Remote Vital Sign Monitoring in Acutely Unwell Hospital at Home Patients: Nonrandomized Feasibility Study

Remote vital sign monitoring of acute hospital at home (aHAH) patients is recommended in policy without clear guidance on implementation. While such monitoring has the potential to improve patient care, there is limited evidence for its feasibility and acceptability.

This study aimed to evaluate the feasibility and acceptability of using a remote, community-based monitoring system using a vital sign wearable patch and pulse oximeter in aHAH patients.

In this nonrandomized feasibility study, we recruited patients from an aHAH service in Oxford, United Kingdom, between January and October 2024. Eligible patients were aged 18 years and older with an acute illness (lower respiratory tract infection, cellulitis, urinary tract infection, systemic evidence of acute infection, acute kidney injury, or heart failure with acute fluid overload) requiring aHAH care. Pregnant women and those with contraindications to monitoring were excluded. Participants were asked to wear a chest patch to estimate their heart rate and respiratory rate (passive monitoring), and to intermittently check their oxygen saturations, blood pressure, and temperature (active monitoring). Participants were asked to complete a Technology Acceptance Questionnaire. All aHAH patients were screened. Recruitment was nonconsecutive due to the availability of the research team. Participants were monitored for 7 days or until discharge from the aHAH service, whichever was shorter. Fixed time windows were used to assess real-time vital sign data coverage during each participant's monitoring period. The primary outcomes were the proportion of 4-hour monitoring windows with a recorded heart rate and 12-hour daytime windows with a recorded oxygen saturation level. Time-series analyses and descriptive statistics were used for quantitative data. Content analysis was used to analyze the open-ended comments in the questionnaire.

In total, 29 participants were recruited and 3 immediately withdrew from the study. Participants were monitored for 4.8 (IQR 2.9-6.2) days on average. Overall, 89% (600/674) of the 4-hour monitoring windows had a heart rate and 75.4% (508/674) had a respiratory rate recorded in real-time. For the 12-hour daytime windows, 58.1% (75/129) had an oxygen saturation, 54.3% (70/129) had a blood pressure, and 51.2% (66/129) had a temperature recorded. Data coverage was higher for passive monitoring compared to active monitoring. Most participants who had capacity found the combined monitoring system easy to use and thought it was useful for their health care.

Remote monitoring of vital signs in aHAH patients is feasible. Good data coverage was achieved for the passive monitoring, which did not require specific actions by the participants or their caregivers. Further work is required to ascertain which patients would benefit most from this monitoring.