Hospital-wide physiological surveillance–A new approach to the early identification and management of the sick patient

• Published in: Resuscitation 2006-10, Vol.71 (1), p.19-28
• Main Authors: Smith, Gary B., Prytherch, David R., Schmidt, Paul, Featherstone, Peter I., Knight, Debbie, Clements, Gill, Mohammed, Mohammed A.
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Computers, Handheld; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency and intensive care: techniques, logistics; Emergency treatment; Heart Arrest - diagnosis; Hospital Communication Systems; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Local Area Networks; Medical emergency team; Medical sciences; Monitoring, Physiologic - methods; Outcome; Prevention; Safety
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2006.03.008

Hospitalised patients, who suffer cardiac arrest and require unanticipated intensive care unit (ICU) admission or die, often exhibit premonitory abnormalities in vital signs. Sometimes, the deterioration is well documented, though there is little discernable evidence of intervention. In other cases, monitoring and recording of vital signs is infrequent or incomplete. Healthcare providers have introduced “track and trigger” systems to allow early identification of patients with physiological abnormalities, and rapid response teams to facilitate rapid and appropriate management. However, even when “track and trigger” systems are used, the recording of vital signs, patient chart completion and team activation remain sub-optimal. We have developed a system for collecting routine vital signs data at the bedside using standard personal digital assistants (PDA). The PDAs act as “thin clients” linked by a wireless local area network (W-LAN) to the hospital's intranet system, where raw and derived data are integrated with other patient information, e.g., name, hospital number, laboratory results. It is possible for raw physiology data, early warning scores (EWS), vital signs charts and oxygen therapy records to be made instantaneously available to any member of the hospital healthcare team via the W-LAN or hospital intranet. Early and direct contact with members of the patient's primary clinical team or rapid response team can be made through an automated alerting system, triggered by the EWS data. The ability to capture physiological data at the bedside, and to make these available to anyone with appropriate access rights at any time and in any place, should provide previously unattainable, clinical and administrative benefits. Analysis of the raw physiological data and patient outcomes will also make it possible to validate existing and future “track and trigger” systems.