title: Factors related to monitoring during admission of acute patients.
abstract: Understanding the use of patient monitoring systems in emergency and acute facilities may help to identify reasons for failure to identify risk patients in these settings. Hence, we investigate factors related to the utilization of automated monitoring for patients admitted to an acute admission unit by introducing monitor load as the proportion between monitored time and length of stay. A cohort study of patients admitted and registered to patient monitors in the period from 10/10/2013 to 1/10/2014 at the acute admission unit of Odense University Hospital in Denmark. Admissions with at least one measurement were analyzed using quantile regression by looking at the impact of distance from nursing office, number of concurrent patients, wing type (medical/surgical), age, sex, comorbidities, and severity conditioned on how much patients were monitored during their admissions. We registered 11,848 admissions, of which we were able to link patient monitor readings to 3149 (26.6 %) with 50 % being monitored <1.4 % of total admission time. Distance from nursing office had little influence on patients monitored <10 % of their admission time. But for other patients, being positioned further away from the office reduced the level of monitoring. Higher levels of severity were related to higher degrees of monitoring, but being admitted to the surgical wing reduce how much patients were monitored, and periods with many concurrent patients lead to a small increase in monitoring. We found a significant variation concerning how much patients were monitored during admission to an acute admission unit. Our results point to potential patient safety improvements in clinical procedures, and advocate an awareness of how patient monitoring systems are utilized.
authors.affiliation: The Maersk Mc-Kinney Moeller Institute, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark. schmidt@mmmi.sdu.dk.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Camilla N
authors.initials: CN
authors.lastname: Bech
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.|Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Brabrand
authors.affiliation: The Maersk Mc-Kinney Moeller Institute, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
authors.forename: Uffe Kock
authors.initials: UK
authors.lastname: Wiil
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Annmarie
authors.initials: A
authors.lastname: Lassen
mesh_terms: D003422:Critical Care / Q000706:statistics & numerical data*; D064648:Critical Care Nursing / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000453:epidemiology* / Q000628:therapy*; D003718:Denmark / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D009730:Nursing Assessment / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D014600:Utilization Review
keywords: Computerized decision support; Emergency departments; Patient monitoring