Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study

Abstract

Background Postoperative pain, side‐effects and time to mobilisation are indicators for the quality of postoperative recovery. The aim of this randomised controlled study was to investigate if efficacy safety score (ESS) combined with a wireless patient monitoring system would improve these clinical outcomes for patients at a general surgical ward. Methods The trial included 195 patients randomised to a standard care group (SC‐Group) or intervention group (INT‐Group) receiving continuous wireless monitoring of vital signs combined with ESS during the first 24 postoperative hours. The primary outcome was time to mobilisation. Secondary outcomes were average pain, doses of postoperative opioids, unscheduled interventions, side‐effects, patient satisfaction and length of hospital stay (LOS). Results Mean time to postoperative mobilisation was 10.1 hours for patients in the INT‐Group compared to 14.2 hours in the SC‐Group; this corresponds to an adjusted hazard ratio of 1.54 (95% confidence interval 1.04‐2.28). INT‐Group patients received a higher dose of oral morphine equivalents; 26 mg vs 15 mg, P < .001; reported lower intensity of pain on a 0‐10 scale; 2.1 vs 3.3, P < .001; and had higher patient satisfaction on a 5‐point scale; 4.9 vs 4.3, P < .001. The LOS was similar between the groups; 71 hours in INT‐Group vs 77 hours in SC‐Group, P = .58. No serious side‐effects were registered in INT‐Group, whereas two were registered in SC‐Group. Conclusions Introducing ESS as a decision tool combined with a wireless monitoring system resulted in less pain, increased satisfaction and more rapid mobilisation for patients in this study. Trial Registration: http://clinicaltrials.gov Identifier: NCT03438578.

What Is the Impact of Ambulatory Vital Sign Monitoring on Deterioration Detection and Related Clinical Outcomes in Hospitalised Patients: a Systematic Review and Meta-analysis.

“…As the authors provided the total number of discharges, the actual event numbers were calculated for inclusion in our analysis [26]. Similarly, another included study presented the hospital length of stay (LoS) in hours [27], this was converted to days for the analysis. In a further study, the authors presented LoS in median (Interquartile range, IQR), which was converted to mean (standard deviation, SD).…”

“…Four studies also reported the patient American Society of Anaesthesiologists (ASA) score for preoperative functional status [42], with a median ASA score of 2 ("Patient has mild systemic disease") in three studies [29,30,43] and 3 ("Patient has severe systemic disease that is not incapacitating.") in one [27].…”

“…Devices A variety of devices were used in the studies included in this review: four studies used the VisiMobile (Sotera Visi Mobile, San Diego, California) [26,[36][37][38], with two studies also adding the HealthPatch (Vital Connect, Campbell, CA, USA) [37,38]; two studies used Sensium Vitals (Sensium, Abingdon, United Kingdom) [29,30]. The remaining four studies used different devices, including the Patient Status Engine (Isansys Lifecare Ltd.) [27], the Auricall monitoring system [39], the Avant-4100 (Nonin) [40] and the Monica Novii wireless patch system (General Electric Company, Milwaukee, WI) [41]. Included studies and outcomes Of the ten studies identi ed, seven were included in the meta-analysis with a total of 4127 patients.…”

“…Included studies and outcomes Of the ten studies identi ed, seven were included in the meta-analysis with a total of 4127 patients. These included two RCTs [27,30], one cluster RCT [29], and four before-and-after observational studies [26,36,39,40]. Three further studies (RCTs) were included in the narrative synthesis [37,38,41], including a total of 306 further patients.…”

“…2 and 3. For the included RCTs, using the ROB2, two were identi ed as at "low risk" of bias [30,41] and a further three were assessed as raising "some concerns" [27,37], including the cluster RCT [29]. The risk of bias, assessed by the ROBINS-I was "moderate" for all before-and-after studies [26,36,39,40].…”