N437 Module 7 Wearable Continuous Monitoring on the Ward Example

Between the Four-Hour Checks: Wearable Continuous Vital Sign Monitoring on General Wards and What the Evidence Shows So Far

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Pre-licensure BSN Program, Aspen University

N437: Healthcare Informatics

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Between the Four-Hour Checks: Wearable Continuous Vital Sign Monitoring on General Wards and What the Evidence Shows So Far

On most general wards, vital signs are measured every four to eight hours, and a patient can deteriorate between checks. Wearable wireless sensors, patches or small devices worn on the chest or wrist that send heart rate, breathing rate, temperature and sometimes oxygen saturation to a central screen or a nurse's phone, promise to fill those gaps. This paper describes the technology, follows a composite night on a medical-surgical unit, reviews what the evidence shows so far and sets out the questions a unit should answer before adopting it.

How the Technology Works

A typical system uses a disposable patch that measures heart rate and breathing rate every minute or so and a separate probe for oxygen saturation. Readings travel wirelessly to a server, which displays trends and sends alerts when values cross set thresholds or combine into a worrying pattern. Unlike bedside monitors in intensive care, the patient can walk, shower in some cases and go home with the patch removed. The system does not replace nurse assessment; it adds data between checks.

A Night on the Unit

Mr. N., a composite 67-year-old man, was two days after bowel surgery on a unit piloting wearable sensors. His 10 p.m. vital signs were normal. At 1:30 a.m., the system alerted the nurse's phone that his heart rate had risen from the 80s to 118 over 90 minutes and his breathing rate to 26. The nurse found him sweaty and uncomfortable, with a temperature of 38.4 degrees Celsius and a firm abdomen. She called the rapid response team. A leak where his bowel had been joined was found, and he was in the operating room by 4 a.m. Without the sensor, the next scheduled vital signs would have been at 2 a.m. at the earliest, and the rising trend would not have been visible.

What the Evidence Shows

A systematic review of wearable wireless continuous monitoring in hospitalized adults found that most studies were still testing validation and feasibility, that the few reporting clinical outcomes did not show significantly better results than standard vital sign measurement, that none reported costs, and that study quality was mostly low or moderate (Leenen et al., 2020). A pilot study on a general ward found that wearable devices could be used by patients and staff but also identified problems with connectivity and data gaps (Weenk et al., 2017). More encouraging, a before-and-after study of 2,466 baseline and 2,303 intervention admissions found fewer unplanned intensive care admissions after wireless monitoring was introduced (3.1% in the monitored period), and rapid response calls that did not lead to intensive care fell from 2.8% to 2.0%, although length of stay and deaths did not change (Eddahchouri et al., 2022).

How Strong Is That Evidence?

The review's conclusion is the fairest summary: there are no large, high-quality controlled trials yet showing clinical benefit or cost-effectiveness (Leenen et al., 2020). A before-and-after comparison leaves open the possibility that something else, a new protocol or a staffing change, drove the improvement. Mr. N.'s story is persuasive, but single cases cannot show how often alerts help and how often they distract. For now, wearable monitoring is a promising emerging technology rather than an established standard.

Alarm Burden and Workflow

The biggest nursing question is alerts. Continuous data can produce many alerts that do not reflect real deterioration, for example a heart rate rise when a patient walks to the bathroom. If thresholds are too sensitive, nurses receive constant notifications and may begin to ignore them, which defeats the purpose. Units adopting the technology need agreed thresholds, delays that filter brief spikes, clear rules on who responds to which alert and how quickly, and a way for nurses to acknowledge and document their response. The technology should be tested with nurses before thresholds are fixed.

The Nurse's Part in Adoption

Nurses are the main users of continuous monitoring on the ward, so their involvement in adoption is essential. During a pilot, bedside nurses should help set and adjust thresholds, record whether each alert led to action, and describe what the alerts did to their workload. Charge nurses can track alerts per shift and identify patients whose alerts are persistently false, such as a patient with a known fast heart rate from atrial fibrillation, so that individual thresholds can be changed by an agreed process. Nurses also teach patients why they are wearing the patch and what to do if it comes off. Units that treat nurses as partners in setting up the system are more likely to find a balance between catching deterioration and avoiding constant noise.

Equity, Privacy and Cost

Sensors must work reliably on all skin tones, since some optical sensors are less accurate on darker skin, and devices must be validated in the populations where they are used. Continuous data streams must be protected like other health information. Finally, the patches are disposable and add cost per patient, which, given the lack of cost-effectiveness studies, must be weighed against uncertain savings from fewer transfers to intensive care.

Questions a Unit Should Ask

Before adopting wearable monitoring, a unit should ask: Which patients will wear the sensors, all patients or those at higher risk? What thresholds will trigger alerts, and who set them? Who receives alerts, on which device, and what response time is expected? How will the unit measure alerts per patient per day, false alarms, rapid response calls, unplanned intensive care transfers and nurse satisfaction? What happens when the connection drops? And how will the unit decide, after a defined pilot, whether to continue? Answering these questions in writing before the pilot starts gives the unit a fair basis for its final decision.

Conclusion

Wearable continuous monitoring addresses a real gap between scheduled vital signs, and early studies suggest it may reduce unplanned intensive care admissions. The evidence so far is limited, costs are unknown and alarm burden is a serious risk. Nurses should approach it as they would any emerging technology: interested, involved in setting it up and insistent on measuring whether it helps patients.

References

Eddahchouri, Y., Peelen, R. V., Koeneman, M., Touw, H. R. W., van Goor, H., & Bredie, S. J. H. (2022). Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: A before-and-after study. British Journal of Anaesthesia, 128(5), 857-863. https://doi.org/10.1016/j.bja.2022.01.036

Leenen, J. P. L., Leerentveld, C., van Dijk, J. D., van Westreenen, H. L., Schoonhoven, L., & Patijn, G. A. (2020). Current evidence for continuous vital signs monitoring by wearable wireless devices in hospitalized adults: Systematic review. Journal of Medical Internet Research, 22(6), Article e18636. https://doi.org/10.2196/18636

Weenk, M., van Goor, H., Frietman, B., Engelen, L. J., van Laarhoven, C. J., Smit, J., Bredie, S. J., & van de Belt, T. H. (2017). Continuous monitoring of vital signs using wearable devices on the general ward: Pilot study. JMIR mHealth and uHealth, 5(7), Article e91. https://doi.org/10.2196/mhealth.7208