Exploring the Relationship Between Continuously Monitored Vital Signs, Clinical Deterioration, and Clinical Actions.

Abstract

Continuous monitoring on the general ward leads to more and earlier interventions to prevent clinical deterioration. These clinical actions influence outcomes and may serve as an indicator of impending deterioration. This study aims to correlate clinical actions with clinical endpoints and deviating vital signs. Methods: This cohort study prospectively charted all patients undergoing continuous vital sign monitoring on a gastro-intestinal and oncological surgery, and an internal ward of an academic hospital in The Netherlands from 1 August 2018 till 31 July 2019 (METC 2018-4330, NCT04189653). Clinical actions recorded in electronic medical records were analyzed to assess correlations with patient outcomes, hospital length of stay, and alarming monitoring minutes. Results: A total of 1529 patients were included, of which 68 patients had a negative clinical endpoint. There were 2749 clinical actions recorded. Clinical actions correlated to negative clinical endpoints (ρ = 0.259; p < 0.001, OR: 3.4 to 79.5) and to the length of stay (ρ = 0.560; p < 0.001). Vital sign deviations correlated with clinical actions (ρ = 0.025-0.056; p < 0.001-p = 0.018). In the last 72 h before a clinical endpoint, for alarming minutes, this correlation with clinical actions was more pronounced (ρ = 0.340, p < 0.001). Conclusions: Predefined clinical actions performed on admitted general ward patients correlated with negative endpoints, an increased length of stay, and with deviating vital signs, especially in the period directly preceding severe deterioration. Clinical actions have potential as an intermediate measurement of deterioration.