A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards.
OBJECTIVE
Deteriorating ward patients are at increased risk. Electronic automated advisory vital signs monitors may help identify such patients and improve their outcomes.


METHODS
A total of 349 beds, in 12 general wards in ten hospitals in the United States, Europe, and Australia.


METHODS
Cohort of 18,305 patients.


METHODS
Before-and-after controlled trial.


METHODS
We deployed electronic automated advisory vital signs monitors to assist in the acquisition of vital signs and calculation of early warning scores. We assessed their effect on frequency, type, and treatment of rapid response team calls; survival to hospital discharge or to 90 days for rapid response team call patients; overall type and number of serious adverse events and length of hospital stay.


RESULTS
We studied 9,617 patients before (control) and 8,688 after (intervention) deployment of electronic automated advisory vital signs monitors. Among rapid response team call patients, intervention was associated with an increased proportion of calls secondary to abnormal respiratory vital signs (from 21% to 31%; difference [95% confidence interval] 9.9 [0.1-18.5]; p=.029). Survival immediately after rapid response team treatment and survival to hospital discharge or 90 days increased from 86% to 92% (difference [95% confidence interval] 6.3 [0.0-12.6]; p=.04). Intervention was also associated with a decrease in median length of hospital stay in all patients (unadjusted p<.0001; adjusted p=.09) and more so in U.S. patients (from 3.4 to 3.0 days; unadjusted p<.0001; adjusted ratio [95% confidence interval] 1.03 [1.00-1.06]; p=.026). The time required to complete and record a set of vital signs decreased from 4.1±1.3 mins to 2.5±0.5 mins (difference [95% confidence interval] 1.6 [1.4-1.8]; p<.0001).


CONCLUSIONS
Deployment of electronic automated advisory vital signs monitors was associated with an improvement in the proportion of rapid response team-calls triggered by respiratory criteria, increased survival of patients receiving rapid response team calls, and decreased time required for vital signs measurement and recording (NCT01197326).
Department of Intensive Care, Austin Health, Melbourne, Australia. rinaldo.bellomo@austin.org.au
Rinaldo
R
Bellomo
Michael
M
Ackerman
Michael
M
Bailey
Richard
R
Beale
Greg
G
Clancy
Valerie
V
Danesh
Andreas
A
Hvarfner
Edgar
E
Jimenez
David
D
Konrad
Michele
M
Lecardo
Kimberly S
KS
Pattee
Josephine
J
Ritchie
Kathie
K
Sherman
Peter
P
Tangkau
D056902:Clinical Alarms; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006769:Hospitals, General / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D055986:Vital Signs / Q000502:physiology*