Hospital-Based Electrocardiographic Monitoring: The Good, the Not So Good, and Untapped Potential.

Area of Science:

• Cardiovascular monitoring
• Critical care technology
• Nursing science

Background:

• Continuous electrocardiographic (ECG) and vital sign monitoring evolved from basic heart rate assessment to sophisticated analysis of myocardial ischemia, arrhythmias, and multiple physiological parameters.
• These advanced monitoring systems provide real-time patient data, alerting nurses to critical changes and positively impacting high-acuity care.
• Despite benefits, alarm and alert fatigue have emerged as significant challenges in the past decade, tempering enthusiasm for these technologies.

Purpose of the Study:

• To review the evolution and impact of continuous ECG and physiologic monitoring in critical care.
• To discuss the advantages, disadvantages, and future potential of current monitoring systems.
• To share a personal research journey focused on ECG and physiologic monitoring, including community-based research in acute coronary syndrome and heart failure.

Main Methods:

• Retrospective review of the development and application of continuous monitoring technologies in critical care settings.
• Analysis of research findings on the effectiveness and limitations of ECG and vital sign monitoring.
• Description of a 36-year research program trajectory and community-based research experiences.

Main Results:

• Continuous monitoring has expanded from basic functions to complex analyses, offering significant benefits in patient care.
• Alarm and alert fatigue represent a major drawback, necessitating further research and system refinement.
• Significant untapped potential exists within current monitoring systems for improved patient outcomes.

Conclusions:

• Continuous ECG and physiologic monitoring are indispensable in critical care, offering substantial benefits despite challenges like alarm fatigue.
• Further research is needed to optimize monitoring systems, mitigate negative consequences, and harness their full potential.
• The integration of advanced monitoring with community-based research holds promise for managing conditions like acute coronary syndrome and heart failure.