes with wheels, so that the patient can be shifted on the bed itself. This leads to increase in patient safety and decreases patient discomfort.

Over the past years, trends and most relevant innovations to hospital beds have been notably related to design aspects, referred to materials (more hygienic and resistant), population-specific models, ergonomic manual commands, and morphological changes associated with updated mobility-options (elevation, front-back and lateral inclination), updated side-rails, patient-support structures, castors (fifth castor for enhanced transport), while embedded with new technologies. Most advanced hospital beds today can weigh a patient. The organization takes the relevant parameter and enters that into the EHR. And that same bed might also be fitted with a bed-exit alarm. So the parameter studied is whether the patient is in or out of bed. But using the same weight-sensing technology perhaps with more advanced algorithms, the organization can capture the dynamic aspect of the patient’s movements in real time to anticipate an adverse event or otherwise ease their comfort and safety. In other words, with technology already available, but using a different perspective, sensing can offer variable, as opposed to static, data and help caregivers use that data efficiently and effectively.

Surrounding the hospital bed, the integration of information-technologies into the patient-care environment has changed the way patient-information and treatment is handled. Updated user interfaces, dedicated to patients and caregivers, have emerged over the past decade, both as consumer-ready solutions and research projects, covering the management of patient records, and control over the near environment (like TV and lights). As hospital beds become smarter, interaction with these smart environments becomes a possibility.

Indian market dynamics

In 2017, the Indian hospital beds market is estimated at Rs. 730 crore with sales at 112,000 units. The high-end motorized beds with a 38 percent share in value terms, have a 20 percent share by units. Midmark, Arjohuntleigh, Stryker, Paramount, and Hill Rom are the popular brands in this segment. The mid-end, semi-electric beds have a market share in the vicinity of 30 percent both in terms of value and volume. Popular brands include Midmark, Arjohuntleigh, Paramount, and Godrej. Some other brands present are VISCO, Mediline, Meditek, Bharat Surgicals, and Geeta Surgicals. The competitively priced manual ones with their crank system for adjusting the height and posture have a 50 percent market share by volume, albeit in value terms have a 27 percent share. United Surgical, Medimec, Midmark, and many other regional and local brands cater to this segment.

There is tremendous gap between the availability of beds and required beds. With increasing urbanization and problems related to modern-day living in urban settings, currently, about 50 percent of spending on in-patient beds is for lifestyle diseases; this has increased the demand for specialized care. Lifestyle diseases seem to be replacing traditional health problems. Also, the population of people aged 65 years or above is growing at a high rate and they need medical attention.

With a current population of 1.6 million beds, in keeping with the new healthcare policy of two beds per 1000 people, at least 2.6 million beds will need to be provided over the next decade. The WHO standard is a minimum of 3 beds per 1000. Demand for new beds will be met by capital investments, changing status of non-functional beds to functional, public private collaboration, new business models, and focus on preventive healthcare. With a mere count of a total of 634,879 beds in the government hospitals in 2017, and advanced features such as being AC-powered, hydraulic adjustability, and powered patient rotation beds available in hospital beds, this segment is expected to grow over the next few years.

Government initiatives

According to a PwC-CII report, currently, there are 1.35 million hospital beds for the around 180 million population covered under the Rashtriya Swasthya Bima Yojana. The government is banking on the public–private partnership (PPP) model to try and raise an additional 160,000 hospital beds that are needed to provide health cover under its ambitious Ayushman Bharat-National Health Protection Mission (AB-NHPM) or Modicare. From the new population, which comes under coverage for the first time in the AB-NHPM scheme, and also from increased demand from the previously covered population due to higher coverage, the demand for new beds can be met by capital investments, changing the status of non-functional beds to functional, public–private collaboration, new business models, and focus on preventive healthcare.

