The Effect of Continuous Versus Periodic Vital Sign Monitoring on Disease Severity of Patients with an Unplanned ICU Transfer

Abstract

Continuous vital sign monitoring (CM) may detect ward patient’s deterioration earlier than periodic monitoring. This could result in timely ICU transfers or in a transfer delay due to misperceived higher level of care on the ward. The primary objective of this study was to compare patient’s disease severity upon unplanned ICU transfer, before and after CM implementation. We included a one-year period before and after CM implementation between August 1, 2017 – July 31, 2019. Before implementation, surgical and internal medicine patients’ vital signs were periodically monitored, compared to continuous monitoring with wireless linkage to hospital systems after implementation. In both periods the same early warning score (EWS) protocol was in place. Primary outcome was disease severity scores upon ICU transfer. Secondary outcomes were ICU and hospital length of stay, incidence of mechanical ventilation and ICU mortality. In the two one-year periods 93 and 59 unplanned ICU transfer episodes were included, respectively. Median SOFA (3 (2–6) vs 4 (2–7), p = .574), APACHE II (17 (14–20) vs 16 (14–21), p = .824) and APACHE IV (59 (46–67) vs 50 (36–65), p = .187) were comparable between both periods, as were the median ICU LOS (3.0 (1.7–5.8) vs 3.1 (1.6–6.1), p.962), hospital LOS (23.6 (11.5–38.0) vs 19 (13.9–39.2), p = .880), incidence of mechanical ventilation (28 (47%) vs 22 (54%), p.490), and ICU mortality (11 (13%) vs 10 (19%), p.420). This study shows no difference in disease severity upon unplanned ICU transfer after CM implementation for patients who have deteriorated on the ward.

Implementing Wearable Sensors for Clinical Application at a Surgical Ward: Points to Consider before Starting

“…Early detection of deterioration in hospitalized patients by wearable sensors caused a reduction in intensive care unit admissions, rapid response teams, cardiac arrest calls, and complications [ 28 , 29 ]. However, a recent study found that disease severity, length of stay, and mortality of patients with unplanned intensive care unit admission was not affected by continuous vital sign monitoring on the ward [ 30 ]. In addition to early deterioration outcomes, other reported outcomes, as a result of continuous monitoring, were better pain relief and higher patient satisfaction [ 31 ].…”