Detection of Postoperative Vital Signs Abnormalities on a Surgical Ward using Conventional and Remote Automated Monitoring
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Keywords
remote automated monitoring; vital signs
Abstract
Background: The true incidence of abnormal vital signs on post-surgical wards may be seriously underestimated based on nurse obtained conventional measurement. We sought to determine the incidence and severity of postoperative tachycardia, bradycardia and hypoxemia detected by continuous remote automated monitoring (RAM) versus the incidence of these vital sign abnormalities detected during routine nursing care.
Methods: We conducted a prospective cohort proof-of-concept study of 121 patients aged ≥45 years recov-ering from orthopedic surgery. Eligible patients were at risk of postoperative myocardial injury and had a planned hospital stay ≥48 hours. Philips’ IntelliVue MX40 wearable RAM technology was used to continu-ously monitor patients’ heart rate and pulse oximetry up to 72 hours following surgery. In addition, study personnel obtained vital signs collected during routine nursing care from participants’ medical charts. Clinically meaningful tachycardia, bradycardia and hypoxemia were defined as heart rates >100, <55, and blood oxyhemoglobin saturation (SpO2) of <90% for >15 contiguous minutes, respectively.
Results: Continuous RAM identified clinically meaningful episodes of tachycardia in 42 of 121 patients [34.7%] versus 7 patients [5.8%] identified by routine nursing care, for an absolute difference 28.9% (95% confidence interval [CI] 20.8, 37.0; p=0.001). RAM also detected bradycardia in 14 of 121 patients [11.6%] versus 6 patients [5.0%] detected by routine care, for an absolute difference 6.6% (95% CI 2.2, 11.0; p=0.07). RAM detected hypoxemia in 25 of 107 patients [23.3%] compared with 1 patient [0.9%] detected through routine monitoring, for an absolute difference of 22.4% (95% CI 14.5, 30.3; p=0.001).
Conclusion: Most clinically meaningful episodes of vital signs abnormalities detected by continuous RAM were missed by nurses through conventional periodic monitoring. Continuous RAM technologies have the potential to improve patient outcomes through early identification of physiological abnormalities on surgical wards.
Résumé
Contexte: La fréquence réelle des signes vitaux anormaux dans les unités de soins postopératoires peut être grandement sous-estimée sur la base des mesures classiques obtenues par le personnel infirmier. Nous avons cherché à déterminer la fréquence et la gravité de la tachycardie, de la bradycardie et de l’hypoxémie post-opératoires détectées par une surveillance automatisée à distance (SAD) en continu par rapport à la fréquence de ces anomalies des signes vitaux décelées pendant les soins infirmiers courants.
Méthodologie: Nous avons mené une étude prospective de validation de concept auprès de 121 patients âgés de 45 ans ou plus se remettant d’une intervention chirurgicale orthopédique. Les patients admissibles présen-tent un risque de lésion myocardique postopératoire et leur séjour prévu à l’hôpital est d’au moins 48 heures. Le moniteur portable IntelliVue MX40 de Philips issu de la technologie de SAD a été utilisé pour surveiller en continu la fréquence cardiaque et l’oxymétrie de pouls des patients pendant 72 heures après l’interven-tion chirurgicale. En outre, le personnel de l’étude a pu obtenir les mesures des signes vitaux recueillies lors des soins infirmiers courants à partir des dossiers médicaux des participants. La tachycardie, la bradycardie et l’hypoxémie d’importance clinique ont été définies comme étant respectivement une fréquence cardiaque supérieure à 100 pour la tachycardie et inférieure à 55 pour la bradycardie et une saturation pulsée en oxygène (SpO2) inférieure à 90 % pendant plus de 15 minutes consécutives.
