Understanding the challenge

There is a huge unfulfilled need for better monitoring of vital signs in high-risk patients both in general hospital wards and at home.

Despite tremendous improvements in diagnostic and therapeutic options in health care over recent decades, there remains an ‘Achilles heel’ in the care of patients who become acutely unwell, have undergone recent surgery; or have returned to a general ward after discharge from a high dependency or intensive care unit.

Early detection of abnormal vital signs is crucial to prevent death and disability from rapidly fatal conditions such as altered consciousness, upper airway obstruction, respiratory failure, internal bleeding, sepsis, and cardiac arrest. Such monitoring is generally a nursing task. However, nurses on hospital wards must care for more and more high-risk and deteriorating patients, because healthier patients and those needing minor/intermediate surgery are increasingly treated in day-case settings. Increasing the intensity of patient observation by more frequent nurse rounding would seem to be a logical response, but is often impossible due to a shortage of trained nurses and financial constraints: it is only feasible to perform a set of vital signs observations once or twice a day on many wards.

In addition, once discharged home, patients’ vital signs are no longer monitored at all. While this may seem acceptable for patients who appear stable, the reality is often different: considerable mortality occurs in the first week after discharge. What is more, patients now tend to be discharged home earlier than ever before.

A system that connects the high-risk patient at home with the health care team in the hospital and generates alerts when vital signs show impending instability will allow early recognition of deterioration and timely treatment and, if necessary, prompt admission or re-admission to the hospital.

The Nightingale team believe that the solution to unrecognised deteriorationincludes use of one or more wireless sensors that are unobtrusive and do not interfere with the patient’s daily activities or mobilization/rehabilitation. Intelligent analysis software is a key feature, as the false alarm rate must be reasonably low to be acceptable to patients, nurses and informal carers. These devices must also be integrated with the hospital’s electronic patient record,  allow, patients and carers to communicate with the health care team, and, ideally, enable  entry of subjective data such as pain scores and well-being. The team expect that successful implementation of such a system will empower patients and carers; and will have the potential to transform healthcare by reducing death and disability from undetected deterioration, providing a ‘safety net’ for high-risk patients in the hospital and after discharge home.