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Leenen JPL, Ardesch V, Kalkman CJ, Schoonhoven L, Patijn GA. Impact of wearable wireless continuous vital sign monitoring in abdominal surgical patients: before-after study. BJS Open 2024; 8:zrad128. [PMID: 38235573 PMCID: PMC10794900 DOI: 10.1093/bjsopen/zrad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Technological advances have enabled continuous monitoring of vital signs (CMVS) by wearable, wireless devices on general hospital wards to facilitate early detection of clinical deterioration, which could potentially improve clinical outcomes. However, evidence on the impact of these CMVS systems on patient outcomes is limited. This research aimed to explore the effect of CMVS on the clinical outcomes in major abdominal surgery patients in a general surgery ward. METHODS A single-centre before-after study was conducted from October 2019 to June 2022. Patients in the intervention group received CMVS in addition to conventional intermittent vital sign monitoring (standard care for control group). With CMVS, heart rate and respiratory rate were measured every 5 min by a patch sensor. Proactive vital signs trends assessments and, when necessary, subsequent nursing activities were performed every nursing shift. The primary outcome of interest was the length of hospital stay (LOS); also, 12 patient-related outcomes were analysed. In the CMVS group, follow-up nursing activities of deviating vital signs trends were described and patient acceptability was measured. Post-hoc subgroup analysis was performed for colorectal and hepatopancreatobiliary surgery. RESULTS A total of 908 patients were included (colorectal: n = 650; hepatopancreatobiliary: n = 257). Overall, median LOS was lower in the CMVS group (5.0 versus 5.5 days; P = 0.012), respectively. Post-hoc subgroup analysis showed this reduction in LOS was mostly observed in the colorectal group and not in the hepatopancreatobiliary group. Apart from a decrease in nurse-to-house-officer calls (from 15.3% to 7.7%; P = 0.007), all secondary clinical outcomes were similar in CMVS and control groups. However, a non-significant trend towards less-severe complications and reduced ICU LOS was observed in the CMVS group. In CMVS patients, 109 additional nursing activities were performed and 83% of patients indicated CMVS was acceptable. CONCLUSION CMVS was associated with a significant reduction in LOS, while other clinical outcomes were unchanged. CMVS triggered additional nursing activities such as extra patient assessments and therapeutic interventions.
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Affiliation(s)
- Jobbe P L Leenen
- Department of Surgery, Isala, Zwolle, The Netherlands
- Connected Care Centre, Isala, Zwolle, The Netherlands
- Research Group IT Innovations in Healthcare, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Vera Ardesch
- Flex pool department, Isala, Zwolle, The Netherlands
| | - Cor J Kalkman
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Gijs A Patijn
- Department of Surgery, Isala, Zwolle, The Netherlands
- Connected Care Centre, Isala, Zwolle, The Netherlands
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Sharabi A, Abutbul E, Grossbard E, Martsiano Y, Berman A, Kassif-Lerner R, Hakim H, Liber P, Zoubi A, Barkai G, Segal G. Six-Lead Electrocardiography Enables Identification of Rhythm and Conduction Anomalies of Patients in the Telemedicine-Based, Hospital-at-Home Setting: A Prospective Validation Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:8464. [PMID: 37896557 PMCID: PMC10611340 DOI: 10.3390/s23208464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/01/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The hospital-at-home (HAH) model is a viable alternative for conventional in-hospital stays worldwide. Serum electrolyte abnormalities are common in acute patients, especially in those with many comorbidities. Pathologic changes in cardiac electrophysiology pose a potential risk during HAH stays. Periodical electrocardiogram (ECG) tracing is therefore advised, but few studies have evaluated the accuracy and efficiency of compact, self-activated ECG devices in HAH settings. This study aimed to evaluate the reliability of such a device in comparison with a standard 12-lead ECG. METHODS We prospectively recruited consecutive patients admitted to the Sheba Beyond Virtual Hospital, in the HAH department, during a 3-month duration. Each patient underwent a 12-lead ECG recording using the legacy device and a consecutive recording by a compact six-lead device. Baseline patient characteristics during hospitalization were collected. The level of agreement between devices was measured by Cohen's kappa coefficient for inter-rater reliability (Ϗ). RESULTS Fifty patients were included in the study (median age 80 years, IQR 14). In total, 26 (52%) had electrolyte disturbances. Abnormal D-dimer values were observed in 33 (66%) patients, and 12 (24%) patients had elevated troponin values. We found a level of 94.5% raw agreement between devices with regards to nine of the options included in the automatic read-out of the legacy device. The calculated Ϗ was 0.72, classified as a substantial consensus. The rate of raw consensus regarding the ECG intervals' measurement (PR, RR, and QT) was 78.5%, and the calculated Ϗ was 0.42, corresponding to a moderate level of agreement. CONCLUSION This is the first report to our knowledge regarding the feasibility of using a compact, six-lead ECG device in the setting of an HAH to be safe and bearing satisfying agreement level with a legacy, 12-lead ECG device, enabling quick, accessible arrythmia detection in this setting. Our findings bear a promise to the future development of telemedicine-based hospital-at-home methodology.
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Affiliation(s)
- Adam Sharabi
- Beyond Virtual Hospital, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
- Faculty of Medicine, University of Nicosia, 2408 Nicosia, Cyprus
| | - Eli Abutbul
- Beyond Virtual Hospital, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
- Faculty of Medicine, University of Nicosia, 2408 Nicosia, Cyprus
| | - Eitan Grossbard
- Beyond Virtual Hospital, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
- Faculty of Medicine, University of Nicosia, 2408 Nicosia, Cyprus
| | - Yonatan Martsiano
- Beyond Virtual Hospital, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
- Faculty of Medicine, University of Nicosia, 2408 Nicosia, Cyprus
| | - Aya Berman
- Dan Petah-Tikvah District at Clalit Health Services, Petah Tikva 4922297, Israel
| | - Reut Kassif-Lerner
- Department of Pediatric Intensive Care, The Edmond and Lily Safra Children’s Hospital Sheba Medical Center, Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
| | - Hila Hakim
- Beyond Virtual Hospital, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
| | - Pninit Liber
- Beyond Virtual Hospital, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
| | - Anram Zoubi
- Beyond Virtual Hospital, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
| | - Galia Barkai
- Beyond Virtual Hospital, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
| | - Gad Segal
- Beyond Virtual Hospital, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 5265601, Israel
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