Résultats: La SAD en continu a relevé des épisodes d’importance clinique de tachycardie chez 42 des 121 patients (34,7 %) comparativement à 7 patients (5,8 %) dans le cas des soins infirmiers courants, soit une différence absolue de 28,9 % (intervalle de confiance [IC] à 95 % de 20,8 à 37,0; P = 0,001). La SAD a égale-ment détecté une bradycardie chez 14 des 121 patients (11,6 %) comparativement à 6 patients (5,0 %) dans le cas des soins courants, soit une différence absolue de 6,6 % (IC à 95 % de 2,2 à 11,0; P = 0,07). La SAD a détecté une hypoxémie chez 25 patients sur 107 (23,3 %) comparativement à 1 patient (0,9 %) dans le cas des soins courants, la différence absolue étant de 22,4 % (IC à 95 % de 14,5 à 30,3; P = 0,001).
Conclusion: La plupart des épisodes d’importance clinique d’anomalies des signes vitaux détectés par la SAD en continu ont été manqués par les infirmières lors de la surveillance périodique classique. Les technologies de SAD en continu peuvent améliorer l’évolution de l’état de santé des patients grâce à une détection précoce des anomalies physiologiques dans les services de chirurgie.
Methods: We conducted a prospective cohort proof-of-concept study of 121 patients aged ≥45 years recovering from orthopedic surgery. Eligible patients were at risk of postoperative myocardial injury and had a planned hospital stay ≥48 hours. Philips’ IntelliVue MX40 wearable RAM technology was used to continuously monitor patients’ heart rate and pulse oximetry up to 72 hours following surgery. In addition, study personnel obtained vital signs collected during routine nursing care from participants’ medical charts. Clinically meaningful tachycardia, bradycardia and hypoxemia were defined as heart rates >100, <55, and blood oxyhemoglobin saturation (SpO2) of <90% for >15 contiguous minutes, respectively.
Results: Continuous RAM identified clinically meaningful episodes of tachycardia in 42 of 121 patients [34.7%] versus 7 patients [5.8%] identified by routine nursing care, for an absolute difference 28.9% (95% confidence interval [CI] 20.8, 37.0; p=0.001). RAM also detected bradycardia in 14 of 121 patients [11.6%] versus 6 patients [5.0%] detected by routine care, for an absolute difference 6.6% (95% CI 2.2, 11.0; p=0.07). RAM detected hypoxemia in 25 of 107 patients [23.3%] compared with 1 patient [0.9%] detected through routine monitoring, for an absolute difference of 22.4% (95% CI 14.5, 30.3; p=0.001).
Conclusion: Most clinically meaningful episodes of vital signs abnormalities detected by continuous RAM were missed by nurses through conventional periodic monitoring. Continuous RAM technologies have the potential to improve patient outcomes through early identification of physiological abnormalities on surgical wards.
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Michael McGillion, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada;
Population Health Research Institute, Hamilton, Ontario, Canada
Maura Marcucci , McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada;
Population Health Research Institute, Hamilton, Ontario, Canada
Flavia Borges , McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada;
Population Health Research Institute, Hamilton, Ontario, Canada
David Conen , McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada;
Population Health Research Institute, Hamilton, Ontario, Canada
Brenda Coleman, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada;
Krysten Gregus, Population Health Research Institute, Hamilton, Ontario, Canada
Population Health Research Institute, Hamilton, Ontario, Canada
Saman Parvaneh , Philips Research North America, Cambridge, Massachusetts
Philips Research North America, Cambridge, Massachusetts
Amal Bessisow, McGill University Health Centre, Division of General Internal Medicine, Montreal, Quebec
McGill University Health Centre, Division of General Internal Medicine, Montreal, Quebec
Ameen Patel , McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
Prathiba Harsha , Hamilton Health Sciences, Hamilton, Ontario
Hamilton Health Sciences, Hamilton, Ontario
Carley Ouellette, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
Sandra Ofori , McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada;
Population Health Research Institute, Hamilton, Ontario, Canada
Daniel Sessler , Population Health Research Institute, Hamilton, Ontario, Canada, Cleveland Clinic, Cleveland, Ohio
Population Health Research Institute, Hamilton, Ontario, Canada
Cleveland Clinic, Cleveland, Ohio
P.J. Devereaux, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada;
Population Health Research Institute, Hamilton, Ontario, Canada