Clinical efficacy of Remote continuous Monitoring supplementary to intermittent monitoring compared to intermittent monitoring on a surgical ward in a large Teaching hospital in the Netherlands

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 at least
three elements: (1) an afferent, "crisis detection" and "response triggering" mechanism; (2) an efferent, predetermined rapid response team; and (3) 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
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 supplementary wireless continuous vital signs
monitoring contributes to timely recognition and treatment of the deterioration patient on a surgical ward resulting in a reduced total length of hospital stay.

Remote continuous vital signs monitoring, supplementary to the RRS, contributes to timely recognition and treatment of the deterioration patient on a surgical ward resulting in a reduced total hospital length of stay.

6 month trial: total length of hospital stay, mortality, unplanned ICU admissions, 30-day readmissions data is extracted from our EMR; experience patients & care professionals is measured through a single questionnaire; alarmfatigue is measured indirectly through our continuous monitor/ patch system

supplementory remote continuous monitoring provided by a wireless patch, worn on the patient's chest, with data transmitted wirelessly every 2 minutes to a mobile device carried by the patient's nurse e.g.
respiratory rate, heartrate and temperature; thus, the continuous monitor functions as an organization's "safety net" for deteriorating inpatients in between the intermittent monitoring of vital signs
in the afferent limb of the RRS.