Clinical Evaluation of a Real-Time Wearable System for Monitoring In-Hospital Ambulatory Patients With COVID-19:...

Many studies have evaluated the use of wearable monitoring systems to improve patient safety in hospital. Although some have demonstrated effects on intensive care admissions, there remains little evidence of impact on patient outcomes such as mortality, hospital length of stay, and time to antibiotic administration. Very few studies have focused on how wearable monitoring systems are used in clinical practice, including how the rate of manual vital sign measurements (MVSMs) is affected.

Our primary aim was to describe the physiological pattern of vital signs in hospitalized patients treated for COVID-19 outside of critical care. We also report an exploratory post hoc analysis of the impact of displaying wearable monitoring system data on the frequency of intermittent MVSMs.

We conducted a retrospective study during the COVID-19 pandemic following deployment of a wearable monitoring system that continuously displayed heart rate, respiratory rate, and oxygen saturation levels. We included patients treated for COVID-19 in 3 isolation wards in a large UK hospital. Wearable monitoring system data were displayed on a dashboard in the center of each ward. We analyzed the patterns of vital signs in patients monitored using the wearable monitoring system. We compared the time to next observation (led by nursing staff) for routinely collected MVSMs between periods when patients were continuously monitored and those when they were not. In exploratory post hoc analysis, we tested whether the difference varied between stable (early warning score [EWS] above the escalation threshold) and unstable patients.

Patients (N=144) had continuous vital signs above the EWS threshold for escalation for 32.7% (2133/6528) of time monitored. The unadjusted median time between MVSMs for continuously monitored periods was 39 minutes (95% CI 29-49; P<.001) longer than for unmonitored periods. When adjusted for EWS category and participant-level clustering, the effect was attenuated but remained significant (14.6 minutes; P<.001). In exploratory post hoc analysis, we found that increases were larger during stable observation periods (51 minutes, 95% CI 39-62; P<.001) than during unstable periods (16 minutes, 95% CI 8-24; P<.001). However, adjusted analyses did not support a significant difference between stable and unstable periods.

Patients in this study were at elevated risk of deterioration, spending a third of monitored time at or above the escalation threshold. We found that, by offering additional vital sign data between manual measurements, the time between routine MVSMs increased, which may reflect changes in nursing task prioritization. Although patient safety outcomes were not directly measured, we found no indication that reducing observation frequency adversely affected patient safety.