Several states have adopted the PPP model while others are attempting to use the PPP framework to set up secondary and tertiary care facilities. For instance, The Haryana government entered into a PPP agreement with the Kerala-based Meditrina Group of hospitals for cardiac care in 2017 while the Odisha government planned to develop 19 hospitals having 2600 beds under the PPP model with an investment of about Rs. 1200 crore. In April 2018, Uttar Pradesh announced that it will establish more than 1000 hospitals under the PPP model. Moreover, the Chhattisgarh government also decided in July 2018 to build six multi-specialty hospitals on PPP basis in the state which will have 100 beds each and would be in addition to the government hospitals or the primary health centers existing in the areas where they are being set up.

Global market

The global hospital bed market generated USD 3.4 billion revenue in 2017 and is projected to witness a CAGR of 5.4 percent during 2018–2023, according to P&S Market Research. Increasing prevalence of chronic diseases, growing healthcare expenditure, surging aging population, and technological advancements in hospital beds are the key factors driving the market growth. Increasing life expectancy and fall in birth rates are the major factors behind the growing aging population. The advanced features offered by hospital beds such as being AC-powered, hydraulic adjustability, and powered patient rotation beds also support the growth of the hospital bed industry worldwide.

Geographically, Europe held the largest share in the hospital bed industry, with 33.4 percent contribution in 2017. The market growth in the region can mainly be attributed to the growing number of hospitals, increasing prevalence of chronic diseases, and rising aging population. In addition, the increasing incidence of hospitalization, technological advancement in hospital beds, and growing healthcare expenditure are also driving the market growth in the region. Asia-Pacific (APAC) region is expected to witness the fastest growth, at a CAGR of 6.4 percent. This growth is supplemented by growing medical tourism, increasing prevalence of chronic diseases, rising aging population, and continuously improving healthcare infrastructure in the region. Increasing chronic diseases along with aging population lead to a high chance of hospitalization, which further drives the market growth.

Key players in the hospital bed market are actively engaged in the research and development for advanced hospital beds to improve patient safety. For instance, in April 2018, LINET spol. s r.o. introduced the TOM 2 pediatric bed and MiMi cot for newborns. In May 2017, Hill-Rom Holdings Inc. launched the Hill-Rom Envella Air Fluidized Therapy Bed, a solution for wound care patients providing a better healing environment for the prevention and treatment of advanced pressure injuries. Moreover, the companies are also engaged in acquiring related businesses of other companies for market expansion. For instance, in May 2017, Savaria Corporation acquired Span-America Medical Systems Inc., a manufacturer of therapeutic support surfaces and other related products, for approximately USD 80.2 million. This acquisition was aimed at providing Savaria Corporation with an additional product line, new distribution channel, and increased presence in the U.S. market. Some of the other key players in the hospital bed industry are Invacare Corporation, Paramount Bed Holdings Co. Ltd, Gendron Inc., Medline Industries Inc., Savaria Corporation, LINET spol. s r.o., Hill-Rom Holdings Inc., Savion Industries Ltd, Stryker Corporation, and Getinge AB.

Technological advances

Today’s beds implement new technologies (graphical interfaces, novel environment-aware sensors, and actuating solutions), to provide a higher level of service and function, like real-time monitoring, caregiver and patient assistance, automated functions and positions (chair, assisted bed exit), and data logging, as well as more advanced means of communication.

Smart features. Addition of new features such as bed-exit alarms, obstacle detection, advanced motion options, therapy routines, patient and bed history logging, integrated scale, head-of-bed angle monitoring and measurements, patient-blocking, local and remote information on patient conditions, integrated accessory-controls, are all relevant in their own right, but most impactful when controlled under a single patient-care interface. From the perspective of robustness and safety, battery backup, and eased CPR release, the new beds provide for fast responses to emergencies under power-failure conditions. With the help of blockchain technology, healthcare professionals will be able to track pediatric beds with a detailed location history which will increase security and reliability. Moreover, with the help of geofence technology, they will also be able to assign beds to specific locations within the hospital to ensure that no beds exit their designated location without approval.

