Continuous Monitoring of Vital Signs Using Wearable Devices on the General Ward: Pilot Study

Abstract

BackgroundMeasurement of vital signs in hospitalized patients is necessary to assess the clinical situation of the patient. Early warning scores (EWS), such as the modified early warning score (MEWS), are generally calculated 3 times a day, but these may not capture early deterioration. A delay in diagnosing deterioration is associated with increased mortality. Continuous monitoring with wearable devices might detect clinical deterioration at an earlier stage, which allows clinicians to take corrective actions.ObjectiveIn this pilot study, the feasibility of continuous monitoring using the ViSi Mobile (VM; Sotera Wireless) and HealthPatch (HP; Vital Connect) was tested, and the experiences of patients and nurses were collected.MethodsIn this feasibility study, 20 patients at the internal medicine and surgical ward were monitored with VM and HP simultaneously for 2 to 3 days. Technical problems were analyzed. Vital sign measurements by nurses were taken as reference and compared with vital signs measured by both devices. Patient and nurse experiences were obtained by semistructured interviews.ResultsIn total, 86 out of 120 MEWS measurements were used for the analysis. Vital sign measurements by VM and HP were generally consistent with nurse measurements. In 15% (N=13) and 27% (N=23) of the VM and HP cases respectively, clinically relevant differences in MEWS were found based on inconsistent respiratory rate registrations. Connection failure was recognized as a predominant VM artifact (70%). Over 50% of all HP artifacts had an unknown cause, were self-limiting, and never took longer than 1 hour. The majority of patients, relatives, and nurses were positive about VM and HP.ConclusionsBoth VM and HP are promising for continuously monitoring vital signs in hospitalized patients, if the frequency and duration of artifacts are reduced. The devices were well received and comfortable for most patients.

Evaluation of Wearable Digital Devices in a Phase I Clinical Trial

“…The observed diurnal patterns in HR, RR, ST, and activity were consistent with the previous reports . Our experience of periods of missing vital sign data is consistent with previously published results …”

“…We also observed missing data, an effect that is likely to be amplified in study subjects with medical conditions who are seen in usual practice. Adherence was an issue in this study of relatively low complexity, although it was comparable with other similar reports 8 ; it is likely to be a limiting factor in subjects with disease conditions as well.…”

“…17,18 Our experience of periods of missing vital sign data is consistent with previously published results. 8 There were significant limitations with the HR data produced by the HealthPatch device because of the volume of artefacts produced that require a follow-up and a manual review. Although the HR recordings showed good correlation with traditional in-clinic measures, there were many reported episodes of tachycardia due to voltage artefacts that required manual visual review by a physician to resolve.…”

“…Moreover, the results of some studies indicate that digital innovation in health care is more complicated than anticipated and that some technologies do not perform as the researchers had planned . In addition, published results indicate that there is a need for extensive manual review of data and for the investigation of potential device‐derived data artefacts, activities that can be time consuming …”

“…7 In addition, published results indicate that there is a need for extensive manual review of data and for the investigation of potential device-derived data artefacts, activities that can be time consuming. 8…”