Early detection of physiological deterioration in post-surgical patients using wearable technology combined with an integrated monitoring system: a pre- and post-interventional study
Watkinson P., Pimentel MAF., Clifton L., Clifton D., Vollam S., Young D., Tarassenko L.
ABSTRACT Objectives Late recognition of physiological deterioration is a frequent problem in hospital wards. We assessed whether ambulatory (wearable) physiological monitoring combined with a system that continuously merges physiological variables into a single “risk” score (VSI), changed care and outcome in patients after major surgery. Design Pre- and post-interventional study. Setting A single centre tertiary referral university hospital upper-gastrointestinal service. Participants Patients who underwent major upper-gastrointestinal surgery. Interventions Phase-I (pre-intervention phase): Patients received continuous wearable monitoring and standard care, but the VSI score was not available for clinical use. Phase-II (post-intervention phase): Patients received continuous wearable monitoring. In addition to standard care the VSI score was displayed for use in clinical practice. Measurements and Main Results 200 participants were monitored in phase-I. 207 participants were monitored in phase-II. Participants were monitored (median, interquartile range, IQR) for 30.2% (13.8-49.2) of available time in phase-I and 58.2% (33.1-75.2) of available time in phase-II. Clinical staff recorded observations more frequently in the 36 hours prior to a major adverse event (death, cardiac arrest or unplanned admission to intensive care) for phase-II participants (median, IQR, time between observations of 1.00, 0.50-2.08 hours) than phase-I participants (1.50, 0.75-2.50 hours, p <0.001). There was no difference in observation frequency between the two phases for participants who did not undergo an adverse event ( p =0.129). 6/200 participants died before hospital discharge in phase-I, 1/207 participants died in hospital in phase-II. 20 (10.0%) patients in phase-I and 26 (12.6%) patients in phase-II had an unplanned admission to intensive care. Ward length-of-stay was unaltered (8.91, 6.71-14.02 days in phase-I, vs. 8.97, 5.99-13.85 days in phase-II, p =0.327). Conclusion The combination of the integrated monitoring system with ambulatory monitoring in high-risk post-surgical patients improved recognition and management of deteriorating patients without increasing the observation rate in those patients who did not deteriorate.