title: Monitoring cardiorespiratory instability: Current approaches and implications for nursing practice.
abstract: Unrecognised in-hospital cardiorespiratory instability (CRI) risks adverse patient outcomes. Although step down unit (SDU) patients have continuous non-invasive physiologic monitoring of vital signs and a ratio of one nurse to four to six patients, detection of CRI is still suboptimal. Telemedicine provides additional surveillance but, due to high costs and unclear investment returns, is not routinely used in SDUs. Rapid response teams have been tested as possible approaches to support CRI patients outside the intensive care unit with mixed outcomes. Technology-enabled early warning scores, though rigorously studied, may not detect subtle instability. Efforts to utilise nursing intuition as a means to promote early identification of CRI have been explored, but the problem still persists. Monitoring systems hold promise, but nursing surveillance remains the key to reliable early detection and recognition. Research directed towards improving nursing surveillance and facilitating decision-making is needed to ensure safe patient outcomes and prevent CRI.
authors.affiliation: School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Building, Pittsburgh, PA 15261, USA. Electronic address: elb93@pitt.edu.
authors.forename: Eliezer
authors.initials: E
authors.lastname: Bose
authors.affiliation: School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Building, Pittsburgh, PA 15261, USA. Electronic address: lhof@pitt.edu.
authors.forename: Leslie
authors.initials: L
authors.lastname: Hoffman
authors.affiliation: School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Building, Pittsburgh, PA 15261, USA. Electronic address: mhra@pitt.edu.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Hravnak
mesh_terms: D003661:Decision Support Techniques; D006305:Health Status Indicators; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards; D012720:Severity of Illness Index; D017216:Telemedicine / Q000592:standards
keywords: Cardiorespiratory instability; Early warning scores; Medical emergency team; Nursing surveillance; Physiologic monitoring; Rapid response systems; Vital signs