Both cardiac arrest and sepsis are primarily identified by vital sign abnormalities.
However, the practice of nurses and their designees routinely checking hospitalized
patients' vital signs every four to eight hours throughout the day and night has remained
essentially unchanged for over one hundred years. While respiratory rate has been shown
to be the most predictive vital sign for adverse events on the wards, it is often
inaccurately measured and poorly documented. For example, a disproportionate amount of
respiratory rates are recorded as either 18 or 20 breaths/min, which is often higher than
actual rates.
We have previously statistically derived a physiology-based early warning score, called
the electronic cardiac arrest risk triage score (eCART), using vital signs and lab
values. The eCART was more accurate than scores commonly used in hospitals today.
However, the vital sign values utilized for our score were manually collected by nursing
staff every four hours. Recent technological advances have allowed for high-frequency
measurement of pulse and respiratory rate using a cableless respiration monitor. These
devices allow for more frequent and potentially more accurate measures of respiration,
which may enhance the prediction ability for detecting adverse events on the wards. In
addition, the increase in monitoring frequency may result in earlier detection of adverse
events, which could translate into further improvements in patient outcomes.
A subset of patients may be continuously measured using a telemetry system. The alarms
and ECGs from these patients are monitored by staff in a centralized station in the
hospital. When a clinical event requiring action is observed, a call is made to the unit
alerting the clinical staff that action is necessary. We will collect the continuous
measurements collected from this system and compare these continuous measurements to the
high frequency and manual measurements.