Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: a before-and-after study

Eddahchouri, Yassin; Peelen, Roel V; Koeneman, Mats; Touw, H.R.W.; Goor, Harry van; Bredie, S.J.H.

doi:10.1016/j.bja.2022.01.036

Cited by 55 publications

(34 citation statements)

References 32 publications

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“…Since June 2018, all patients admitted to two selected wards are routinely connected to the ViSi Mobile device, that continuously measures heart rate, respiration rate, blood oxygen saturation, skin temperature, and cuffless blood pressure [ 16 , 24 , 25 ]. Real-time vitals and waveforms are shown on monitors and every minute a set of vital signs is transferred to a research database.…”

Section: Methodsmentioning

confidence: 99%

“…In 2018, a continuous vital sign monitoring system with the ViSi Mobile (Sotera Wireless Inc, San Diego, USA) wearable device was introduced at our medical and surgical nurse wards [ 16 ]. With this introduction, ICU-admissions were reduced by 36% [ 24 ]. This result was obtained with the periodic EWS protocol still in use for assessing the continuous measurements, while provided with trend information.…”

Section: Introductionmentioning

confidence: 99%

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Comparing Continuous with Periodic Vital Sign Scoring for Clinical Deterioration Using a Patient Data Model

et al. 2023

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To evaluate a minute-by-minute monitoring algorithm against a periodic early warning score (EWS) in detecting clinical deterioration and workload. Periodic EWSs suffer from large measurement intervals, causing late detection of deterioration. This might be prevented by continuous vital sign monitoring with a real-time algorithm such as the Visensia Safety Index (VSI). This prospective comparative data modeling cohort study (NCT04189653) compares continuous algorithmic alerts against periodic EWS in continuous monitored medical and surgical inpatients. We evaluated sensitivity, frequency, number of warnings needed to evaluate (NNE) and time of initial alert till escalation of care (EOC): Rapid Response Team activation, unplanned ICU admission, emergency surgery, or death. Also, the percentage of VSI alerting minutes was compared between patients with or without EOC. In 1529 admissions continuous VSI warned for 55% of EOC (95% CI: 45-64%) versus 51% (95% CI: 41-61%) by periodic EWS. NNE for VSI was 152 alerts per detected EOC (95% CI: 114-190) compared to 21 (95% CI: 17-28). It generated 0.99 warnings per day per patient compared to 0.13. Time from detection score till escalation was 8.3 hours (IQR: 2.6-24.8) with VSI versus 5.2 (IQR: 2.7-12.3) hours with EWS (P=0.074). The percentage of warning VSI minutes was higher in patients with EOC than in stable patients (2.36% vs 0.81%, P<0.001). Although sensitivity of detection was not significantly improved continuous vital sign monitoring shows potential for earlier alerts for deterioration compared to periodic EWS. A higher percentage of alerting minutes may indicate risk for deterioration.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing Continuous with Periodic Vital Sign Scoring for Clinical Deterioration Using a Patient Data Model

et al. 2023

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“…To overcome these limitations, security and privacy protection systems should be considered from the design/developmental stage of the IoT medical devices and services, and infringement factors that may occur during IoT medical device development should be investigated in advance by benchmarking the privacy impact assessment [ 27 ]. Despite the related problems of such a wireless-based medical device or IoT medical device, there are recent evidence that it is being used as a standard of care system in several hospitals [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there are increasing reports of clinical deterioration detection in the general ward using continuous and wireless systems, but its contribution to the quality improvement of the afferent limb of the RRS has rarely been examined. [ 14 , 15 ]…”