User interfaces. Starting with wired hand-held controls (which persist in most models), interfaces have advanced up to solutions with redundant side-rail integrated controls (exterior and interior), remote controls, foot-pedals, integrated numeric displays, and touchscreens (mostly directed to caregiver control), and variants like hanging controls reachable by the patient. Additionally, current inventions contemplate new integrations between these technologies for future devices. Smart interfaces like patient blocking, nurse-call functions, networking and interaction with other devices and accessories (i.e., air-pressure mattresses), and redundancy through multiple controls are available for most options, favoring robust and reliable operation. The addition of advanced graphical means and touchscreens with dedicated user interfaces is currently present in a select number of beds. Since this provides eased access to features like alarm setup and monitoring, and is essential to the control of a growing number of states and functions in beds (like bed-history functions), their presence is expected to increase in the future.

Hospital beds with continuous monitoring. Among the biggest priorities for healthcare providers with regards to hospitalized patients is ensuring their comfort. Often that can be a challenge when those receiving care are hooked up to a plethora of sensors measuring heart and respiratory rates, among other metrics. Continuous monitoring is extremely important for nurses and doctors to detect subtle changes in the heart or breathing rate of a patient that may be indicative of a more serious problem. The new beds with sensors underneath the mattress are now able to monitor heart rate and breathing rate (both reassuringly healthy) in real time, to an accuracy of about 5 beats per minute for heart rate, and two breathing cycles for respiratory rate.

Bed management systems. Bed management systems coordinate the communication and resource support of a patient’s journey through the hospital. These systems focus on flow from emergency departments to wards, while others also take in theatres, radiology, and pharmacy. Clinicians are now using these systems to manage the placement of patients in real time across a health system. They help administrators maximize access by improving flow, reducing length of stay, and managing capacity.

Digital bed flow systems. They map a patient pathway throughout the hospital with various key stages highlighted. This cuts out numerous phone calls and means key personnel can access it via real-time wall boards in the accident and emergency department (A&E), in wards, and in physiotherapy, pharmacy, and theatres to track where a patient is and what is needed to deliver the required stage of care on the pathway. Benefits being cited by manufacturers include reduced A&E times and length of stay, better matching of staff skills to patients, and reducing the dead bed time when one patient has left the bed before another occupies it.

Road ahead

The market of hospital beds is currently broad, competitive, and still has potential to spread. Dedicated devices for different demographics are being developed, and high-end functionality under customizable solutions has become a common feature. Research is also continuously promoting novel or updated integrations of technology. It is expected that these changes will continue to spread into further automation and design adaptations, with the smart bed becoming the heart of the smart patient-care environment of the future. The full potential of hospital beds will not only be achieved with isolated technological or morphological advances, but when they are seamlessly integrated into the healthcare system, enabling more efficient efforts for caregivers, and more responsive environments for patients. Manufacturers need to design beds with simple patient controls that are easy to access and are more comfortable and quiet.

A growing trend looks to change the experience of the healthcare environment for patients, providing new means of communication and entertainment at their reach, particularly aimed at patients with restricted mobility (acute, recovering, and long-term patients). These proposals integrate connectivity and a higher control over the environment, while including informative resources (tutorials) concerning different conditions. Even when not including control over the bed itself, these interactive patient-care systems may integrate a touchscreen through adjustable stands. The development of personalized healthcare and medical devices for injuries and chronic diseases has been deemed as one of the most impactful and feasible challenges to be tackled by biomedical engineers in the near future, and the evolution of medical beds and devices in the immediate surroundings of the patient is instrumental to these advances.

Powered by a surge in user technological-awareness, the acceptance of new technologies into smart beds and accessories will likely continue to grow, reaching more complex, upgraded, and even bold iterations in the near future. The future of hospital beds will be shaped by the continued, conscious supplement of technologies into the healthcare environment. As for patients and environments, research is heading in the way of providing even further functionality and integration with the hospital bed. Embedded monitoring, autonomous responses, and accessibility-enabled systems can take full advantage of the potential of these devices, while also posing future challenges in the development of reliable solutions for the severely-disabled. Accessibility-enabled smart hospital beds have the potential of becoming the center of new, comprehensive, and patient-conscious healthcare environments.