In Reply

Abstract

We appreciate the interest Dr. and Mrs. Rampil have taken in our recent article in Anesthesiology.1As highlighted in their letter, the introduction of surveillance monitoring, as commonly used in the intensive care unit or the operating room, into the general-care setting (a traditionally unmonitored environment) does break new ground. It provides tremendous opportunities for research, education, and improvement in patient safety.In our article, we demonstrated a reduction in intensive care unit transfers by almost 50% and a decrease in rescue events by 65%; in our view, these are meaningful changes. Although we did see a statistically significant reduction in mortality, we deemphasized that change because of a possible small number effect. Even though Dr. and Mrs. Rampil are concerned about adequate power, the study's sample size with 19,070 patient days analyzed was clearly sufficient; indeed, as stated above, we chose to not emphasize some changes (such as mortality), even though they were statistically significant.We do agree that a reduction in intensive care unit transfers and rescue events are proxy outcomes as a measure of escalation in care and that better surveillance prompts earlier intervention, which leads to a reduction in escalation in care. Our interpretation is indeed, as hypothesized by the Rampils, that improved monitoring leads to an increase in early interventions and thus prevents adverse events and an escalation in care. Nursing interventions, such as those triggered by the monitoring system, were by protocol. A measure of these early interventions may be desirable, but we had decided that if a clear link could be established between the introduction of the system and a decrease in escalation of care, we may conclude that it is due to earlier interventions without measuring them directly.We are continuously monitoring overall patient satisfaction, as well as nurse satisfaction, with Patient Surveillance. Patient satisfaction has not changed with the introduction of Patient Surveillance on the unit we reported on, nor on two more surgical units that the system has been introduced to since, while nurse satisfaction has increased.Abenstein and Narr2stated in an accompanying editorial to our article, “Early intervention guided by this system reduced the need for patient rescue interventions, including Intensive Care Unit transfers. These results could have important implications for hospital wards throughout the country.” We entirely agree and would like to point out that much work remains to be done in the area of Patient Surveillance. Our publication was a first step in that direction. We hope that anesthesiologists, given their expertise in patient safety and monitoring, will be at the forefront of these exciting developments.*Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire. andreas.h.taenzer@dartmouth.edu