Abstract
ObjectiveDelayed response to clinical deterioration as a result of intermittent vital sign monitoring is a cause of preventable morbidity and mortality. This review focuses on the clinical impact of multi-parameter continuous non-invasive monitoring of vital signs (CoNiM) in non-intensive care unit patients.DesignSystematic review and meta-analysis of primary studies. Embase, MEDLINE, HMIC, PsycINFO and Cochrane were searched from April 1964 to 18 June 2019 with no language restriction.SettingThe search was limited to hospitalised, non-intensive care unit adult patients who had two or more vital signs continuously monitored.ParticipantsAll primary studies that evaluated the clinical impact of using multi-parameter CoNiM in adult hospital wards outside of the intensive care unit.Main outcome measuresClinical impact of multi-parameter CoNiM.ResultsThis systematic review identified 14 relevant studies from 3846 search results. Five studies were classified as Group A – associations found between measured vital signs and clinical parameters. Nine studies were classified as Group B – comparison between clinical outcomes of patients with and without multi-parameter CoNiM. Vital signs data from CoNiM were found to associate with type of presenting complaint, level of renal function and incidence of major clinical events. CoNiM also assisted in diagnosis by differentiating between patients with acute heart failure, stroke and sepsis (with sub-clustering of septic patients). In the meta-analysis, patients on multi-parameter CoNiM had a 39% decrease in risk of mortality (risk ratio [RR] 0.61; 95% confidence interval [95% CI] 0.39, 0.95) when compared to patients with regular intermittent monitoring. There was a trend of reduced intensive care unit transfer (RR 0.86; 95% CI 0.67, 1.11) and reduced rapid response team activation (RR 0.61; 95% CI 0.26–1.43). A trend towards reduced hospital length of stay was also found using weighted mean difference (WMD –3.32 days; 95% CI -8.82–2.19 days).ConclusionThere is evidence of clinical benefit in implementing CoNiM in non-intensive care unit patients. This review supports the use of multi-parameter CoNiM outside of intensive care unit with further large-scale RCTs required to further affirm clinical impact.
Highlights
In response to the need for early detection, the National Early Warning Score was introduced by the Royal College of Physicians in 2012 with further updates in 2017.14,15 The vital signs monitored by the National Early Warning Score include heart rate, respiratory rate, blood pressure, temperature and peripheral capillary oxygen saturation (SpO2)
The present review aims to investigate the clinical impact of implementing continuous noninvasive monitoring of vital signs (CoNiM)
The protocol of this review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.[36]
Summary
Failure to detect clinical deterioration is an important cause of preventable morbidity and mortality in hospitals as vital sign changes can occur up to several hours before the incidence of adverse events.[1,2,3,4,5,6] Underlying causes such as sepsis, acute coronary syndrome and pulmonary embolism may be treated promptly with early detection.[7,8,9,10,11,12] Such delays have been highlighted in the 2018 National Confidential Enquiry into Patient Outcome and Death Common Themes and Recommendations report.[13] In response to the need for early detection, the National Early Warning Score was introduced by the Royal College of Physicians in 2012 with further updates in 2017.14,15 The vital signs monitored by the National Early Warning Score include heart rate, respiratory rate, blood pressure, temperature and peripheral capillary oxygen saturation (SpO2). The National Early Warning Score is used for all non-obstetric adult in patients 16 years).[15] Similar early warning scoring systems have been adopted in the United States, Denmark and Australia, among other countries.[16,17,18]
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