Wearable continuous vital sign monitoring for deterioration detection and clinical outcomes in hospitalised patients

Abstract

 Current practice uses physiological early warning scoring (EWS) systems to monitor “standard” vital signs, including heart rate (HR), respiratory rate (RR), blood pressure (BP), oxygen saturations (SpO2) and temperature, coupled with a graded response such as referral for a senior review or increasing monitoring frequency. Early detection of the deteriorating patient is a known challenge within hospital environments, as EWS is dependent on correct frequency of physiological observations tailored to specific patient needs, that can be time consuming for healthcare professionals, resulting in missed or incomplete observations. Wearable monitoring systems (WMS) may bring the potential to fill the gap in vital sign monitoring between traditional intermittent manual measurements and continuous automatic monitoring. However, evidence on the feasibility and impact of WMS implementation remains scarce. The virtual High Dependency Unit (vHDU) project was designed to develop and test the feasibility of deploying a WMS system in the hospital ward environment. This doctoral work aims to critically analyse the roadmap work of the vHDU project, containing ten publications distributed throughout 7 chapters. Chapter 1 (with 3 publications) includes a systematic review and meta-analysis identifying the lack of statistical evidence of the impact of WMS in early deterioration detection and associated clinical outcomes, highlighting the need for high-quality randomised controlled trials (RCTs). It also supports the use of WMS as a complement, and not a substitute, for standard and direct care. Chapter 2 explores clinical staff and patient perceptions of current vital sign monitoring practices, as well as their early thoughts on the use of WMS in the hospital environment through a qualitative interview study. WMS were seen positively by both clinical and patient groups as a potential tool to bridge the gap between manual observations and the traditional wired continuous automatic systems, as long as it does not add more noise to the wards nor replaces direct contact from the clinical staff. In chapter 3, the wearability of 7 commercially available wearables (monitoring HR, RR and SpO2) was assessed, advocating for the use of pulse oximeters without a fingertip probe and a small chest patch to improve worn times from the patients. Out of these, five devices were submitted to measurement accuracy testing (chapter 4, with 3 publications) under movement and controlled hypoxaemia, resulting in the validation of a chest patch (monitoring HR and RR) and proving the diagnostic accuracy of 3 pulse oximeters (monitoring pulse rate, PR and SpO2) under test. These results were timely for the final selection of the devices to be integrated in our WMS, namely vHDU system, explored in chapter 5, outlining the process for its development and rapid deployment in COVID-19 isolation wards in our local hospital during the pandemic. This work is now converging in the design of a feasibility RCT to test the impact of the vHDU system (now augmented with blood pressure and temperature monitoring, completing all 5 vital signs) versus standard care in an unbiased environment (chapter 6). This will also ascertain the feasibility for a multicentre RCT, that may in the future, contribute with the much-needed statistical evidence to my systematic review and meta-analysis research question, highlighted in chapter 1. Finally, chapter 7 includes a critical reflection of the vHDU project and overall doctoral work, as well as its contributions to the field of wearable monitoring.

Date of Award	2023
Original language	English
Awarding Institution	Coventry University
Supervisor	Haipeng Liu (Supervisor)