Patients deteriorate
All hospitalised patients are at risk of deterioration but most catastrophic incidents are preceded by periods of change and abnormality in patients’ vital signs. If these changes in vital signs are detected and reacted to in a timely fashion then a significant proportion of costly patient deterioration can be avoided.
Currently approx. 10% of patients are harmed during their hospital stay and this represents a cost to the NHS of over £2.5B just to cover the additional length of stay for these patients.
Improved monitoring regimes & early detection of deterioration is key to reducing this significant burden for:
10% of patients harmed in UK hospitals5
The cost of extended length of stay to the NHS for patients harmed during their hospital stay.6
Lead indicators and possible causes...
The Sensium® Patch provides accurate and continuous monitoring of the three key lead indicators of patient deterioration: heart-rate (HR), respiration rate (RR) and axillary temperature. These lead indicators and possible associated causes are listed below.
Tachycardia (>100 bpm)
- Heart failure
- Pulmonary embolism
- Pneumonia
- Acute respiratory distress syndrome
- Anaphylaxis
- Shock
- Hypovolaemia
- Thyrotoxicosis
Bradycardia (<60 bpm)
- Myocardial infarction
- Hypothermia
- Hypoxia
- Hypothyroidism
- Raised intracranial pressure
Tachypnoea (>20 Br/m)
- Asthma
- Pulmonary embolism
- Pneumonia
- Heart failure
- Anaphylaxis
- Shock
- Acute respiratory distress syndrome
Pyrexia (>37.5 °c)
- Infection – 50% of pyrexia cases
- High ambient temp
- Stroke
- Myocardial infarction
- Drugs
Sensium® throughout all general care areas
Sensium® is focussed exclusively on general care clinicians whose patients currently do not have the safety and security of continuous vital signs monitoring.
A & E
Patient deteriorates while waiting for:
- Formal medical review.
- For further treatment or tests.
- For an in-patient bed.
General Medical
Emergency admissions – especially with potential instability.
Step down from ICU/Higher acuity areas.
Potential for patients to readmit to Critical Care.
Work closely with clinical outreach teams.
Post surgical
In-patient surgery - elective or emergency.
Complications after surgery:
- Haemorrhage
- Cardiovascular- Infection/sepsis
- Respiratory depression
Elderly Care
Increased co-morbidities.
This patient group can deteriorate quickly.
Atypical presentation more likely.
Less likely to raise awareness of feeling unwell.
Neutropenic Patients
Cancer/Chemotherapy.
Autoimmune Diseases.
Drug regimes.
Patient group is more susceptible to infection.
More severe results.
Important to get antibiotics on board asap
Unmonitored patients
The 3 most serious, costly and avoidable care incidents in these areas are: Sepsis, Cardiac arrest, Respiratory depression
Sepsis...
Sepsis is a life-threatening illness caused the body's response to an infection. Your immune system protects you from many illnesses and infections, but it’s also possible for it to go into overdrive in response to an infection.
Sepsis develops when the chemicals the immune system releases into the bloodstream to fight an infection cause inflammation throughout the entire body instead. Severe cases of sepsis can lead to septic shock, which is a medical emergency.
Sepsis may develop when you're already in hospital.
For example, you're more likely to develop sepsis if:
- You've recently had surgery
- You've had a urinary catheter fitted
- You have to stay in hospital for a long time
In the UK, hospital acquired severe sepsis accounts for about 11% of all instances of sepsis and is 100% preventable. Hospital acquired sepsis has double the mortality rate of community acquired sepsis and costs twice as much to treat11
Of the 37,000 patients that die in the UK from sepsis each year over 8,000 of them will have died of avoidable hospital acquired sepsis. This equates to 53 avoidable hospital deaths each year for each UK NHS trust.12
Sepsis starts with Systemic Inflammatory Response Syndrome (SIRS) and is defined when there is a known or suspected infection plus 2 or more of:
- Temp is over 38°C or below 36°C,
- Heart Rate is over 90 bpm,
- Resp Rate is over 20 Br/m
Sensium® can be configured to send notifications at these physiological limits to warn of potential sepsis as soon as it becomes apparent. If identified early treatment can be delivered to halt the development of SIRS to severe sepsis.
In hospital Cardiac Arrest...
A cardiac arrest happens when your heart stops pumping blood around your body. Most in-hospital cardiac arrests result in death within minutes – however, it is possible to recover from a cardiac arrest providing the right treatment is delivered quickly.
Cardiac arrests are usually preceded by measurable changes in a patient’s vital signs. By monitoring and reacting to these changes in vital signs, a significant proportion of in-hospital cardiac arrest deaths can be predicted and ultimately prevented.
The instance of in-hospital cardiac arrest is 1.6 per 1000 hospital admissions in the UK. Currently there are approx. 15.8M hospital admissions per year16 and this puts the total number of in-hospital cardiac arrests at over 25,000. Of these 25,000 patients over 80% will not recover to discharge and this results in more than 20,000 in-hospital cardiac arrests deaths per year.
Studies have shown that of these 20,000 deaths, more than 38% are preventable and this figure represents 7700 avoidable deaths. The would equate to more than 50 avoidable deaths each year for each UK NHS trust.
By continuously monitoring patients’ vital signs these changes to HR, RR and temp can be detected early. Notifications of the subtle changes that may be precursors to a cardiac arrest can be sent direct to the relevant caregiver ensuring that early clinical intervention can occur.
Respiratory depression...
Opioid analgesics (such as morphine, methadone, and fentanyl) have been in common use for decades for the treatment and management of moderate to severe post operative pain. Of the more common side effects, respiratory depression (reduced breathing rate) is the most serious due to the real potential for death and profound brain injury.
Opiates and opioids are Central Nervous System (CNS) depressants. The CNS controls your ability to breathe and keep the heart beating. When depressed too far by CNS depressants, these functions can slow down or eventually stop leading to serious injury or death.
Around 1% of patients being treated with opioids for post operative pain management will suffer effects related to respiratory depression. Currently in the UK there are approx. 7M operations performed20 each year resulting in a potential 70,000 cases of respiratory depression.
Studies have shown that over 97% of deaths or serious brain injuries related to opioid induced respiratory depression could be avoided21 with more robust patient monitoring regimes, and that the standard level of intermittent “spot checks” may be insufficient to reliably detect the condition.
Sensium continuously monitors respiratory rate and can notify clinicians of a reduced respiratory rate indicative of opioid induced respiratory depression. Studies suggest that the focus for preventing respiratory depression cases post operatively should be on the high risk time period rather than concentrating on high risk patient groups.
97% of deaths or serious brain injury following opioid induced respiratory depression are preventable21