Abstract
Background
For hospitalized patients with unexpected clinical deterioration, delayed or suboptimal
intervention is associated with increased morbidity and mortality. Lack of continuous
monitoring for average-risk patients has been suggested as a contributing factor for
unexpected in-hospital mortality. Our objective was to assess the effects of continuous
heart rate and respiration rate monitoring in a medical-surgical unit on unplanned
transfers and length of stay in the intensive care unit and length of stay in the
medical-surgical unit.
Methods
In a controlled study, we have compared a 33-bed medical-surgical unit (intervention
unit) to a “sister” control unit for a 9-month preimplementation and a 9-month postimplementation
period. Following the intervention, all beds in the intervention unit were equipped
with monitors that allowed for continuous assessment of heart and respiration rate.
Results
We reviewed 7643 patient charts: 2314 that were continuously monitored in the intervention
arm and 5329 in the control arms. Comparing the average length of stay of patients
hospitalized in the intervention unit following the implementation of the monitors
to that before the implementation and to that in the control unit, we observed a significant
decrease (from 4.0 to 3.6 and 3.6 days, respectively; P <.05). Total intensive care unit days were significantly lower in the intervention
unit postimplementation (63.5 vs 120.1 and 85.36 days/1000 patients, respectively;
P = .04). The rate of transfer to the intensive care unit did not change, comparing
before and after implementation and to the control unit (P = .19). Rate of code blue events decreased following the intervention from 6.3 to
0.9 and 2.1, respectively, per 1000 patients (P = .02).
Conclusions
Continuous monitoring on a medical-surgical unit was associated with a significant
decrease in total length of stay in the hospital and in intensive care unit days for
transferred patients, as well as lower code blue rates.
Keywords
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Article Info
Publication History
Published online: December 16, 2013
Footnotes
Funding: The study was funded by an industry grant provided by EarlySense Inc .
Conflict of Interest: HB has received consulting fees from EarlySense LTD; JT and PV have no conflicts to report; DWB has received consulting fees and Honoraria from EarlySense LTD and has received a research grant supported by EarlySense LTD; EZ has received a research grant supported by EarlySense LTD.
Authorship: HB has contributed to conception and design, to acquisition of data, and to the analysis and interpretation of data. HB has drafted the article and gave final approval of the version to be published. JT has contributed to conception and design, to acquisition of data, has critically revised the manuscript for important intellectual content, and gave final approval of the version to be published. PV has contributed to acquisition of data, has critically revised the manuscript for important intellectual content, and gave final approval of the version to be published. DWB has contributed to conception and design, to the analysis and interpretation of data, has critically revised the manuscript for important intellectual content, and gave final approval of the version to be published. EZ has contributed to conception and design, to the analysis and interpretation of data, has drafted the article, and gave final approval of the version to be published.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
