title: Impact of introducing an electronic physiological surveillance system on hospital mortality.
abstract: BACKGROUND
  Avoidable hospital mortality is often attributable to inadequate patient vital signs monitoring, and failure to recognise or respond to clinical deterioration. The processes involved with vital sign collection and charting; their integration, interpretation and analysis; and the delivery of decision support regarding subsequent clinical care are subject to potential error and/or failure.
  
  
  OBJECTIVE
  To determine whether introducing an electronic physiological surveillance system (EPSS), specifically designed to improve the collection and clinical use of vital signs data, reduced hospital mortality.
  
  
  METHODS
  A pragmatic, retrospective, observational study of seasonally adjusted in-hospital mortality rates in three main hospital specialties was undertaken before, during and after the sequential deployment and ongoing use of a hospital-wide EPSS in two large unconnected acute general hospitals in England. The EPSS, which uses wireless handheld computing devices, replaced a paper-based vital sign charting and clinical escalation system.
  
  
  RESULTS
  During EPSS implementation, crude mortality fell from a baseline of 7.75% (2168/27,959) to 6.42% (1904/29,676) in one hospital (estimated 397 fewer deaths), and from 7.57% (1648/21,771) to 6.15% (1614/26,241) at the second (estimated 372 fewer deaths). At both hospitals, multiyear statistical process control analyses revealed abrupt and sustained mortality reductions, coincident with the deployment and increasing use of the system. The cumulative total of excess deaths reduced in all specialties with increasing use of the system across the hospital.
  
  
  CONCLUSIONS
  The use of technology specifically designed to improve the accuracy, reliability and availability of patients' vital signs and early warning scores, and thereby the recognition of and response to patient deterioration, is associated with reduced mortality in this study.
authors.affiliation: Medical Assessment Unit, Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, UK.
authors.forename: Paul E
authors.identifier: http://orcid.org/0000-0001-5856-8262
authors.initials: PE
authors.lastname: Schmidt
authors.affiliation: TEAMS centre, Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Meredith
authors.affiliation: TEAMS centre, Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, UK School of Computing, University of Portsmouth, Portsmouth, Hampshire, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Prytherch
authors.affiliation: Intensive Care Medicine and Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: Watson
authors.affiliation: Critical Care Outreach, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: Valerie
authors.initials: V
authors.lastname: Watson
authors.affiliation: The Learning Clinic, London, UK.
authors.forename: Roger M
authors.initials: RM
authors.lastname: Killen
authors.affiliation: The Learning Clinic, London, UK Department of Primary Care and Public Health, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Greengross
authors.affiliation: Quality & Effectiveness, School of Health Studies, University of Bradford, Bradford, UK.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Mohammed
authors.affiliation: School of Health & Social Care, University of Bournemouth, Bournemouth, UK.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Smith
mesh_terms: D000368:Aged; D034201:Computers, Handheld; D004739:England; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006769:Hospitals, General / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000451:nursing*; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055986:Vital Signs
keywords: Adverse events, epidemiology and detection; Control charts, run charts; Decision support, computerized; Information technology; Mortality (standardized mortality ratios)