Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial
Abstract Background For hospitalized patients with unexpected clinical deterioration, delayed or suboptimal intervention is associated with increased morbidity and mortality. Lack of continuous monitoring for average-risk patients has been suggested as a contributing factor for unexpected in-hospita...
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| Veröffentlicht in: | The American journal of medicine 2014-03, Vol.127 (3), p.226-232 |
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| creator | Brown, Harvey, MD Terrence, Jamie, RN Vasquez, Patricia, RN, BSN Bates, David W., MD, MSc Zimlichman, Eyal, MD, MSc |
| description | Abstract Background For hospitalized patients with unexpected clinical deterioration, delayed or suboptimal intervention is associated with increased morbidity and mortality. Lack of continuous monitoring for average-risk patients has been suggested as a contributing factor for unexpected in-hospital mortality. Our objective was to assess the effects of continuous heart rate and respiration rate monitoring in a medical-surgical unit on unplanned transfers and length of stay in the intensive care unit and length of stay in the medical-surgical unit. Methods In a controlled study, we have compared a 33-bed medical-surgical unit (intervention unit) to a “sister” control unit for a 9-month preimplementation and a 9-month postimplementation period. Following the intervention, all beds in the intervention unit were equipped with monitors that allowed for continuous assessment of heart and respiration rate. Results We reviewed 7643 patient charts: 2314 that were continuously monitored in the intervention arm and 5329 in the control arms. Comparing the average length of stay of patients hospitalized in the intervention unit following the implementation of the monitors to that before the implementation and to that in the control unit, we observed a significant decrease (from 4.0 to 3.6 and 3.6 days, respectively; P |
| doi_str_mv | 10.1016/j.amjmed.2013.12.004 |
| format | Article |
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Lack of continuous monitoring for average-risk patients has been suggested as a contributing factor for unexpected in-hospital mortality. Our objective was to assess the effects of continuous heart rate and respiration rate monitoring in a medical-surgical unit on unplanned transfers and length of stay in the intensive care unit and length of stay in the medical-surgical unit. Methods In a controlled study, we have compared a 33-bed medical-surgical unit (intervention unit) to a “sister” control unit for a 9-month preimplementation and a 9-month postimplementation period. Following the intervention, all beds in the intervention unit were equipped with monitors that allowed for continuous assessment of heart and respiration rate. Results We reviewed 7643 patient charts: 2314 that were continuously monitored in the intervention arm and 5329 in the control arms. Comparing the average length of stay of patients hospitalized in the intervention unit following the implementation of the monitors to that before the implementation and to that in the control unit, we observed a significant decrease (from 4.0 to 3.6 and 3.6 days, respectively; P <.05). Total intensive care unit days were significantly lower in the intervention unit postimplementation (63.5 vs 120.1 and 85.36 days/1000 patients, respectively; P = .04). The rate of transfer to the intensive care unit did not change, comparing before and after implementation and to the control unit ( P = .19). Rate of code blue events decreased following the intervention from 6.3 to 0.9 and 2.1, respectively, per 1000 patients ( P = .02). Conclusions Continuous monitoring on a medical-surgical unit was associated with a significant decrease in total length of stay in the hospital and in intensive care unit days for transferred patients, as well as lower code blue rates.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/j.amjmed.2013.12.004</identifier><identifier>PMID: 24342543</identifier><identifier>CODEN: AJMEAZ</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; APACHE ; Cardiology ; Clinical alarms ; Female ; Heart arrest ; Heart attacks ; Heart Rate ; Hospital Mortality - trends ; Hospital rapid response team ; Hospital Units - statistics & numerical data ; Hospitalization ; Humans ; Intensive care ; Intensive care unit ; Intensive Care Units - statistics & numerical data ; Internal Medicine ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; Monitoring, Physiologic ; Mortality ; Patient Transfer - statistics & numerical data ; Prospective Studies ; Respiratory Rate ; Surgery Department, Hospital - statistics & numerical data ; Surgical outcomes</subject><ispartof>The American journal of medicine, 2014-03, Vol.127 (3), p.226-232</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Mar 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c529t-32b3b763d0bf3880761e0b903eb038a9b0e2bfeab61fcfe377242d3d3a2eea003</citedby><cites>FETCH-LOGICAL-c529t-32b3b763d0bf3880761e0b903eb038a9b0e2bfeab61fcfe377242d3d3a2eea003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjmed.2013.12.