Are current wireless monitoring systems capable of detecting adverse events in high-risk surgical patients? A descriptive study

Breteler M, KleinJan E, Numan L, Ruurda J, Van Hillegersberg R, Leenen L et al. Injury, 2019 

Summary

Background: 

The objective of the study was to describe the ability of currently available wireless sensors to detect adverse events in high-risk patients. 

Methods:

A descriptive analysis was performed of all vital signs trend data obtained during an observational comparison study of wearable sensors for vital signs monitoring in high-risk surgical patients during the initial days of recovery at a surgical step-down unit (SDU). Heart rate (HR), respiratory rate (RR) and oxygen saturation (SpO 2 ) were continuously recorded. Vital sign trend patterns of patients that developed adverse events were described and compared to vital sign recordings of patients without occurrence of adverse events. Two wearable patch sensors were used (SensiumVitals and HealthPatch), a bed-based mattress sensor (EarlySense) and a patient-worn monitor (Masimo Radius-7). 

Example of a patient in whom vital signs were recorded continuously on the surgical ward with the two wireless patch sensors (SensiumVitals: black, HealthPatch MD: blue), the bed-based system EarlySense (green) and a patient-worn monitor (Masimo Radius-7: red). The night from 11 p.m. to 7 a.m. is illustrated by shaded gray areas. No adverse events occurred during the measurement period. 

Results:

Twenty adverse events occurred in 11 of the 31 patients included. Atrial fibrillation (AF) was most common (20%). The onset of AF was recognizable as a sudden increase in HR in all recordings, and all patients with new-onset AF after esophagectomy developed other postoperative complications. Patients who developed respiratory insufficiency showed an increase in RR and a decrease in SpO2, but an increase in HR was not always visible. In patients without adverse events, temporary periods of high HR and RR are observed as well, but these were transient and less frequent. 

Conclusions:

Current systems for remote wireless patient monitoring on the ward are capable of detecting abnormalities in vital sign patterns in patients who develop adverse events. Remote patient monitoring may have potential to improve patient safety by generating early warnings for deterioration to nursing staff.