What does this research mean for the field?

Combining continuous wearable physiological monitoring with an integrated risk score system improves the early recognition and management of clinical deterioration in high-risk post-surgical patients without increasing unnecessary clinical observations. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 2, 2020Open Access

Early detection of physiological deterioration in post-surgical patients using wearable technology combined with an integrated monitoring system: a pre- and post-interventional study

PICO estructurado

Does continuous wearable monitoring combined with a VSI risk score improve recognition of physiological deterioration in post-surgical patients?

Población

407 patients who underwent major upper-gastrointestinal surgery at a single centre tertiary referral university hospital.

Intervención

Continuous wearable monitoring with an integrated monitoring system displaying a single 'risk' score (VSI) for clinical use, in addition to standard care.

Comparador

Continuous wearable monitoring and standard care, with the VSI score not available for clinical use.

Resultado

Frequency of clinical staff observations in the 36 hours prior to a major adverse event (death, cardiac arrest or unplanned admission to intensive care)

Combining an integrated monitoring system with ambulatory monitoring in high-risk post-surgical patients improved the frequency of clinical observations prior to adverse events without increasing unnecessary observations.

Resumen

ABSTRACT Objectives Late recognition of physiological deterioration is a frequent problem in hospital wards. We assessed whether ambulatory (wearable) physiological monitoring combined with a system that continuously merges physiological variables into a single “risk” score (VSI), changed care and outcome in patients after major surgery. Design Pre- and post-interventional study. Setting A single centre tertiary referral university hospital upper-gastrointestinal service. Participants Patients who underwent major upper-gastrointestinal surgery. Interventions Phase-I (pre-intervention phase): Patients received continuous wearable monitoring and standard care, but the VSI score was not available for clinical use. Phase-II (post-intervention phase): Patients received continuous wearable monitoring. In addition to standard care the VSI score was displayed for use in clinical practice. Measurements and Main Results 200 participants were monitored in phase-I. 207 participants were monitored in phase-II. Participants were monitored (median, interquartile range, IQR) for 30.2% (13.8-49.2) of available time in phase-I and 58.2% (33.1-75.2) of available time in phase-II. Clinical staff recorded observations more frequently in the 36 hours prior to a major adverse event (death, cardiac arrest or unplanned admission to intensive care) for phase-II participants (median, IQR, time between observations of 1.00, 0.50-2.08 hours) than phase-I participants (1.50, 0.75-2.50 hours, p <0.001). There was no difference in observation frequency between the two phases for participants who did not undergo an adverse event ( p =0.129). 6/200 participants died before hospital discharge in phase-I, 1/207 participants died in hospital in phase-II. 20 (10.0%) patients in phase-I and 26 (12.6%) patients in phase-II had an unplanned admission to intensive care. Ward length-of-stay was unaltered (8.91, 6.71-14.02 days in phase-I, vs. 8.97, 5.99-13.85 days in phase-II, p =0.327). Conclusion The combination of the integrated monitoring system with ambulatory monitoring in high-risk post-surgical patients improved recognition and management of deteriorating patients without increasing the observation rate in those patients who did not deteriorate.

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