IoT-based smart triage of Covid-19 suspicious cases in the Emergency Department Barbara Fyntanidou Emergency Department AHEPA University Hospital Thessaloniki, Greece barbarafyntanidou@gmail.com Panagiotis D. Bamidis Lab of Medical Physics, Medical School Aristotle University of Thessaloniki Thessaloniki, Greece bamidis@auth.gr Pantelis Angelidis University of West Macedonia, Vidavo Greece paggelidis@uowm.gr Maria Zouka Emergency Department AHEPA University Hospital Thessaloniki, Greece mariazouka@gmail.com Antonis Billis Lab of Medical Physics, Medical School Aristotle University of Thessaloniki Thessaloniki, Greece ampillis@med.auth.gr Alexis Fourlis Vidavo Thessaloniki, Greece afourlis@vidavo.eu Aikaterini Apostolopoulou Emergency Department AHEPA University Hospital Thessaloniki, Greece aikateriniapostolopoulou@gmail.com Konstantinos Mitsopoulos Lab of Medical Physics, Medical School Aristotle University of Thessaloniki Thessaloniki, Greece konsmits1@gmail.com Abstract—According to scientific reports, the main and most common Covid-19 symptoms are fever and shortness of breath. Therefore, monitoring of vitals such as temperature, breathing and heart rate and blood oxygen saturation is of essence. Our team has designed and developed a wrist-worn wearable device that continuously monitors relevant vital signs with the aim to prioritize and triage Covid-19 patients in the Emergency Department. Keywords—photoplethysmography, Covid-19, respiratory evaluation, wrist wearable, triage, emergency department, tinyML I. INTRODUCTION Despite the fact that we are in the middle of a significant transformation regarding the way products and services are produced and distributed, known as Industry 4.0, Health 4.0 is still in its infancy [1]. However, new IoT technologies and techniques are making the difference aiming to change the way healthcare is delivered. The recent Covid-19 outbreak highlighted the weaknesses of healthcare systems across the world and revealed the clinical need for new innovative IoT solutions. In order to limit the spread of Covid-19, certain measures are needed to alleviate the burden from public health organisations, including reference hospitals. One of the most significant is to reduce Emergency Department (ED) overcrowding, minimising waiting time of suspicious incidents and increase in-hospital safety. Fever and shortness of breath are considered as two of the main symptoms of patients infected by Covid-19 [2],[3]. Both symptoms can be objectively tracked by measuring vital signs, such as body temperature, breathing rate and/or oxygen saturation levels. Continuous monitoring of those vitals is not currently considered as an option offered by EDs, unless a patient is admitted to the ICU. Instead sporadic checks may occur depending on the availability of human resources (usually limited and under huge pressure). In addition, the commercially available medical devices are not always portable, while more than one device is needed to provide the full spectrum of required vital signs. In this work, we present the ongoing development of a wrist-wearable device we have designed and developed, which uses advanced digital signal processing algorithms on PPG (Photoplethysmogram) to continuously extract heart rate, blood oxygen saturation levels, body temperature estimation and respiratory classification. The wearable device has been already integrated with a cloud-based infrastructure. The wrist-wearable device supports common communication protocols, thus being able to transfer processed data to other third-party systems and apps through an API. A mobile application for the ED personnel that we also developed is used for real-time detection of health deterioration and enables highlighting the most critical Covid-19 cases, thus reducing clinical decision- making and patient waiting time and allowing for more efficient triage. Finally, recorded vital signs might act as a complementary source of information to the results of the clinical examination to make a final diagnosis of patients. The proposed solution has been set up and piloted in the Emergency Department of AHEPA hospital in Thessaloniki, Greece, where suspicious Covid-19 cases are referred to from the Region of Central Macedonia. To our knowledge, a similar application of Covid-19 continuous monitoring in the ED has not been applied in clinical settings yet. This paper demonstrates the development of such a smart device and its feasibility to collect vital signs in the clinical operational environment. II. RELATED WORK The use of wearable medical sensors is limited due to several practical factors, such as lack of comfortable wearable sensors and absence of low-power affordable hardware [4]. These restrictions have resulted in a very limited number of commercial wearable devices already in use inside hospitals. Despite these restrictions, with the advent of the Covid-19 outbreak, there has been an increased interest in the implementation of telemedicine techniques, including robotics and wearable electronics [5]. The employment of the latter, as of the writing of this paper, has been restricted to either the development of new applications utilizing novel materials for the detection of specific pathophysiological symptoms related to the disease, or to the use of already existing devices and technologies to either predict the early onset of the disease [6], or to monitor patients already in quarantine [7][8]. One such example is a study by Natarajan et al (2020) [9], that utilizes Fitbit device measurements of confirmed, (via PCR test) Covid-19 978-1-7281-7307-8/20/$31.00 ©2020 IEEE 2020 IEEE Globecom Workshops (GC Wkshps) | 978-1-7281-7307-8/20/$31.00 ©2020 IEEE | DOI: 10.1109/GCWkshps50303.2020.9367584