title: Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial.
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.
authors.affiliation: California Hospital Medical Center, a member of Dignity Health, Los Angeles.
authors.forename: Harvey
authors.initials: H
authors.lastname: Brown
authors.affiliation: California Hospital Medical Center, a member of Dignity Health, Los Angeles.
authors.forename: Jamie
authors.initials: J
authors.lastname: Terrence
authors.affiliation: California Hospital Medical Center, a member of Dignity Health, Los Angeles.
authors.forename: Patricia
authors.initials: P
authors.lastname: Vasquez
authors.affiliation: The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.affiliation: The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: ezimlichman@partners.org.
authors.forename: Eyal
authors.initials: E
authors.lastname: Zimlichman
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D005260:Female; D006339:Heart Rate; D017052:Hospital Mortality / Q000639:trends*; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007388:Internal Medicine; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011446:Prospective Studies; D056152:Respiratory Rate; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*
keywords: Clinical alarms; Heart arrest; Hospital rapid response team; Intensive care unit