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A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards*

Bellomo, Rinaldo; Ackerman, Michael; Bailey, Michael; Beale, Richard; Clancy, Greg; Danesh, Valerie; Hvarfner, Andreas LU ; Jimenez, Edgar; Konrad, David and Lecardo, Michele, et al. (2012) In Critical Care Medicine 40(8). p.2349-2361
Abstract
OBJECTIVES:

Deteriorating ward patients are at increased risk. Electronic automated advisory vital signs monitors may help identify such patients and improve their outcomes.



SETTING:

A total of 349 beds, in 12 general wards in ten hospitals in the United States, Europe, and Australia.



PATIENTS:

Cohort of 18,305 patients.



DESIGN:

Before-and-after controlled trial.



INTERVENTION:

We deployed electronic automated advisory vital signs monitors to assist in the acquisition of vital signs and calculation of early warning scores. We assessed their effect on frequency, type, and treatment of rapid response team calls;... (More)
OBJECTIVES:

Deteriorating ward patients are at increased risk. Electronic automated advisory vital signs monitors may help identify such patients and improve their outcomes.



SETTING:

A total of 349 beds, in 12 general wards in ten hospitals in the United States, Europe, and Australia.



PATIENTS:

Cohort of 18,305 patients.



DESIGN:

Before-and-after controlled trial.



INTERVENTION:

We deployed electronic automated advisory vital signs monitors to assist in the acquisition of vital signs and calculation of early warning scores. We assessed their effect on frequency, type, and treatment of rapid response team calls; survival to hospital discharge or to 90 days for rapid response team call patients; overall type and number of serious adverse events and length of hospital stay.



MEASUREMENTS AND MAIN RESULTS:

We studied 9,617 patients before (control) and 8,688 after (intervention) deployment of electronic automated advisory vital signs monitors. Among rapid response team call patients, intervention was associated with an increased proportion of calls secondary to abnormal respiratory vital signs (from 21% to 31%; difference [95% confidence interval] 9.9 [0.1-18.5]; p = .029). Survival immediately after rapid response team treatment and survival to hospital discharge or 90 days increased from 86% to 92% (difference [95% confidence interval] 6.3 [0.0-12.6]; p = .04). Intervention was also associated with a decrease in median length of hospital stay in all patients (unadjusted p < .0001; adjusted p = .09) and more so in U.S. patients (from 3.4 to 3.0 days; unadjusted p < .0001; adjusted ratio [95% confidence interval] 1.03 [1.00-1.06]; p = .026). The time required to complete and record a set of vital signs decreased from 4.1 ± 1.3 mins to 2.5 ± 0.5 mins (difference [95% confidence interval] 1.6 [1.4-1.8]; p < .0001).



CONCLUSIONS:

Deployment of electronic automated advisory vital signs monitors was associated with an improvement in the proportion of rapid response team-calls triggered by respiratory criteria, increased survival of patients receiving rapid response team calls, and decreased time required for vital signs measurement and recording (NCT01197326). (Less)
Please use this url to cite or link to this publication:
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
rapid response team, vital signs, monitoring, early warning score, intensive care
in
Critical Care Medicine
volume
40
issue
8
pages
2349 - 2361
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000306604900012
  • pmid:22809908
  • scopus:84864201163
ISSN
1530-0293
DOI
10.1097/CCM.0b013e318255d9a0
language
English
LU publication?
yes
id
929840af-9fbd-4fcd-af1e-3c2b78dc5757 (old id 2966941)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22809908?dopt=Abstract
date added to LUP
2012-08-09 21:00:36
date last changed
2017-11-05 03:52:49
@article{929840af-9fbd-4fcd-af1e-3c2b78dc5757,
  abstract     = {OBJECTIVES:<br/><br>
Deteriorating ward patients are at increased risk. Electronic automated advisory vital signs monitors may help identify such patients and improve their outcomes. <br/><br>
<br/><br>
SETTING:<br/><br>
A total of 349 beds, in 12 general wards in ten hospitals in the United States, Europe, and Australia. <br/><br>
<br/><br>
PATIENTS:<br/><br>
Cohort of 18,305 patients. <br/><br>
<br/><br>
DESIGN:<br/><br>
Before-and-after controlled trial. <br/><br>
<br/><br>
INTERVENTION:<br/><br>
We deployed electronic automated advisory vital signs monitors to assist in the acquisition of vital signs and calculation of early warning scores. We assessed their effect on frequency, type, and treatment of rapid response team calls; survival to hospital discharge or to 90 days for rapid response team call patients; overall type and number of serious adverse events and length of hospital stay. <br/><br>
<br/><br>
MEASUREMENTS AND MAIN RESULTS:<br/><br>
We studied 9,617 patients before (control) and 8,688 after (intervention) deployment of electronic automated advisory vital signs monitors. Among rapid response team call patients, intervention was associated with an increased proportion of calls secondary to abnormal respiratory vital signs (from 21% to 31%; difference [95% confidence interval] 9.9 [0.1-18.5]; p = .029). Survival immediately after rapid response team treatment and survival to hospital discharge or 90 days increased from 86% to 92% (difference [95% confidence interval] 6.3 [0.0-12.6]; p = .04). Intervention was also associated with a decrease in median length of hospital stay in all patients (unadjusted p &lt; .0001; adjusted p = .09) and more so in U.S. patients (from 3.4 to 3.0 days; unadjusted p &lt; .0001; adjusted ratio [95% confidence interval] 1.03 [1.00-1.06]; p = .026). The time required to complete and record a set of vital signs decreased from 4.1 ± 1.3 mins to 2.5 ± 0.5 mins (difference [95% confidence interval] 1.6 [1.4-1.8]; p &lt; .0001). <br/><br>
<br/><br>
CONCLUSIONS:<br/><br>
Deployment of electronic automated advisory vital signs monitors was associated with an improvement in the proportion of rapid response team-calls triggered by respiratory criteria, increased survival of patients receiving rapid response team calls, and decreased time required for vital signs measurement and recording (NCT01197326).},
  author       = {Bellomo, Rinaldo and Ackerman, Michael and Bailey, Michael and Beale, Richard and Clancy, Greg and Danesh, Valerie and Hvarfner, Andreas and Jimenez, Edgar and Konrad, David and Lecardo, Michele and Pattee, Kimberly S and Ritchie, Josephine and Sherman, Kathie and Tangkau, Peter},
  issn         = {1530-0293},
  keyword      = {rapid response team,vital signs,monitoring,early warning score,intensive care},
  language     = {eng},
  number       = {8},
  pages        = {2349--2361},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Critical Care Medicine},
  title        = {A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards*},
  url          = {http://dx.doi.org/10.1097/CCM.0b013e318255d9a0},
  volume       = {40},
  year         = {2012},
}