A Prospective Study of Nighttime Vital Sign Monitoring Frequency and Risk of Clinical Deterioration

Yoder, Jordan C.; Yuen, Trevor C.; Churpek, Matthew M.; Arora, Vineet M.; Edelson, Dana P.

doi:10.1001/jamainternmed.2013.7791

Cited by 59 publications

(52 citation statements)

References 8 publications

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“…This research can be accomplished by clinical assessments or perhaps risk stratifications, similar to what has been proposed for nonsurgical patients. For example, in a study involving 54,096 hospitalised patients, Yoder, Yuen, Churpek, Arora, and Edelson () suggested that night‐time vital sign monitoring may be safely omitted in medically stable patients (low risk) based on the Modified Early Warning Score (MEWS). With the goal of promoting sleep and facilitating physiological repair during recovery and rehabilitative periods, investigators should attempt to examine the feasibility and usability of MEWS (a risk stratification model) 22 in adult cardiac surgery by starting with select “stable patients” in progressive‐care units.…”

Section: Discussionmentioning

confidence: 99%

Night‐time care routine interaction and sleep disruption in adult cardiac surgery

Casida

Davis

Zalewski

et al. 2018

Journal of Clinical Nursing

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Section: Discussionmentioning

confidence: 99%

Night‐time care routine interaction and sleep disruption in adult cardiac surgery

Casida

Davis

Zalewski

et al. 2018

Journal of Clinical Nursing

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“…Early warning scores, such as the Modified Early Warning Score (MEWS) (17), can be used to risk stratify patients for additional surveillance. We have previously shown that an 11 PM MEWS score correlates well with overnight risk of clinical deterioration on the general wards (18) and that more advanced tools which incorporate vital signs, laboratory data and demographics with machine learning modeling are even more accurate (19). Further, these tools can be configured to automatically notify caregivers and even activate the rapid response team directly when patients pass a pre-set threshold.…”

Section: Discussionmentioning

confidence: 99%

Association Between Survival and Time of Day for Rapid Response Team Calls in a National Registry

Churpek

Edelson

Lee

et al. 2017

Critical Care Medicine

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Objective Decreased staffing at nighttime is associated with worse outcomes in hospitalized patients. Rapid response teams (RRTs) were developed to decrease preventable harm by providing additional critical care resources to patients with clinical deterioration. We sought to determine whether RRT call frequency suffers from decreased utilization at night and how this is associated with patient outcomes. Design Retrospective analysis of a prospectively collected registry database Setting National registry database of inpatient RRT calls Patients Index RRT calls occurring on the general wards in the American Heart Association Get With the Guidelines-Medical Emergency Team database between 2005 and 2015 were analyzed. Interventions None Measurements and Main Results The primary outcome was in-hospital mortality. Patient and event characteristics between the hour with the highest and lowest mortality were compared, and multivariable models adjusting for patient characteristics were fit. A total of 282,710 RRT calls from 274 hospitals were included. The lowest frequency of calls occurred in the consecutive 1 AM–6:59 AM period, with 266/274 (97%) of hospitals having lower than expected call volumes during those hours. Mortality was highest during the 7 AM hour and lowest during the noon hour (18.8 vs. 13.8%; adjusted OR 1.41 (1.31–1.52); P<0.001). Compared to calls at the noon hour, those during the 7 AM hour had more deranged vital signs, were more likely to have a respiratory trigger, and were more likely to have >2 simultaneous triggers. Conclusions RRT activation is less frequent during the early morning and is followed by a spike in mortality in the 7 AM hour. These findings suggest that failure to rescue deteriorating patients is more common overnight. Strategies aimed at improving RRT utilization during these vulnerable hours may improve patient outcomes.

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“…Manually assessment of vital parameters might take up to 10 mins, meaning that even if vital functions are measured every 4 h (6 times a day), this will result in only 60 min of direct surveillance of the ward patient within 24 h, leaving the post-operative ward patient un-monitored for 96% of the time. Taking vital parameters during night might add burden because of sleep deterioration and its consequences in the hospitalised patient [30]. Continuous wireless monitoring can help to dramatically reduce the interval for assessing vital parameters without affecting mobilization of the patient, or disturbing sleep.…”

Section: Discussionmentioning

confidence: 99%

Insights into postoperative respiration by using continuous wireless monitoring of respiratory rate on the postoperative ward: a cohort study

Posthuma

Visscher

Lirk

et al. 2019

J Clin Monit Comput

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Change of respiratory rate (RespR) is the most powerful predictor of clinical deterioration. Brady-(RespR ≤ 8) and tachypnea (RespR ≥ 31) are associated with serious adverse events. Simultaneously, RespR is the least accurately measured vital parameter. We investigated the feasibility of continuously measuring RespR on the ward using wireless monitoring equipment, without impeding mobilization. Continuous monitoring of vital parameters using a wireless SensiumVitals® patch was installed and RespR was measured every 2 mins. We defined feasibility of adequate RespR monitoring if the system reports valid RespR measurements in at least 50% of time-points in more than 80% of patients during day-and night-time, respectively. Data from 119 patients were analysed. The patch detected in 171,151 of 227,587 measurements valid data for RespR (75.2%). During postoperative day and night four, the system still registered 68% and 78% valid measurements, respectively. 88% of the patients had more than 67% of valid RespR measurements. The RespR's most frequently measured were 13-15; median RespR was 15 (mean 16, 25th-and 75th percentile 13 and 19). No serious complications or side effects were observed. We successfully measured electronically RespR on a surgical ward in postoperative patients continuously for up to 4 days post-operatively using a wireless monitoring system. While previous studies mentioned a digit preference of 18-22 for RespR, the most frequently measured RespR were 13-16. However, in the present study we did not validate the measurements against a reference method. Rather, we attempted to demonstrate the feasibility of achieving continuous wireless measurement in patients on surgical postoperative wards. As the technology used is based on impedance pneumography, obstructive apnoea might have been missed, namely in those patients receiving opioids post-operatively.

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A Prospective Study of Nighttime Vital Sign Monitoring Frequency and Risk of Clinical Deterioration

Cited by 59 publications

References 8 publications

Night‐time care routine interaction and sleep disruption in adult cardiac surgery

Night‐time care routine interaction and sleep disruption in adult cardiac surgery

Association Between Survival and Time of Day for Rapid Response Team Calls in a National Registry

Insights into postoperative respiration by using continuous wireless monitoring of respiratory rate on the postoperative ward: a cohort study

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