Adding to the challenges, hospitals continue struggling with ongoing workforce shortages among nurses and physicians, as the population ages in the next several years.
That heightened patient complexity—combined with the growing number of people to be cared for by a clinical workforce that is not expanding to meet increased demand—means hospitals and health systems need more effective ways to monitor patients to detect deterioration earlier than traditional spot checks.
Despite the need for improved methods of monitoring patients, this technology has advanced only incrementally over the last few decades and legacy bedside monitors are not designed to support the higher acuity and rapid changes seen in today's medical-surgical patients. Instead, those tools often produce an abundance of alarms that are burdensome to clinicians, rather than meaningful or actionable.
New research, however, shows that continuously monitoring vital signs with the right technologies can yield data that mitigates alert fatigue and optimizes actionable alarms1. Continuous monitoring technologies enable earlier detection than intermittent spot checks2 to help clinicians improve patient safety3, and drive cost-savings4.
While continuous monitoring has long been the standard in intensive care units, new wireless and wearable monitoring devices are enabling hospitals to achieve the benefits of earlier, more efficient detection in three key departments beyond the ICU:
- Medical-surgical units
- Telemetry units
- Emergency departments
Medical-Surgical Units
With new technologies, hospitals can transform their practices from the spot check model to continuous patient monitoring. That’s critical given how common inconsistencies are in spot checks. One study shows that fewer than half (40%) of vital signs were monitored according to physician orders5. Delayed or inaccurate spot check monitoring can lead to late detection of deterioration and potentially dangerous failure-to-rescue events.
To address delayed detection, continuous monitoring enables hospitals to expand monitoring parameters to include heart rate, pulse oximetry, and respiratory rates, amongst others, to detect clinical deterioration earlier6. Multiple studies have shown that surveillance programs can result in earlier deterioration being recognized earlier7, continuously monitoring more vital signs reduces transfers to the ICU8, and continuous monitoring decreases ICU utilization, length-of-stay, code blue events, and costs9.
By reducing alarm fatigue and delivering actionable data, continuous monitoring equips clinicians with the information to identify patients who either need to be moved to the ICU, kept in a lower-acuity unit, or prepared for discharge.
Telemetry Units
Many clinicians recognize the need for continuous monitoring and therefore prescribe cardiac telemetry, which historically has been the only mobile continuous monitoring technology available. Yet, estimates vary as to the exact percentage of patients in telemetry who do not require cardiac monitoring. Even the conservative finding that 25% of patients do not meet American Heart Association telemetry guidelines10 is too many. Overuse of telemetry adds to costs, diminishes patient throughput, and increases length of stay11.
Respiratory rate has been shown to be the leading indicator of patient deterioration for non-cardiac patients12. Traditional sources for respiratory rate have been limited to the bedside, but that compromises mobility, and multiple studies have shown that mobilizing patients as early as possible leads to improved outcomes, including reducing both length of stay and readmission rates13,14,15. Bedside monitors, on the other hand, can create blind spots where critical changes to patient acuity might go unrecognized when people move around without monitors16.
As wireless and wearable monitors have expanded to track parameters beyond ECG, these tools can enable clinicians to shift patients from cardiac telemetry to the more appropriate respiratory rate telemetry. Wireless and wearable monitors, in fact, can complement cardiac tools by monitoring respiratory rates for non-cardiac patients to predict or detect deterioration earlier than cardiac-only monitors17.
Leveraging continuous monitoring as an alternative to telemetry also allows hospitals to open telemetry beds for patients who are accurately indicated to need cardiac monitoring18.
Emergency Departments
Because care is not immediately available to all patients presenting to the ED—whether the department is full, or the hospital is full and the ED cannot shift patients to the right unit or room—bottlenecks are among the main drivers of inefficiencies that limit timely and correct care in EDs19.
As such, hospitals are dependent on pre-admission observation units to evaluate patients and avoid overcrowding20. Continuously monitoring patients can produce early warnings at triage that have demonstrated success in predicting deterioration of one or more vital signs, such as heart rate, oxygen saturation, or blood pressure21. Early warning scores have been shown to enable clinicians to more effectively identify patients who need to be transferred to a higher level of care22. Continuous monitoring can help clinicians recognize patient deterioration even earlier than spot check intervals.
