Undetected clinical deterioration that results from inefficient and ineffective vital signs monitoring practices, coupled with the potential for overmedication or other unanticipated adverse event, can result in prolonged hospitalization, decreased quality of life and even death. Those patients that survive, frequently require treatment in an Intensive Care Unit (ICU) to avoid further deterioration. Patients who are shifted from a general care ward to an intensive care unit require more resources, have a longer hospital stay, and are more likely to have poor outcomes. More frequent vital signs monitoring can prevent undetected patient deterioration, but how is that possible in today’s understaffed and overstressed healthcare environment?
Why Vital Signs Monitoring is Important
The postoperative complication rate after major abdominal surgery ranges from 20% to 44%, leading to re-interventions, extended hospital stays, intensive care unit (ICU) admissions, and mortality, ultimately leading to reduced life expectancy, lower quality of life, and higher healthcare expenses.
Early identification of postoperative deterioration allows for earlier management and improved outcomes. Currently, the best frequency of vital sign measurements is uncertain. Still, most surgical wards are tasked with running from patient to patient, getting frequent vital signs measurements immediately post-op and then decreasing the frequency of measurements as the first 24 hours of their stay wears on. According to data, about half of all adverse occurrences in hospitals occur outside of ICU units, and a majority of postoperative complications occur within the first 24 hours.
Application of Continuous Vital Signs Monitoring
Early warning tools, such as the Modified Early Warning Score (MEWS), are used to identify high-risk patients and treat them before the development of life-threatening events such as cardiac arrest or the need for an ICU transfer. However, a key weakness of current monitoring practice is its sporadic and intermittent character, which may result in the diagnosis of clinical deterioration being delayed, particularly during night shifts with lower staffing per patient rates.
Wearable, wireless sensor technology advancements allow for continuous monitoring of vital signs. Emerging research suggests that these monitoring sensors are accurate and may enhance outcomes and decrease costs in clinical practice by allowing for early detection of changes in vital signs. A prior trial on continuous monitoring of abdominal surgery patients resulted in early antibiotic delivery, shorter hospital stays, and lower readmission rates within 30 days.
Another study revealed more quick reaction team treatments, fewer cardiac arrests, lower overall mortality, lower illness severity and death in ICU patients, and an increase in proactive end-of-life care decision-making. Several other trials using wearable monitoring devices revealed possible benefits such as reduced patient disturbance and increased sleep, reduced effort among nurses, and enhanced patient safety during patient transit between departments.
However, there is currently a lack of understanding about the feasibility of utilizing such a continuous monitoring device on a general ward, particularly because continuous monitoring can be classified as a complex intervention with numerous interacting components and healthcare professional behavior modification.
The Use of ViSi Mobile in General Wards
In a study, ViSi Mobile was examined in a setting of hospitalized non-ICU patients. MEWS data were compared between regular periodic measurements by nurses and device measurements, and high MEWS durations between nurses' measurements were discovered.
The main findings include:
- Nurses were alarmed by VM between two regular nurse measurements in three patients in this research and alerted a physician. Later on, the patients were diagnosed with pneumonia, atrial fibrillation, and anastomotic leaking.
- Almost half of all high MEWS computed on VM measures happened in the evenings and nights, when patients are less likely to be observed and more prone to unrecognized deterioration.
- Algorithms based on machine learning can reduce these false alarms.
- The frequency of the Rapid Response Teams (RRT) activations increased, and complete and timely vital sign documentation improved.
- Continuous monitoring has the potential to increase patient well-being by eliminating sleep disruptions caused by nurse measurements.
ViSi Mobile appears to have promise for continuous vital signs monitoring in the general ward. It is more accurate than nurses at measuring respiratory rate. High MEWS levels can be detected in hospitalized patients around the clock, allowing for the detection of clinical deterioration in previously unnoticed times at an earlier stage. The availability of continuous monitoring may open the way for accurate prediction of impending clinical deterioration and prompt management.
