The publication from the Department of Anesthesiology at Amsterdam University Medical Center, reviews elements of rapid response systems for recognising deteriorating patients on the ward and suggests possible further improvements for clinical settings. The publication states that ‘Some systems measure vital signs accurately, like the SensiumVitals system1 (Sensium Healthcare, London, UK). This is a wireless patch measuring respiratory rate, heart rate, and temperature every 2 minutes.’
The review highlights that ‘monitoring vital signs might improve early recognition of a deteriorating patient because adverse events (AEs) preceded by changes in vital signs in most patients’. Research reported a ‘5.7% incidence of AEs in hospitalized patients in the Netherlands. Forty percent of the AEs were preventable. More than half of these AEs were related to surgical procedures2.’
It is recommended, although not often practiced, that ‘vital signs/MEWS measurement takes place at least once every 6–12 hours on the ward’. Early Warning Scores have been introduced to highlight patients at risk for critical events when their vital signs are deranging from predetermined baseline/cut off scores. However ‘timely and accurate monitoring of vital signs is a crucial first step in providing adequate input for EWS systems’. The review emphasises that changes in respiratory rate seem to be the most important predictor of clinical deterioration.
The publication defines remote wireless monitoring as ‘technology whereby patients wear a non-invasive sensor that measures physiological variables’ with the advantage being that vital signs are constantly measured. ‘Wireless monitoring technology sometimes rejects data when, for instance, vital signs measurement is distorted due to severe motion artefacts. Hence, only accurate data is transferred to the caregivers. Accurate vital signs are available 50%–96% of the time, thus far more frequently than when vital signs are measured manually1’.
Introducing remote monitoring technology requires significant implementation and the report highlights that ‘caregivers need to realize that the system provides for a reduction in workload because vital signs monitoring is time consuming and stressful, particularly at night, when the nurse: patient ratio declines.’
The publication concludes that elements of rapid response systems need further improvement, and education and training are essential. ‘Remote monitoring systems can support caregivers in the afferent arm of the system by measuring vital signs continuously and most importantly in an accurate manner.’
Copyright © 2019 International Anesthesia Research Society
1. Hernandez-Silveira M, Ahmed K, Ang SS, et al. Assessment of the feasibility of an ultra-low power, wireless digital patch for the continuous ambulatory monitoring of vital signs. BMJ Open. 2015;5:e006606.
2. Zegers M, de Bruijne MC, Wagner C, et al. Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. Qual Saf Health Care. 2009;18:297–302.