The Opportunity of Vital Signs Monitoring and Clinical Decision Support
Improving patient safety though better patient monitoring
Vital signs monitoring is essential at every stage of the patient journey, from triage, diagnosis to discharge and transfer of care. During admission to hospital, patients often show signs of acute physical deterioration before a serious event occurs, such as cardiac arrest. Current variation in vital signs charts, early warning scores, skills and knowledge of responders and availability of responders in hospitals means these patients may not receive timely, expert care when they need it. Here lies a significant opportunity to intervene and prevent these patients from ending up in the intensive care unit.
In my previous post, I discussed the importance of vital signs monitoring and the possibility of severe consequences if vital signs monitoring is ignored, especially in deteriorating patients. To help hospitals reduce these negative outcomes, we are currently working on a project to develop an end-to-end vital signs monitoring system, building a digital bridge between a patient who is deteriorating and the clinician who can respond in real-time.
Precision Driven Health recently funded a research project to capture vital signs, from medical devices and wearables, and present it in a meaningful way to clinicians. PDH acknowledged the current gap in real-time vital sign monitoring and decision support systems currently available for clinicians. The connection needs to be made between patient deterioration and notifying the clinician in real-time so they can respond and take appropriate action. This project involves working closely with clinicians to solve the critical piece that is auto-escalation of deteriorating patients based on the National Early Warning Score.
We aim to empower clinicians via cross-platform mobile application that collects vital sign data from wireless devices in real-time to enable faster and efficient clinician responses to changes in vital signs and monitor patients from anywhere, at any time. The mobile app integrates with medical devices, clinical risk tools and calculators as well as evidence-based knowledgebase, empowering junior doctors and nurses by providing them with accurate decision support tools at point of care.
This project is closely aligned with a national programme to reduce the harm caused by failure to respond to acute patient deterioration. The Health Quality and Safety Commission of New Zealand (HQSC) has established a five-year programme from 2016-2021 to develop and implement systems that improve recognition and response to patient deterioration in hospitals.
Last year, HQSC completed a review of the current practice in responding to deteriorating adult patients. The review concluded that due to variability in responses to deteriorating patients and availability of resources, a new framework was required to standardise the early warning score and vital signs chart. This chart states that when a patient’s early warning score is 8-9, the patient is likely to deteriorate rapidly. It is at this point that our advanced vital sign solution would trigger an automatic escalation for a clinical response so that the patient’s deterioration can be managed by the right clinician in a timely manner.
This two-year project is a collaboration between university researchers, clinicians, technical leaders and other end-users/stakeholders (including Māori Research Advisors). Currently, in phase one (Jul 2018 to Dec 2018), the team is working on the user experience, investigating advanced medical devices to integrate and conducting wider stakeholder consultations.