Research articles
Monitoring of Vitals Signs
Failure to detect ward hypoxaemia and hypotension: contributions of insufficient assessment frequency and patient arousal during nursing assessment.
Research article: (Br. J. Anaesth 2021;127, 760-768)
The study investigates the challenges in detecting hypoxaemia and hypotension in hospital wards.The researchers found that a significant number of these episodes are missed due to the infrequency of nursing assessments and the temporary improvement in patients' conditions when they are aroused for vital sign measurements. 79% of hypotensive episodes and 82% of desaturation episodes were not detected because they did not coincide with nursing assessments. Mean blood preassure and oxygen saturation did not improve by clinically meaningful amounts during nursing vital sign assessments.The study suggests that more frequent or continuous monitoring could help in early detection and intervention, potentially improving patient outcomes.
A Comparison of Oxygen Saturation Data in Inpatients with Low Oxygen Saturation Using Automated Continuous Monitoring and Intermittent Manual Data Charting.
Research article: (STA 2014; 118, 326–331)
The study compares the accuracy of oxygen saturation data in hospitalised patients with low oxygen saturation using automated continuous monitoring and intermittent manual recording. The results showed that manually recorded oxygen saturations were on average 6.5% higher than automatically collected values, suggesting that manual recording does not accurately reflect patients' true physiological status. In addition, no significant effect of patient awakening on oxygen saturation increases was observed during nurse visits.
The study highlights that traditional intermittent monitoring of vital signs can lead to inaccurate patient information and compromise patient safety, particularly in patients with prolonged oxygen deficits. The researchers recommend the use of continuous, automated monitoring of vital signs to improve accuracy and detect patient deterioration in a timely manner.
The rise of ward monitoring: opportunities and challenges for critical care specialists.
Research article: (ICM 2019; 45, 671–673)
The article discusses the increasing implementation of continuous monitoring systems in hospital wards and the implications for critical care. Continuous monitoring systems, such as wireless pulse oximeters and adhesive patches, help in the early detection of clinical deterioration, potentially preventing ICU admissions and improving patient outcomes. These systems can monitor various vital signs continuously, including heart rate, respiratory rate, and oxygen saturation, providing real-time data to healthcare providers. The implementation of these systems comes with challenges, such as managing false alarms and the additional workload on healthcare staff. The article emphasizes the potential benefits of continuous monitoring in improving patient care while also highlighting the need to address the associated challenges.
Physiological abnormalities in patients admitted with acute exacerbation of COPD: an observational study with continuous monitoring.
Research article: (JCMC 2020; 34, 1051–1060)
The study investigates the effectiveness of continuous monitoring in detecting physiological abnormalities in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Continuous monitoring detected episodes of low oxygen saturation (SpO2 < 92%) in 97% of patients, compared to only 43% detected by conventional Early Warning Score (EWS) assessments. Severe desaturation events (SpO2 < 80%) were detected in 63% of patients using continuous monitoring, while none were detected by EWS. Continuous monitoring also more frequently detected episodes of tachycardia (rapid heart rate), tachypnoea (rapid breathing), and bradypnoea (slow breathing) compared to EWS. The study concludes that continuous monitoring is more effective in detecting critical physiological abnormalities in AECOPD patients, which could lead to earlier interventions and better patient outcomes.
IV Therapy
Advantages in management and remote monitoring of intravenous therapy: Exploratory survey and economic evaluation of gravity-based infusions in Finland
Research article: (Adv Ther 2022;39:2096-2108)
A comprehensive and representative research sample: 216 nurses responded to the survey from 15 wards in 6 hospitals throughout Finland. On average, Monidor remote monitoring of IV therapy enabled the following as per each shift
• the end of infusion was detected 1.34 times
• 2.06 routine visits to the patient room were avoided
• 5.06 minutes of nursing time was freed up
At the ward that was used as an example, an estimated 1,270.90 euros a month is saved. 50.5% of this is due to saved time and 49.5% is due to saved consumables (e.g., protective gear and cannula replacements). The conservatively estimated ROI is 2.63, i.e., the net profit is more than 2.6 times the cost of the solution.
Perioperative Fluid Utilisation Variability and Association with Outcomes
Research article: (Ann Surg 2016;263:502–510)
The aim of this study was to investigate the role of the perioperative fluid therapy on the overall outcomes of surgical treatments (i.e. costs and complications). The study included three patient groups: 84 722 colon, 22 178 rectal, and 548 526 primary hip or knee replacement surgical patients. The research population was gathered from The Premier Research Database in the US.
The study shows significant associations between high fluid volume given on the day of the surgery with both the increased length of stay and the increased total costs. High fluid utilisation was associated with the increased presence of postoperative ileus for both rectal and colon surgery patients. Low fluid utilisation was also associated with worse outcomes. The authors underline the importance of fluid optimisation for improving the outcomes of the surgical treatments.
The Economic Burden of Hyponatremia: Systematic Review and Meta-Analysis
Research article: (Am J Med 2016;129(8):823-835.e4.)
Hyponatremia is the most common electrolyte abnormality observed in clinical practice. The economical impact of hyponatremia has remained unclear, though several studies suggest increased costs and prolonged hospital stay.
This extensive meta-analysis consisted of 46 studies that compared hospital length of stay and cost between patients with and without hyponatremia. A study population encompassed almost four million patients and 19.2% among these were hyponatremic.
Hyponatremia was found to be an important reason for a prolonged hospital length. It also increases the risk of readmission in certain patient groups. As a conclusion, hyponatremia causes increased costs for healthcare. For instance, in the US, the direct medical costs of hyponatremia were estimated up to $3.5 billion annually.
Intravenous infusion is a very common treatment procedure in the hospital wards
Research article: (Am J Hosp Pharm. 1985;42:328-31)
Intravenous infusion is typically delivered without any electronic device or supervision even nowadays. In addition, the infusion rate and the administered fluid volume are typically estimated visually.
This study was conducted to define the accuracy of gravity flow i.v-infusion systems. A total of 509 observations of the infusion rate were recorded during the study. The main results of the study were alarming. Less than 15% of the observations were within ± 10% of the desired drop rates, while only 21% of the observations fell within ± 20% of the desired drop rates.
To improve the accuracy and quality of the intravenous infusion therapy, better monitoring practices and routine use of the electronic infusion devices were recommended.