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Cardiorespiratory instability before and after implementing an integrated monitoring system
Marilyn Hravnak1, Michael A Devita, Amy Clontz
1School of Nursing, School of Medicine, University of Pittsburgh, USA.
Critical Care Medicine
|October 12, 2010
Summary
An integrated monitoring system (INDEX) effectively identified cardiorespiratory instability in step-down unit patients before critical events. Nurse response to INDEX alerts reduced the duration and severity of instability.
Area of Science:
- Critical Care Medicine
- Biomedical Engineering
- Nursing Informatics
Background:
- Cardiorespiratory instability in step-down units often goes undetected.
- Current monitoring relies on single parameters, potentially missing early signs of deterioration.
Purpose of the Study:
- To evaluate an integrated monitoring system (INDEX) for detecting cardiorespiratory instability.
- To assess the correlation between the INDEX and traditional instability criteria.
- To determine if nurse response to INDEX alerts reduces instability.
Main Methods:
- Prospective study in a 24-bed trauma step-down unit.
- Integrated monitoring system (INDEX) combined heart rate, respiratory rate, blood pressure, and SpO2.
- Phases included background recording and then active alert response using a clinical algorithm.
Main Results:
- The INDEX significantly correlated with cardiorespiratory instability (r = .713 for INDEXmin, r = .815 for INDEXfull).
- INDEX alerts preceded instability events by an average of 9.4 minutes in 80% of cases.
- Instability duration/admission decreased from Phase I to Phase III (p = .018), with fewer severe instability episodes (p = .03).
Conclusions:
- The integrated monitoring system (INDEX) accurately identifies cardiorespiratory instability.
- The INDEX provides early warnings, often preceding overt clinical signs.
- Implementing the INDEX with a nursing alert protocol improves patient outcomes by reducing instability.
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