The risk of not closely monitoring patients is considerable. One study found that nearly one-third (31%) of people admitted to an ED with normal vital signs deteriorated within the first 24 hours23, and deteriorating patients had four times higher 30-day all-cause mortality24.
Continuous Patient Monitoring Benefits Across All Three Units
Although continuous monitoring has traditionally been limited to ICUs, a new generation of wireless and wearable devices is enabling continuous monitoring in additional units. Whether in medical-surgical, telemetry, or ED, continuous monitoring can enable hospitals to escalate or de-escalate patients appropriately, increase patient capacity to improve throughput and reduce wait times. In addition, it can help augment the workforce with accurate and actionable data—all of which enable clinicians to make faster decisions with greater confidence to positively impact patients.
Sources:
1. Alarm threshold and duration limits on medical-surgical wards through alarm burden modeling, American Society of Anesthesiologists
https://www.abstractsonline.com/pp8/#!/10809/presentation/6664
2. Deviating vital signs in continuous monitoring prior to discharge and risk of readmissions: an observational study, Internal and Emergency Medicine
https://pubmed.ncbi.nlm.nih.gov/37326796/
3. Surveillance monitoring to improve patient safety in acute hospital care units, Agency for Healthcare Research & Quality
4. Cost-savings through continuous vital signs monitoring, GE Healthcare
5. Delayed recognition of deterioration in patients in general wards is mostly caused by human related monitoring failures: a root cause analysis of unplanned ICU admissions, PLoS One
https://pubmed.ncbi.nlm.nih.gov/27537689/
6. Importance of respiratory rate for the prediction of clinical deterioration after emergency department discharge: a single-center, case–control study
https://onlinelibrary.wiley.com/doi/10.1002/ams2.252
7. Impact of remote patient monitoring systems on nursing time, healthcare providers, and patient satisfaction in general wards, Cureus https://www.cureus.com/articles/255710-impact-of-remote-patient-monitoring-systems-on-nursing-time-healthcare-providers-and-patient-satisfaction-in-general-wards#!/
8. The effect of continuous versus periodic vital sign monitoring on disease severity of patients with an unplanned ICU transfer, Journal of Medical Systems
https://link.springer.com/article/10.1007/s10916-023-01934-3
9. Reducing ICU utilization, length of stay, and cost by optimizing the clinical use of continuous monitoring system technology in the hospital, American Journal of Medicine https://www.sciencedirect.com/science/article/abs/pii/S0002934321006987
10. Impact of 2017 American Heart Association guidelines on cardiac telemetry utilization: study from a tertiary medical center, Circulation, a journal of the AHA
https://www.ahajournals.org/doi/10.1161/circ.140.suppl_1.15093
11. AHA telemetry guidelines improve telemetry utilization in the inpatient setting, American Journal of Managed Care
12. Respiratory rate monitoring and early detection of deterioration practices, British Journal of Nursing
https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2023.32.13.620
1[3. The effect of mobilization at 6 months after critical illness: a meta-analysis, New England Journal of Medicine
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200234
14. The effects of early mobilization on patients requiring extended mechanical ventilation across multiple ICUs, Critical Care Explorations
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314317/
15. A novel early mobility bundle improves length of stay rates and readmission among hospitalized general medicine patients, Journal of Community Hospital Internal Medicine Perspectives
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671722/
16. Research interview conducted with GE HealthCare executive in March 2024
17. Respiratory rate monitoring and early detection of deterioration practices, British Journal of Nursing
https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2023.32.13.620
18. Research interview conducted with GE HealthCare executive in March 2024
19. Emergency department overcrowding: understanding the factors to find corresponding solutions, Journal of Personalized Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8877301/
20. Untapped potential for emergency observation unit use: a national hospital ambulatory medical care survey study, West Journal of Emergency Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8967459/
21. Combination of the National Early Warning Score (NEWS) and inflammatory biomarkers for early risk stratification in emergency department patients: results of a multinational, https://bmjopen.bmj.com/content/9/1/e024636
22. Combination of the National Early Warning Score (NEWS) and inflammatory biomarkers for early risk stratification in emergency department patients: results of a multinational, observational study, BMJ Journals https://bmjopen.bmj.com/content/9/1/e024636
23. Prognosis and risk factors for deterioration in patients admitted to a medical emergency department, PLoS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0094649
24. Prognosis and risk factors for deterioration in patients admitted to a medical emergency department, PLoS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0094649