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24342543$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brown, Harvey, MD</creatorcontrib><creatorcontrib>Terrence, Jamie, RN</creatorcontrib><creatorcontrib>Vasquez, Patricia, RN, BSN</creatorcontrib><creatorcontrib>Bates, David W., MD, MSc</creatorcontrib><creatorcontrib>Zimlichman, Eyal, MD, MSc</creatorcontrib><title>Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial</title><title>The American journal of medicine</title><addtitle>Am J Med</addtitle><description>Abstract Background For hospitalized patients with unexpected clinical deterioration, delayed or suboptimal intervention is associated with increased morbidity and mortality. Lack of continuous monitoring for average-risk patients has been suggested as a contributing factor for unexpected in-hospital mortality. Our objective was to assess the effects of continuous heart rate and respiration rate monitoring in a medical-surgical unit on unplanned transfers and length of stay in the intensive care unit and length of stay in the medical-surgical unit. Methods In a controlled study, we have compared a 33-bed medical-surgical unit (intervention unit) to a “sister” control unit for a 9-month preimplementation and a 9-month postimplementation period. Following the intervention, all beds in the intervention unit were equipped with monitors that allowed for continuous assessment of heart and respiration rate. Results We reviewed 7643 patient charts: 2314 that were continuously monitored in the intervention arm and 5329 in the control arms. Comparing the average length of stay of patients hospitalized in the intervention unit following the implementation of the monitors to that before the implementation and to that in the control unit, we observed a significant decrease (from 4.0 to 3.6 and 3.6 days, respectively; P <.05). Total intensive care unit days were significantly lower in the intervention unit postimplementation (63.5 vs 120.1 and 85.36 days/1000 patients, respectively; P = .04). The rate of transfer to the intensive care unit did not change, comparing before and after implementation and to the control unit ( P = .19). Rate of code blue events decreased following the intervention from 6.3 to 0.9 and 2.1, respectively, per 1000 patients ( P = .02). Conclusions Continuous monitoring on a medical-surgical unit was associated with a significant decrease in total length of stay in the hospital and in intensive care unit days for transferred patients, as well as lower code blue rates.</description><subject>Adult</subject><subject>Aged</subject><subject>APACHE</subject><subject>Cardiology</subject><subject>Clinical alarms</subject><subject>Female</subject><subject>Heart arrest</subject><subject>Heart attacks</subject><subject>Heart Rate</subject><subject>Hospital Mortality - trends</subject><subject>Hospital rapid response team</subject><subject>Hospital Units - statistics & numerical data</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intensive care unit</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Internal Medicine</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Monitoring, Physiologic</subject><subject>Mortality</subject><subject>Patient Transfer - statistics & numerical data</subject><subject>Prospective Studies</subject><subject>Respiratory Rate</subject><subject>Surgery Department, Hospital - statistics & numerical data</subject><subject>Surgical outcomes</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkkFr3DAQhUVpaDZp_0Ephl56sTvSWPa6h0JYkjaQ0EMS6E3I9jjI9UpbyS7k30fKbijk0p4kMd97w-gNY-85FBx49Xks9HbcUl8I4FhwUQCUr9iKSynzmlfiNVsBgMgbLPGYnYQwxic0snrDjkWJpZAlrtjPjbOzsYtbQnbtrJmdN_Y-MzbTNru0Oz0bsnN2Tb3p9JTfLP4-XbK7iH7JzrIk926aqM82k7FPtVtv9PSWHQ16CvTucJ6yu4vz2833_OrHt8vN2VXeSdHMOYoW27rCHtoB12uoK07QNoDUAq510wKJdiDdVnzoBsK6FqXosUctiDQAnrJPe9-dd78XCrPamtDRNGlLcSjFJa-iqRT8P1DgaxR1U0X04wt0dIu3cZBE1aVEwNS73FOddyF4GtTOm632D4qDSiGpUe1DUikkxYWKIUXZh4P50qbas-g5lQh83QMUP-6PIa9CF2PoYgieuln1zvyrw0uD7hDOL3qg8HcWFaJA3aRFSXvCETjUAvERVY-3lg</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Brown, Harvey, MD</creator><creator>Terrence, Jamie, RN</creator><creator>Vasquez, Patricia, RN, BSN</creator><creator>Bates, David W., MD, MSc</creator><creator>Zimlichman, Eyal, MD, MSc</creator><general>Elsevier Inc</general><general>Elsevier Sequoia