Cairos 4.0 - Engineering Patient Safety reinventing transfusion

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Cairos 4.0

Cairos 4.0 is an eHealth process assistant helping healthcare teams to protect patients from preventable infusion-related harm by smart services that radically simplify workflows. It ensures constant learning on the job and compliance with guidelines. It is a tool to implement both patient blood management and active pharmacovigilance.


Zero preventable adverse events (patient safety).


European pharmacovigilance database (db) using Linked Data and high-performance db technology (aggregation-on-the-fly, column-oriented) for the sake of patient safety.

Type of Sustainable Investment:

Proactive prevention of inappropriate treatments through active vigilance and high-precision processes with reduction of related costs and increased patient benefit (win-win).

The Problem

Treatment with blood products is driven by information and highly regulated in medicine worldwide. Severe adverse events (SAE) due to "never events" (process errors supposed to never ever occur), however, indicate that guidelines and written rules do not always meet implementation. "Never events" due to process errors include wrong decision making, flawed pretransfusion sampling and mistransfusion. They occur at frequencies of 1:100, 1:2.000, and 1:10.000, respectively (Dzik et al., BJH 2006, Murphy et al. Tr.Med. 2004). 5 million blood products being used in Germany per year thus translate to an average of at least 50.000 patients affected each year by process errors in hemotherapy. Inappropriate red cell transfusions in particular belong to the top overused interventions in medicine. It is estimated that 110 million € in addition to avoidable risks can be saved each year by optimizing decision making with user-friendly information technology support in Germany alone. Poor quality pharmacovigilance, i.e. underreporting of side effects, creates a climate of situational unawareness among healthcare workers. As a result, their intrinsic motivation to constantly improve process quality by learning from adverse events need support to reach levels required for patient safety.

The Challenge

  • Ensure processing of 70-90 information items and 10 correct logical decision makings per treatment by 7 professional roles acting across 7 interfaces with high precision under routine and emergency/disaster conditions on a 24/7 basis.
  • Deal with data locked-up in silos.
  • Resolve parallel electronic and paper-based documentation impairing efficiency and communication.

Key Benefits

  • Protect against SAE through misidentification and misindication
  • Reduce inappropriate use of red cell concentrates (by 30%) and related costs.
  • Reduce waste through real-time tracking.
  • Active pharmacovigilance. 
  • Improved emergency/disaster management (new PTS standard,(Notter et al., 112(11), 2008).
  • Radical workflow simplification.
  • Compliance with guidelines.

Key Functions

  • Augmented redundant independent patient identification. 
  • Automated pretransfusion sampling (Hans-Hirschfeld-Device). 
  • Electronic order entry with decision support and semi-automated process monitoring.
  • Real time tracking of processes.

Key Technological Features

  • Industry 4.0 design: "smart IV access", "smart resource" (blood product, medication), "smart services" that organize, capture and deliver risk-relevant information.
  • Cross-sectional multi-user single database resulting in data integration across entire process chain. 
  • Radiofrequency identification (RFID). 
  • Smartphone APP and web-based SaaS.
  • Comprehensive wireless and paper-free documentation.

Ihr Ansprechpartner

Dr. med. Michael Notter


CBF: Campus Benjamin Franklin