Green Line Hospital-Territory Study: A Single-Blind Randomized Clinical Trial for Evaluation of Technological Challenges of Continuous Wireless Monitoring in Internal Medicine, Preliminary Results.

Filomena Pietrantonio,Elena Alessi,Fabrizio Montagnese,Antonio Vinci,Matteo Pascucci,Francesco Rosiello,Roberto D’Amico,Antonella Valerio,Michela Delli Castelli,Marianna Rainone,Angela Ciamei,Dario Manfellotto

doi:10.3390/ijerph181910328

Abstract

Background: Wireless vital parameter continuous monitoring (WVPCM) after discharge is compared to regular monitoring to provide data on the clinical-economic impact of complex patients (CPs) discharged from Internal Medicine Units of Ospedale dei Castelli, Lazio. Primary outcome: Major complications (MC) reduction. Secondary outcomes: Patients who reached discharge criteria within the 7th day from admission; difference in MC incidence at the conclusion of the standard telemonitoring/clinical monitoring phase, 5 and 30 days after discharge; and conditions predisposing to MC occurrence. Methods: Open label randomized controlled trial with wearable wireless system that creates alerts on portable devices. Continuous glycemic monitoring is performed for patients with diabetes mellitus. Results: There were 110 patients enrolled (mean age: 76.2 years). Comorbidity: Cumulative Illness Rating Scale CIRS-CI (comorbidities index): 3.93, CIRS SI (severity index): 1.93. About 19% scored a BRASS (Blaylock Risk Assessment Screening Score) ≥20 indicating need for discharge planning requiring step-down care. Globally, 48% of patients in the control group had major complications (27 out of 56 patients), in contrast to 22% in the intervention group (12 out of 54 patients). Conclusions: Since WVPCM detects early complications during the post-discharge CPs monitoring, it increases safety and reduces inappropriate access to the Emergency Room, preventing avoidable re-hospitalizations.

Highlights

In recent years, more and more patients admitted to internal medicine (IM) wards have been reported as being in large part affected by a wide range of acute, subacute, Int
Recent studies have shown a reduction of up to 60% (345 min per day) [25] of nurse care with telemedicine systems
Since there are no studies in current literature comparthe use of wireless monitoring systems of vital signs in complex patients to a more tradiing the use of wireless monitoring systems of vital signs in complex patients to a more tional monitoring system, the intent of this work is to help highlight the potential benefits traditional monitoring system, the intent of this work is to help highlight the potential of a continuous monitoring strategy in terms of reduction in major complications, imbenefits of a continuous monitoring strategy in terms of reduction in major complications, provement of outcomes, and reduction in costs

Summary

Introduction

More and more patients admitted to internal medicine (IM) wards have been reported as being in large part affected by a wide range of acute, subacute, Int. Often the patients are elderly, frail, and with multiple co-morbidities, requiring intensive care treatment [1] Hospitalization of such patients in large wards without prior stratification of severity, complexity, level of dependence, co-morbidities and, without a proper risk assessment for rapid clinical deterioration, has been demonstrated to be a major cause of suboptimal treatment, leading to an increase in hospital length of stay and rising care costs [2]. The definition of the roles of hospital and community, in response to patient needs, is the fundamental component of the socio-health organizational models that is being implemented in various Italian regions In this context it is necessary to define the most appropriate care settings, such as the care for standard patient management, the technological requirements, and the crucial pathways. Comorbidity: Cumulative Illness Rating Scale CIRS-CI (comorbidities index): 3.93, CIRS SI (severity index): 1.93

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