S.A</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>20140301</creationdate><title>Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial</title><author>Brown, Harvey, MD ; Terrence, Jamie, RN ; Vasquez, Patricia, RN, BSN ; Bates, David W., MD, MSc ; Zimlichman, Eyal, MD, MSc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c529t-32b3b763d0bf3880761e0b903eb038a9b0e2bfeab61fcfe377242d3d3a2eea003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>APACHE</topic><topic>Cardiology</topic><topic>Clinical alarms</topic><topic>Female</topic><topic>Heart arrest</topic><topic>Heart attacks</topic><topic>Heart Rate</topic><topic>Hospital Mortality - trends</topic><topic>Hospital rapid response team</topic><topic>Hospital Units - statistics & numerical data</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Intensive care unit</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Internal Medicine</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monitoring, Physiologic</topic><topic>Mortality</topic><topic>Patient Transfer - statistics & numerical data</topic><topic>Prospective Studies</topic><topic>Respiratory Rate</topic><topic>Surgery Department, Hospital - statistics & numerical data</topic><topic>Surgical outcomes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brown, Harvey, MD</creatorcontrib><creatorcontrib>Terrence, Jamie, RN</creatorcontrib><creatorcontrib>Vasquez, Patricia, RN, BSN</creatorcontrib><creatorcontrib>Bates, David W., MD, MSc</creatorcontrib><creatorcontrib>Zimlichman, Eyal, MD, MSc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brown, Harvey, MD</au><au>Terrence, Jamie, RN</au><au>Vasquez, Patricia, RN, BSN</au><au>Bates, David W., MD, MSc</au><au>Zimlichman, Eyal, MD, MSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>127</volume><issue>3</issue><spage>226</spage><epage>232</epage><pages>226-232</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><coden>AJMEAZ</coden><abstract>Abstract Background For hospitalized patients with unexpected clinical deterioration, delayed or suboptimal intervention is associated with increased morbidity and mortality. Lack of continuous monitoring for average-risk patients has been suggested as a contributing factor for unexpected in-hospital mortality. Our objective was to assess the effects of continuous heart rate and respiration rate monitoring in a medical-surgical unit on unplanned transfers and length of stay in the intensive care unit and length of stay in the medical-surgical unit. Methods In a controlled study, we have compared a 33-bed medical-surgical unit (intervention unit) to a “sister” control unit for a 9-month preimplementation and a 9-month postimplementation period. Following the intervention, all beds in the intervention unit were equipped with monitors that allowed for continuous assessment of heart and respiration rate. Results We reviewed 7643 patient charts: 2314 that were continuously monitored in the intervention arm and 5329 in the control arms. Comparing the average length of stay of patients hospitalized in the intervention unit following the implementation of the monitors to that before the implementation and to that in the control unit, we observed a significant decrease (from 4.0 to 3.6 and 3.6 days, respectively; P <.05). Total intensive care unit days were significantly lower in the intervention unit postimplementation (63.5 vs 120.1 and 85.36 days/1000 patients, respectively; P = .04). The rate of transfer to the intensive care unit did not change, comparing before and after implementation and to the control unit ( P = .19). Rate of code blue events decreased following the intervention from 6.3 to 0.9 and 2.1, respectively, per 1000 patients ( P = .02). Conclusions Continuous monitoring on a medical-surgical unit was associated with a significant decrease in total length of stay in the hospital and in intensive care unit days for transferred patients, as well as lower code blue rates.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24342543</pmid><doi>10.1016/j.amjmed.2013.12.004</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged APACHE Cardiology Clinical alarms Female Heart arrest Heart attacks Heart Rate Hospital Mortality - trends Hospital rapid response team Hospital Units - statistics & numerical data Hospitalization Humans Intensive care Intensive care unit Intensive Care Units - statistics & numerical data Internal Medicine Length of Stay - statistics & numerical data Male Middle Aged Monitoring, Physiologic Mortality Patient Transfer - statistics & numerical data Prospective Studies Respiratory Rate Surgery Department, Hospital - statistics & numerical data Surgical outcomes |
| title | Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial |
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