Background: Failure to promptly recognize clinically deteriorating patients in the hospital leads to delays in critical interventions and worse health outcomes. Current standard practice in patient monitoring on most medical-surgical wards involves vital sign assessment at discrete time points, typically every four to eight hours. More frequent or continuous vital sign monitoring has historically been relegated to intensive care unit (ICU) settings, since cumbersome and tethering devices such as arterial catheters have typically been necessary. Detection and interventions for medical-surgical ward patients who deteriorate between discrete vital sign time intervals may be delayed, making critical interventions less effective.
Purpose: We have adopted wearable continuous vital sign monitoring technology in the inpatient setting with the aim of identifying clinical deterioration earlier in hospitalized medical-surgical patients.
Description: At University of Colorado Health, we have adopted inpatient wearables (ViSi, Sotera Wireless) across 300 medical-surgical beds in four hospitals throughout our health system. These comprise noninvasive sensors that monitor heart rate, respiration rate, temperature, SpO2, and 3-5 lead ECG, and also have the ability to detect posture and motion. Continuous blood pressure is computed based on the above measurements using pulse-arrival-time, and is periodically calibrated to traditional cuff-based measurements. We have examined the effects of implementation at our flagship academic medical center, where these wearables are in use in approximately 180 beds. Preliminary data have shown a decrease in code blue events as well as rapid response initiation rates, and stable ICU transfer rates. Logistical issues that have arisen include increased cognitive burden and alarm fatigue for bedside nurses. Our continuous vital sign monitoring program has been incorporated into a larger virtual health center that uses the continuous data to compute real-time deterioration scores. These scores are interpreted by trained clinicians at the center prior to notification of the bedside team, in an attempt to mitigate communication and alarm fatigue and to augment accuracy of the scores with clinical decision making.
Conclusions: We describe novel implementation of inpatient wearables for continuous vital sign monitoring on a large scale in our multi-center healthcare system. Preliminary data suggest benefits include decreased code blue and rapid response rates, which may be due to earlier detection of clinical deterioration and resultant therapeutic interventions.