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

Bellomo, Rinaldo MD, FRACP, FCICM; Ackerman, Michael RN, PhD; Bailey, Michael PhD, MSc; Beale, Richard MB, BS, MD, FRCA; Clancy, Greg RN, MSN; Danesh, Valerie PhD; Hvarfner, Andreas MD, PhD; Jimenez, Edgar MD; Konrad, David MD, PhD; Lecardo, Michele RN, BSN, CCRN; Pattee, Kimberly S. RN, BSN; Ritchie, Josephine RN; Sherman, Kathie RN; Tangkau, Peter MD; The Vital Signs to Identify, Target, and Assess Level of Care Study (VITAL Care Study) Investigators

doi: 10.1097/CCM.0b013e318255d9a0
Clinical Investigations

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).

From the Department of Intensive Care (RB), Austin Health, Melbourne, Australia; Division of Nursing (MA), University of Rochester Medical Center, Rochester, NY; Department of Biostatistics (MB), Australian and New Zealand Intensive Care Research Center, Melbourne, Australia; Department of Critical Care Medicine (RB), St. Thomas’ Hospital, London, UK; Department of Nursing (GC, KSP), Mercy Hospital, Iowa City, IA; Department of Medical Intensive Care (VD, EJ), Orlando Regional Medical Center, Orlando, FL; Department of Intensive Care Medicine (AH), University of Lund Hospital, Lund, Sweden; Department of Intensive Care Medicine (DK), Karolinska Hospital, Stockholm, Sweden; Division of Nursing (ML), Norwalk Hospital, Norwalk, CT; Department of Critical Care Medicine (JR), Norwalk Hospital, Norwalk, CT; Department of Nursing (KS), Reinier Melrose-Wakefield Hospital, Melrose MA; Department of Intensive Care Medicine (PT), Reinier de Graaf Hospital, Delft, The Netherlands.

*See also p. 2509.

Dr. Tangkau received a study grant from Phillips International. The remaining authors have not disclosed any potential conflicts of interest.

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Dr. Bellomo acts as paid consultant for Philips Medical, the manufacturers of the MP5 monitors used in this study. Dr. Bellomo takes responsibility for the integrity and accuracy of the data. Drs. Bellomo and Bailey take responsibility for the statistical analysis of the data.

For information regarding this article, E-mail: rinaldo.bellomo@austin.org.au

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins