title: Effectiveness of continuous or intermittent vital signs monitoring in preventing adverse events on general wards: a systematic review and meta-analysis.
abstract: BACKGROUND
  Vital signs monitoring is an old hospital practice for patient safety but evaluation of its effectiveness is not widespread. We aimed to identify strategies to improve intermittent or continuous vital signs monitoring in general wards; and their effectiveness in preventing adverse events on general hospital wards.
  
  
  METHODS
  Publications searched between 1980 and June 2014 in five databases. Main outcome measures were in-hospital death, cardiac arrest, intensive care unit (ICU) transfers, length of stay, identification of physiological deterioration and activation of rapid response systems.
  
  
  RESULTS
  Twenty-two studies assessing the effect of continuous (9) or intermittent monitoring (13) and reporting outcomes on 203,407 patients in-hospital wards across 13 countries were included in this review. Both monitoring practices led to early identification of patient deterioration, increased rapid response activations and improvements in timeliness or completeness of vital signs documentation. Innovative intermittent monitoring approaches are associated with modest reduction in in-hospital mortality over intermittent vital signs monitoring in 'usual care'. However, there was no evidence of significant reduction in ICU transfers or other adverse events with either intermittent or continuous monitoring.
  
  
  CONCLUSIONS
  This review of heterogeneous monitoring approaches found no conclusive confirmation of improvements in prevention of cardiac arrest, reduction in length of hospital stay, or prevention of other neurological or cardiovascular adverse events. The evidence found to date is insufficient to recommend continuous vital signs monitoring in general wards as routine practice. Future evaluations of effectiveness need to be undertaken with more rigorous methods and homogeneous outcome measurements.
authors: The Simpson Centre for Health Services Research, South Western Sydney Clinical School and The Ingham Institute for Applied Medical Research, The University of NSW, Sydney, NSW, Australia. m.cardonamorrell@unsw.edu.au.
authors: M
authors: M
authors: Cardona-Morrell
authors: Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
authors: M
authors: M
authors: Prgomet
authors: School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, Australia.
authors: R M
authors: RM
authors: Turner
authors: Intensive Care Unit, Liverpool Hospital, Sydney, NSW, Australia.
authors: M
authors: M
authors: Nicholson
authors: The Simpson Centre for Health Services Research, South Western Sydney Clinical School and The Ingham Institute for Applied Medical Research, The University of NSW, Sydney, NSW, Australia.|Intensive Care Unit, Liverpool Hospital, Sydney, NSW, Australia.
authors: K
authors: K
authors: Hillman
mesh_terms: D003422:Critical Care; D006323:Heart Arrest / Q000517:prevention & control; D057209:Hospital Rapid Response Team; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008991:Monitoring, Physiologic / Q000379:methods*; D061214:Patient Safety; D010360:Patient Transfer / Q000706:statistics & numerical data; D010362:Patients' Rooms; D055986:Vital Signs / Q000502:physiology*