Factors related to monitoring during admission of acute patients

Thomas Schmidt,Uffe Kock Wiil,Annmarie Lassen,Mikkel Brabrand,Camilla N Bech

doi:10.1007/s10877-016-9876-y

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.

Highlights

Patients of all sorts and with a wide range of diagnoses are treated in emergency departments (ED) around the world every single day
There exists a gap between the clinical reality and the vital sign registration procedures defined by guidelines [7, 8], and as most research on automated monitoring has been conducted in the settings of intensive care units (ICU) [9] we in this work focus instead on monitoring in acute settings
The purpose of this paper is to investigate the use of automated monitoring of patients admitted to an acute admission unit by analyzing how much the effects of distance from the nursing office, number of concurrently admitted patients, wing type, age, sex, comorbidities, and severity change conditioned on how much patients are monitored during admission

Summary

Introduction

Patients of all sorts and with a wide range of diagnoses are treated in emergency departments (ED) around the world every single day. Keeping track of such a diverse group of patients challenges both clinicians and systems. J Clin Monit Comput (2017) 31:641–649 reduced by a more frequent and rigorous approach to monitoring of patient vital signs [2]. The decision to continuously monitor a patient’s vital signs can still be a result of multiple causes; e.g., raised patient concern, or to optimize working procedures by not having to attach sensors repeatedly on patients requiring frequent registrations. There exists a gap between the clinical reality and the vital sign registration procedures defined by guidelines [7, 8], and as most research on automated monitoring has been conducted in the settings of intensive care units (ICU) [9] we in this work focus instead on monitoring in acute settings

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