Clinical efficacy of continuous remote monitoring compared to intermittent monitoring on a surgical ward in a large European teaching hospital

In the last decades 10% of all clinically admitted patients in hospitals
experienced harm, of which at least 33% of the most severe incidents was due to
failure to recognize and treat the deteriorating patient timely on the general
wards. Therefore, to improve early recognition and adequate treatment for
deteriorating patients, Rapid Response Teams (RRT) have been introduced
worldwide since 1995 During a first Consensus meeting it was stated that
hospitals should implement an rapid response system (RRS), which consists of
four elements: an afferent, "crisis detection" and "response triggering"
mechanism; an efferent, predetermined rapid response team; a
governance/administrative structure to supply and organize resources; and a
mechanism to evaluate crisis antecedents and promote hospital process
improvement to prevent future events, thus implementing a system rather than a
team.
But even in hospitals with an established mature RRS, failure to rescue events
occur, mostly related to the *afferent limb* of the system, e.g. failure to
identify patients at risk. One of the key underlying mechanisms is that the
present Rapid Response System (RRS) is based on intermittent monitoring (*spot
checks*) every 6-12 hours which may lead to failure to detect a deteriorating
patient timely.
For example, a recent study showed that 47% of postoperative patients develop
hypotensive periods with a mean arterial pressure < 65 mmHg for at least 15
minutes, while another study showed that more than one third of surgical
patients experience an oxygen saturation level of <90% for an hour or more.
Earlier trials showed that continuous monitoring on the general ward (*low
care* environments) was associated with a reduced need for patient rescue
events or unplanned ICU admissions
Therefore, our aim is to investigate whether wireless continuous vital signs
monitoring contributes to timely recognition and treatment of the deterioration
patient on a surgical ward resulting in a reduced total hospital length of
stay.

Primary Objective: To investigate in surgical ward patients whether the use of
wireless continuous vital signs monitoring will reduce total length of hospital
stay.

Prospective, interventional single arm trial with historical controls.
The duration of the study is from april 6th to October 5th 2021.
Setting is a general ward in a large European teaching hospital.

The intervention group receives at admission continuous monitoring provided by
a wireless patch (CE marked; class2a), worn on the patient*s chest, with data
transmitted wirelessly every 2 minutes to a mobile device carried by the
patient*s nurse.

Apart of wearing a wireless patch during the stay at the general ward and
completing a single short questionnaire on their experience with wearing a
patch, which will take 5-10 minutes, the nature and extent of the burden and
risks are minimal to none.