Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Effect of an automated notification system for deteriorating ward patients on clinical outcomes

Authors: Christian P. Subbe, Bernd Duller, Rinaldo Bellomo

Published in: Critical Care | Issue 1/2017

Login to get access

Abstract

Background

Delayed response to clinical deterioration of ward patients is common.

Methods

We performed a prospective before-and-after study in all patients admitted to two clinical ward areas in a district general hospital in the UK. We examined the effect on clinical outcomes of deploying an electronic automated advisory vital signs monitoring and notification system, which relayed abnormal vital signs to a rapid response team (RRT).

Results

We studied 2139 patients before (control) and 2263 after the intervention. During the intervention the number of RRT notifications increased from 405 to 524 (p = 0.001) with more notifications triggering fluid therapy, bronchodilators and antibiotics. Moreover, despite an increase in the number of patients with “do not attempt resuscitation” orders (from 99 to 135; p = 0.047), mortality decreased from 173 to 147 (p = 0.042) patients and cardiac arrests decreased from 14 to 2 events (p = 0.002). Finally, the severity of illness in patients admitted to the ICU was reduced (mean Acute Physiology and Chronic Health Evaluation II score: 26 (SD 9) vs. 18 (SD 8)), as was their mortality (from 45% to 24%; p = 0.04).

Conclusions

Deployment of an electronic automated advisory vital signs monitoring and notification system to signal clinical deterioration in ward patients was associated with significant improvements in key patient-centered clinical outcomes.

