Abstract
BackgroundTimely recognition of the deteriorating inpatient remains challenging. Wearable monitoring systems (WMS) may augment current monitoring practices. However, there are many barriers to implementation in the hospital environment, and evidence describing the clinical impact of WMS on deterioration detection and patient outcome remains unclear.ObjectiveTo assess the impact of vital-sign monitoring on detection of deterioration and related clinical outcomes in hospitalised patients using WMS, in comparison with standard care.MethodsA systematic search was conducted in August 2020 using MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL, Health Technology Assessment databases and grey literature. Studies comparing the use of WMS against standard care for deterioration detection and related clinical outcomes in hospitalised patients were included. Deterioration related outcomes (primary) included unplanned intensive care admissions, rapid response team or cardiac arrest activation, total and major complications rate. Other clinical outcomes (secondary) included in-hospital mortality and hospital length of stay. Exploratory outcomes included alerting system parameters and clinical trial registry information.ResultsOf 8706 citations, 10 studies with different designs met the inclusion criteria, of which 7 were included in the meta-analyses. Overall study quality was moderate. The meta-analysis indicated that the WMS, when compared with standard care, was not associated with significant reductions in intensive care transfers (risk ratio, RR 0.87; 95% confidence interval, CI 0.66–1.15), rapid response or cardiac arrest team activation (RR 0.84; 95% CI 0.69–1.01), total (RR 0.77; 95% CI 0.44–1.32) and major (RR 0.55; 95% CI 0.24–1.30) complications prevalence. There was also no statistically significant association with reduced mortality (RR 0.48; 95% CI 0.18–1.29) and hospital length of stay (mean difference, MD − 0.09; 95% CI − 0.43 to 0.44).ConclusionThis systematic review indicates that there is no current evidence that implementation of WMS impacts early deterioration detection and associated clinical outcomes, as differing design/quality of available studies and diversity of outcome measures make it difficult to reach a definite conclusion. Our narrative findings suggested that alarms should be adjusted to minimise false alarms and promote rapid clinical action in response to deterioration.PROSPERO Registration number: CRD42020188633.
Highlights
Failure to recognise and act on physiological indicators of worsening illness in acute hospital wards is a generic problem that was recognised over a decade ago [1, 2] and may contribute to increased emergency intensive care unit (ICU) admissions and hospital mortality [1, 3]
The meta-analysis indicated that the Wearable monitoring systems (WMS), when compared with standard care, was not associated with significant reductions in intensive care transfers, rapid response or cardiac arrest team activation (RR 0.84; 95% confidence intervals (CIs) 0.69–1.01), total (RR 0.77; 95% CI 0.44–1.32) and major (RR 0.55; 95% CI 0.24–1.30) complications prevalence
There was no statistically significant association with reduced mortality (RR 0.48; 95% CI 0.18–1.29) and hospital length of stay
Summary
Background Failure to recognise and act on physiological indicators of worsening illness in acute hospital wards is a generic problem that was recognised over a decade ago [1, 2] and may contribute to increased emergency intensive care unit (ICU) admissions and hospital mortality [1, 3]. In the United Kingdom, the use of physiological early warning scoring (EWS) systems (which measure "standard" vital signs such as pulse rate, respiratory rate, blood pressure, oxygen saturation, and temperature) is still common practice in general wards, together with a graded response such as referral for a senior review or increasing monitoring frequency [4]. This frequency of observations is generally guided by the clinical condition of the patient, and due to the requirement of manual physiological measurements, it can be time-consuming for healthcare professionals [5]. There are many barriers to implementation in the hospital environment, and evidence describing the clinical impact of WMS on deterioration detection and patient outcome remains unclear
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