Section: Introductionmentioning

confidence: 99%

Effect of a Wireless Vital Sign Monitoring System on the Rapid Response System in the General Ward

et al. 2022

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While wireless vital sign monitoring is expected to reduce the vital sign measurement time (thus reducing the nursing workload), its impact on the rapid response system is unclear. This study compared the time from vital sign measurement to recording and rapid response system activation between wireless and conventional vital sign monitoring in the general ward, to investigate the impact of wireless vital sign monitoring system on the rapid response system. The study divided 249 patients (age > 18 years; female: 47, male: 202) admitted to the general ward into non-wireless (n = 101) and wireless (n = 148) groups. Intervals from vital sign measurement to recording and from vital sign measurement to rapid response system activation were recorded. Effects of wireless system implementation for vital sign measurement on the nursing workload were surveyed in 30 nurses. The interval from vital sign measurement to recording was significantly shorter in the wireless group than in the non-wireless group (4.3 ± 2.9 vs. 44.7 ± 14.4 min, P < 0.001). The interval from vital sign measurement to rapid response system activation was also significantly lesser in the wireless group than in the non-wireless group (27.5 ± 12.9 vs. 41.8 ± 19.6 min, P = 0.029). The nursing workload related to vital sign measurement significantly decreased from 3 ± 0.87 to 2.4 ± 9.7 (P = 0.021) with wireless system implementation. Wireless vital sign monitoring significantly reduced the time to rapid response system activation by shortening the time required to measure the vital signs. It also significantly reduced the nursing workload.

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“…However, this study was conducted on a relatively small and select population using non-continuous remote measurements operated by the patients themselves which could increase the risk of missing data which limits trend analysis. Additionally, recent evidence suggests the advantages of continuous measurement of vital signs over intermittent measurements [16][17][18]. Nevertheless, despite these early promising results, studies on the feasibility and safety of using remote monitoring devices for patients after surgery remain limited.…”

Section: Introductionmentioning

confidence: 99%

Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial

et al. 2023

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Importance Implementation of bariatric surgery on an outpatient basis is hampered by concerns about timely detection of postoperative complications. Telemonitoring could enhance detection and support transition to an outpatient recovery pathway. Objective This study aimed to evaluate non-inferiority and feasibility of an outpatient recovery pathway after bariatric surgery, supported by remote monitoring compared to standard care. Design Preference-based non-inferiority randomized trial. Setting Center for obesity and metabolic surgery, Catharina hospital Eindhoven, the Netherlands. Participants Adult patients scheduled for primary gastric bypass or sleeve gastrectomy. Interventions Same-day discharge with one week ongoing Remote Monitoring (RM) of vital parameters or Standard Care (SC) with discharge on postoperative day one. Main outcomes Primary outcome was a thirty-day composite Textbook Outcome score encompassing mortality, mild and severe complications, readmission and prolonged length-of-stay. Non-inferiority of same-day discharge and remote monitoring was accepted below the selected margin of 7% upper limit of confidence interval. Secondary outcomes included admission duration, post-discharge opioid use and patients’ satisfaction. Results Textbook Outcome was achieved in 94% (n = 102) in RM versus 98% (n = 100) in SC (RR 2.9; 95% CI, 0.60–14.23, p = 0.22). The non-inferiority margin was exceeded which is a statistically inconclusive result. Both Textbook Outcome measures were above Dutch average (5% RM and 9% SC). Same-day discharge reduced hospitalization days by 61% (p<0.001) and by 58% with re-admission days included (p<0.001). Post-discharge opioid use and satisfaction scores were equal (p = 0.82 and p = 0.86). Conclusion In conclusion, outpatient bariatric surgery supported with telemonitoring is clinically comparable to standard overnight bariatrics in terms of textbook-outcome. Both approaches reached primary endpoint results above Dutch average. However, statistically the outpatient surgery protocol was neither inferior, nor non-inferior to the standard pathway. Additionally, offering same-day discharge reduces the total hospitalization days while maintaining patient satisfaction and safety.

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Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: a before-and-after study

Cited by 55 publications

References 32 publications

Comparing Continuous with Periodic Vital Sign Scoring for Clinical Deterioration Using a Patient Data Model

Comparing Continuous with Periodic Vital Sign Scoring for Clinical Deterioration Using a Patient Data Model

Effect of a Wireless Vital Sign Monitoring System on the Rapid Response System in the General Ward

Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial

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