Trial registration

ClinicalTrials.gov, NCT01692847. Registered on 21 September 2012.
Appendix
Available only for authorised users
Literature
1.
Kause J, Smith G, Prytherch D, Parr M, Intensive Care Society (UK); Australian and New Zealand Intensive Care Society Clinical Trials Group. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom — the ACADEMIA study. Resuscitation. 2004;62:275–82.CrossRefPubMed
2.
Sax FL, Charlson M. Medical patients at high risk for catastrophic deterioration. Crit Care Med. 1987;15:510–5.CrossRefPubMed
3.
McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998;316(7148):1853–8.CrossRefPubMedPubMedCentral
4.
Schein RMH, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98(6):1388–92.CrossRefPubMed
5.
Silber JH, Williams SV, Krakauer H, Schwartz JS. Hospital and patient characteristics associated with death after surgery: a study of adverse occurrence and failure to rescue. Med Care. 1992;30(7):615–29.CrossRefPubMed
6.
Subbe CP, Welch JR. Failure to rescue: using rapid response systems to improve care of the deteriorating patient in hospital. AVMA Med Leg J. 2013;19(1):6–11.
7.
Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, et al. Findings of the First Consensus Conference on Medical Emergency Teams. Crit Care Med. 2006;34(9):2463–78.CrossRefPubMed
8.
Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158:417–25.CrossRefPubMedPubMedCentral
9.
Hammer JA, Jones TL, Brown SA. Rapid response teams and failure to rescue. J Nurs Care Qual. 2012;27(4):352–8.CrossRefPubMed
10.
Hillman K, for the MERIT study investigators. Introduction of the medical emergency team (MET) system: A cluster-randomised controlled trial. Lancet. 2005;365(9477):2091–7.CrossRefPubMed
11.
Morris A, Owen HM, Jones K, Hartin J, Welch J, Subbe CP. Objective patient-related outcomes of rapid-response systems - a pilot study to demonstrate feasibility in two hospitals. Crit Care Resusc. 2013;15(1):33–8.PubMed
12.
Pham H, Galyean WJ. Reliability analysis of nuclear fail-safe redundancy. Reliab Eng Syst Saf. 1992;37(2):109–12.CrossRef
13.
Moehlenbrink C, Wies M, Jipp M. Monitoring principles in aviation and the importance of operator redundancy. In: Conference Proceedings - IEEE International Conference on Systems, Man and Cybernetics. 2011. p. 2828–35.
14.
Groves RH, Holcomb BW, Smith ML. Intensive care telemedicine: evaluating a model for proactive remote monitoring and intervention in the critical care setting. Stud Health Technol Inform. 2008;131:131–46.PubMed
15.
Thomas EJ, Lucke JF, Wueste LR, Weavind L, Patel B. Association of telemedicine for remote monitoring of intensive care patients with mortality, complications, and length of stay. JAMA. 2009;302(24):2671–8.CrossRefPubMed
16.
Jones M. NEWSDIG: The national early warning score development and implementation group. Clin Med. 2012;12(6):501–3.CrossRef
17.
Eccles SR, Subbe C, Hancock D, Thomson N. CREWS: Improving specificity whilst maintaining sensitivity of the National Early Warning Score in patients with chronic hypoxaemia. Resuscitation. 2014;85(1):109–11.CrossRefPubMed
18.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.CrossRefPubMed
19.
Bellomo R, Ackerman M, Bailey M, Beale R, Clancy G, Danesh V, et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012;40(8):2349–61.CrossRefPubMed
20.
Schmidt PE, Meredith P, Prytherch DR, Watson D, Watson V, Killen RM, et al. Impact of introducing an electronic physiological surveillance system on hospital mortality. Qual Saf Health Care. 2015;24(1):10–20.
21.
Aminian M. A hospital healthcare monitoring system using wireless sensor networks. J Heal Med Informatics. 2013;04(02):4–9.
22.
Kummer TF, Schäfer K, Todorova N. Acceptance of hospital nurses toward sensor-based medication systems: a questionnaire survey. Int J Nurs Stud. 2013;50(4):508–17.CrossRefPubMed
23.
Kane B, Decalmer S, Murphy P, Turkington P, O’Driscoll BR. The proposed national early warning system (NEWS) could be hazardous for patients who are at risk of hypercapnic respiratory failure. Thorax. 2012;67:A16–7.CrossRef
24.
O’Driscoll BR, Murphy PTP. Acute monitoring of patients with chronic respiratory disease during hospital admission. Clin Med. 2012;12(1):79–81.CrossRef
25.
Simmes FM, Schoonhoven L, Mintjes J, Fikkers BG, van der Hoeven JG. Incidence of cardiac arrests and unexpected deaths in surgical patients before and after implementation of a rapid response system. Ann Intensive Care. 2012;2(1):20.CrossRefPubMedPubMedCentral
26.
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004;32(4):916–21.CrossRefPubMed
27.
Prgomet M, Cardona-Morrell M, Nicholson M, Lake R, Long J, Westbrook J, Braithwaite J, Hillman K. Vital signs monitoring on general wards: clinical staff perceptions of current practices and the planned introduction of continuous monitoring technology. Int J Qual Health Care. 2016;28(4):515–21.CrossRefPubMed
28.
Cardona-Morrell M, Prgomet M, Turner RM, Nicholson M, Hillman K. Effectiveness of continuous or intermittent vital signs monitoring in preventing adverse events on general wards: a systematic review and meta-analysis. Int J Clin Pract. 2016;70(10):806–24. doi:10.​1111/​ijcp.​12846.CrossRefPubMed
29.
Dixon-Woods M, Leslie M, Tarrant C, Bion J. Explaining matching Michigan: an ethnographic study of a patient safety program. Implement Sci. 2013;8(1):70.CrossRefPubMedPubMedCentral
Metadata
Title
Effect of an automated notification system for deteriorating ward patients on clinical outcomes
Authors
Christian P. Subbe
Bernd Duller
Rinaldo Bellomo
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1635-z

Other articles of this Issue 1/2017

Critical Care 1/2017 Go to the issue

Research

Association between kidney intracapsular pressure and ultrasound elastography

Research

Prolonged acute care and post-acute care admission and recovery of physical function in survivors of acute respiratory failure: a secondary analysis of a randomized controlled trial

Letter

Echocardiography accurately predicts pulmonary hypertension in patients with advanced lung disease

Editorial

Obesity and survival in critically ill patients with acute respiratory distress syndrome: a paradox within the paradox

Research

Catecholamines as outcome markers in isolated traumatic brain injury: the COMA-TBI study

Research

Intestinal T lymphocyte homing is associated with gastric emptying and epithelial barrier function in critically ill: a prospective observational study