Overview

Reax is a startup mobile application development company that is creating a reaction-based test to gauge general cognitive fatigue among medical professionals. Our team was inspired by the value the Armstrong Institute placed on patient safety and strives to push what has come to be accepted as norms in the medical field. Through collaboration with several doctors and medical students, Dr. Nicholas Durr, and researchers at NeuroQWERTY, Elsevier, and TMC BioDesign, our team has created Reax with the aim to decrease medical errors due to physician fatigue. Reax will increase patient safety and quality of care while conserving the current workflow of the medical field.

Clinical Need

→Medical error is the third leading cause of death in the US (after only heart disease and cancer).

→At least 250,000 deaths per year are due to medical error.

→At least 20% of these deaths can be linked to healthcare worker fatigue.

$4.16 billion is spent on preventable fatigue-related deaths.

→"After 24 hours of sustained wakefulness, cognitive psychomotor performance decreased to a level equivalent to that at a blood alcohol concentration of 0.10%."

Solution: Reax

With these problems in mind, our team is developing the Reax mobile application to determine if a healthcare worker is in the state of mind to handle major medical decisions. The application will test an individual’s reaction time and compare it to his or her previously established baseline to provide a suggestion regarding the individual’s mental state and ability to make decisions involving patients.

The current standard for work hours in the healthcare field is a gray area. Most healthcare personnel average more than 100 hours a week. Exhausted residents perform operations and make life-or- death decisions. There have been many studies that link healthcare personnel fatigue to increased medical error, with very few providing a solution. There are several applications on the market that have linked fatigue with low performance, but these applications have not been successfully applied to the medical field. Therefore, there is currently no standard in the fatigue management market. Reax will be a novel application that is creating a new market and new standards.

The fatigue management market is valued at $4.16 billion. Of this, the revenue of applications like Reax is estimated at $100 million. Combined with the lack of competitive products, the fatigue management market presents an appealing opportunity with long-term potential. Additionally, Reax stands to benefit patients greatly, decreasing risk of medical errors and mortality. With 20% of all medical errors being due to healthcare worker fatigue, the economic burden of fatigue is large, costing the United States healthcare system over $4 billion annually. Reax not only delivers value to the United States healthcare system, but also stands to improve the quality medical services delivered in United States healthcare organizations.

How we built it

Reax is an iOS-based application designed using XCode, Swift, and Sketch. Sketch was used to develop mock UI and graphic designs of the final product. XCode and Swift were used to create a proof of concept through the development of the Reax Tilt test.

Accomplishments

Our team strives to change the culture of the medical profession. We believe our novel application will support healthcare providers in their goals to improve patient safety and quality of care.

What's next for Reax

A full working prototype of Reax will be completed by November 2017. Beginning then, Reax will be tested among medical students and residents. After testing, Reax will be ready for the market. Our market entry strategy involves licensing our data and technology to a major accreditation agency, such as the Joint Commission, with a high commitment to improving patient safety and a history of research in fatigue management.

Sources

○ Gupta, S. (2001). AMA Expected to Take up Resident Work Hours. CNN.

○ Daniel, M. (2016). Medical Error: The Third Leading Cause of Death. BMJ. 2016;353:i2139.

○ Bari A, Khan RA, Rathore AW. Medical errors; causes, consequences, emotional response and resulting behavioral change. Pakistan Journal of Medical Sciences. 2016;32(3):523-528. doi:10.12669/pjms.323.9701.

○ The Joint Commission: Sentinel Event Alert (2011). Healthcare worker fatigue and patient safety. Sentinel Event Alert, 48(1), 1-4.

○ Perez, Ken (2016). The Human and Economic Costs of Medical Errors. HFMA.

○ Bratzke, D., Rolke, B., Steinborn, M. B., & Ulrich, R. (2009). The effect of 40 h constant wakefulness on task-switching efficiency. Journal of Sleep Research, 18(2), 167-172.

○ Wilkinson, R. (1990). Response–stimulus interval in choice serial reaction time: Interaction with sleep deprivation, choice, and practice. The Quarterly Journal of Experimental Psychology, 42(2), 401-423.

○ Williamson, A & Feyer, AM (2000). Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occupational Environmental Medicine. 57:649–655.

○ Krull, K. R., Smith, L. T., Sinha, R. and Parsons, O. A. (1993), Simple Reaction Time Event-Related Potentials: Effects of Alcohol and Sleep Deprivation. Alcoholism: Clinical and Experimental Research, 17: 771–777. doi:10.1111/j.1530-0277.1993.tb00839.

○ Healthcare Facilities Accreditation Program (2017). Centers for Disease Control and Prevention Guideline for the Prevention of Surgican Site Infection. JAMA Surgery.

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