Evaluation of a wireless, portable, wearable multi-parameter vital signs monitor in hospitalized neurological and neurosurgical patients

Abstract

Unrecognized changes in patients' vital signs can result in preventable deaths in hospitalized patients. Few publications or studies instituting routine patient monitoring have described implementation and the setting of alarm parameters for vital signs. We wanted to determine if continuous multi-parameter patient monitoring can be accomplished with an alarm rate that is acceptable to hospital floor nurses and to compare the rate of patient deterioration events to those observed with routine vital sign monitoring. We conducted a prospective, observational, 5-month pilot study in a 26-bed adult, neurological/neurosurgical unit (non-ICU) in an academic medical center. A patient surveillance system employing a wireless body-worn vital signs monitor with automated nursing notification of alarms via smartphones was used to gather data. Data collected included: alarm rates, rapid response team (RRT) calls, intensive care unit (ICU) transfers, and unplanned deaths before and during the pilot study. Average alarm rate for all alarms (SpO, HR, RR, NIBP) was 2.3 alarms/patient/day. The RRT call rate was significantly reduced (p < 0.05) from 189 to 158 per 1000 discharges. ICU transfers per 1000 discharges were insignificantly reduced from 53 to 40 compared to the previous 5-month period in the same unit. Similar measures of comparison units did not change over the same period. Although unplanned patient deaths in the study unit were also reduced during the intervention period, this was not statistically significant. Continual, multi-parameter vital signs monitoring can be customized to reduce a high alarm rates, and may reduce rapid response team calls.

Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review

“…Five studies (N=1308) have been published about the ViSi Mobile (Sotera Wireless; Table 1 ) [ 39 , 40 , 51 , 59 , 60 ]. This device is worn on the wrist, upper arm, or chest, and it measures HR, RR, BP, SpO 2 , and skin temperature ( Table 2 ) [ 66 ].…”

Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis

“…27,28 This may then impact clinical outcomes such as mortality, hospital length of stay and transfer to intensive care unit, which are measures of success of the intervention in the context of current resource availability. 29,30 The hypothesis of this systematic review and metaanalysis is: CoNiM in adult hospital wards will aid the diagnostic process through earlier detection of clinical deterioration with the potential to improve patient outcomes. Continuous monitoring of single vital sign parameter such as heart rate telemetry and SpO 2 through oximetry have already been well described.…”

“…[44][45][46][47][48] Monitoring devices used were specified except in Cavallini et al 46 Vital signs monitored were specified in all except Pearl et al 49 All studies in this group only included nonacute and non-high-risk patients from general medical or surgical wards. 29,[44][45][46][47][48][49][50][51] Association with clinical parameters All five studies in Group A demonstrated clinically relevant information can be derived from data obtained through multi-parameter CoNiM. There were three main themes: patient information; predictive information; and diagnostic information.…”

“…Mortality. There was reduced mortality in patients with CoNiM in five studies 29,45,46,49,51 except Langhorne et al 47 Langhorne et al 47 included 'early mobilisation' as a separate intervention; therefore, half of the control population and half of the CoNiM population were also enrolled in 'early mobilisation'. The heterogenous population compounded by a small sample size (n ¼ 32) may have skewed the results.…”

“…Kisner et al 50 and Langhorne et al 47 received the lowest score as their patient population were found to be least representative of general non-acute in-hospital patients. Brown et al 48 and Weller et al 29 received top scores for including multiple control groups to account for both the effect of intervention and temporal changes.…”