Improving detection of patient deterioration in the general hospital ward environment

Abstract

: Patient monitoring on low acuity general hospital wards is currently based largely on intermittent observations and measurements of simple variables, such as blood pressure and temperature, by nursing staff. Often several hours can pass between such measurements and patient deterioration can go unnoticed. Moreover, the integration and interpretation of the information gleaned through these measurements remains highly dependent on clinical judgement. More intensive monitoring, which is commonly used in peri-operative and intensive care settings, is more likely to lead to the early identification of patients who are developing complications than is intermittent monitoring. Early identification can trigger appropriate management, thereby reducing the need for higher acuity care, reducing hospital lengths of stay and admission costs and even, at times, improving survival. However, this degree of monitoring has thus far been considered largely inappropriate for general hospital ward settings due to device costs and the need for staff expertise in data interpretation. In this review, we discuss some developing options to improve patient monitoring and thus detection of deterioration in low acuity general hospital wards.

Fig. 1

Oxygen saturation (blue) and heart rate (pink) traces in a patient with obstructive sleep apnoea. (a) Preoperatively. (b) Postoperatively during patient-controlled morphine analgesia.

Fig. 2

Compressed capnography patterns in a postoperative patient corresponding to different levels of consciousness (yellow line = respiratory rate). Panel (c) shows recurrent partial airway obstruction.

Fig. 3

Continuous pulse oximetry and capnography tracings from a postoperative patient receiving hydromorphone patient-controlled analgesia. x = patient-controlled analgesia dosing. o = patient-controlled analgesia halt enabled due to excessive sedation.

Fig. 4

Integrated patient monitoring on the low acuity ward.