title: A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients.
abstract: We conducted a randomised controlled trial of mandated five-channel physiological monitoring vs standard care, in acute medical and surgical wards in a single UK teaching hospital. In all, 402 high-risk medical and surgical patients were studied. The primary outcome was the proportion of patients experiencing one or more major adverse events, including urgent staff calls, changes to higher care levels, cardiac arrests or death, in 96 h following randomisation. Secondary outcomes were the proportion of patients requiring acute treatment changes, and the 30-day and hospital mortality. In the 96 h following randomisation, 113 (56%) patients in the monitored arm and 116 (58%) in the control arm (OR 0.94, 95% CI 0.63-1.40, p = 0.76) had a major event. An acute change in treatment was necessary in 107 (53%) monitored patients and 101 (50%) control patients (OR 0.55, 95% CI 0.87-1.29). Thirty-four (17%) monitored patients and 35 (17%) control patients died within 30 days. Thirteen patients in the control group received full five-channel monitoring at the request of the ward staff. We conclude that mandated electronic vital signs monitoring in high risk medical and surgical patients has no effect on adverse events or mortality.
authors.affiliation: Intensive Care Society Clinical Trials Group, John Radcliffe Hospital, Oxford, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Watkinson
authors.forename: V S
authors.initials: VS
authors.lastname: Barber
authors.forename: J D
authors.initials: JD
authors.lastname: Price
authors.forename: A
authors.initials: A
authors.lastname: Hann
authors.forename: L
authors.initials: L
authors.lastname: Tarassenko
authors.forename: J D
authors.initials: JD
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D003422:Critical Care; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006323:Heart Arrest / Q000517:prevention & control; D006339:Heart Rate / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D010092:Oximetry; D011379:Prognosis; D012119:Respiration; D012307:Risk Factors; D012881:Skin Temperature / Q000502:physiology; D013997:Time Factors