Continuous Physiological Monitoring Improves Patient Outcomes

Abstract

Background: General patient acuity is increasing in the United States, with more patients having multiple comorbidities and acute-on-chronic conditions. Hospitalizations may also be complicated by serious adverse events, often unrelated to the admitting medical diagnosis. In our facility, the late detection of patient deterioration on general medical units often resulted in increased length of stay (LOS) in the ICU and poor patient outcomes. Purpose: The purpose of this project was to improve patient surveillance and better identify early signs of patient deterioration through the use of continuous vital sign monitoring technology. Methods: To improve detection of patient deterioration, a nurse-led monitoring and response system was developed using a wearable, wireless device for continuous vital sign surveillance. The patient data the device provided was used with early warning scores and sepsis screening protocols for timely goal-directed interventions. Results: Ninety-seven percent of patient deterioration events were recognized and treated as a result of this continuous monitoring and response system. Rapid response team activations decreased by 53% between baseline and the intervention period. LOS among patients transferred to the ICU decreased from 2.82 to 2.19 days. Nurse satisfaction with use of the continuous monitoring device was positive, with 74% of nurses surveyed reporting that information provided by the device enhanced decision-making. Conclusions: New technology for patient surveillance, in this case a nurse-led monitoring and response system, can be successfully integrated into general care practice. Use of the nurse-led response system helped nurses recognize early signs of deterioration and continue meaningful patient interactions.

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

“…38 Multiple subsequent studies investigating a variety of continuous monitoring modalities have also found decreases in RRTs and ICU transfers, and in 1 study decreases in cardiac arrests and in-hospital mortality were also noted. 39–44 Meta-analyses have shown similar results, including reductions in ICU transfers but not in mortality. 45,46 However, most of these studies lacked detailed information about the larger rescue system infrastructure and about how monitoring is operationalized and built into clinical workflows.…”

Early Warning Scores to Support Continuous Wireless Vital Sign Monitoring for Complication Prediction in Patients on Surgical Wards: Retrospective Observational Study

“…Until reliable sensing and preprocessing techniques are available for all relevant parameters, it would be of interest to develop ways to optimally combine sensor and nurse measurements in care routines. Various commercially available systems for wireless or automatic patient monitoring already support or are used for the calculation of complete EWS every few hours [ 12 , 41 ], often after verification of valid measurement values and manual insertion of parameters that cannot yet be measured by the system, such as blood pressure or consciousness. Following this approach, Weenk et al [ 23 ] performed a study that included patients on wards, where an EWS was calculated every 30 minutes using 2 different wireless vital sign sensor systems and complementary nurse measurements.…”

Wireless wearables for postoperative surveillance on surgical wards: a survey of 1158 anaesthesiologists in Western Europe and the USA

“…These findings are consistent with the results of at least seven large (>1000 patients) studies reporting significant postoperative clinical outcome benefits after the implementation of continuous monitoring on hospital wards. 17 , 18 , 19 , 20 , 21 , 22 , 23 Five of these studies 17 , 19 , 21 , 22 , 23 reported a significant decrease in the number of RRT interventions after the implementation of continuous monitoring of heart rate, respiratory rate, blood pressure, and/or oxygenation saturation on regular wards. Two studies 17 , 23 reported a significant decrease in the number of ICU transfers.…”

“… 13 , 14 , 15 By enabling the early detection of clinical trajectories, 16 continuous monitoring of vital signs may help to decrease severe adverse events requiring rescue interventions, ICU admissions, and deaths. 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 …”