Impact on Patient Outcomes of Continuous Vital Sign Monitoring on Medical Wards: Propensity-Matched Analysis
BackgroundContinuous and wireless vital sign (VS) monitoring on hospital wards is superior to intermittent VS monitoring at detecting VS abnormalities; however, the impact on clinical outcomes remains to be confirmed. A recent propensity-matched study of primary surgical pati...
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JMIR Publications
2025-03-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2025/1/e66347 |
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| author | Bradley Rowland Amit Saha Vida Motamedi Richa Bundy Scott Winsor Daniel McNavish William Lippert Ashish K Khanna |
| author_facet | Bradley Rowland Amit Saha Vida Motamedi Richa Bundy Scott Winsor Daniel McNavish William Lippert Ashish K Khanna |
| author_sort | Bradley Rowland |
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BackgroundContinuous and wireless vital sign (VS) monitoring on hospital wards is superior to intermittent VS monitoring at detecting VS abnormalities; however, the impact on clinical outcomes remains to be confirmed. A recent propensity-matched study of primary surgical patients found decreased odds of intensive care unit (ICU) admission and mortality in patients receiving continuous monitoring. Primary surgical patients are inherently different from their medical counterparts who typically have high morbidity, including frailty. Continuous monitoring research has been limited in primary medical patients.
ObjectiveThis study aims to evaluate the clinical outcomes of primary medical patients who received either continuous or, as a contemporaneous control, intermittent vital monitoring as the standard of care using propensity matching.
MethodsPropensity-matched analysis of a population-based sample of 7971 patients admitted to the medical wards between January 2018 and December 2019 at a single, tertiary United States medical center. The continuous monitoring device measures oxygen saturation, heart rate, respiratory rate, continuous noninvasive blood pressure, and either 3-lead or 5-lead electrocardiogram. Patients received either 12 hours or more of continuous and wireless VS monitoring (n=1450) or intermittent VS monitoring (n=6521). The primary outcome was the odds of a composite of in-hospital mortality or ICU transfer during hospitalization. Secondary outcomes were the odds of individual components of the primary outcome, as well as heart failure (HF), myocardial infarction (MI), acute kidney injury (AKI), and rapid response team (RRT) activations.
ResultsThose who received intermittent VS monitoring had greater odds of a composite of in-hospital mortality or ICU admission (odds ratio [OR] 2.79, 95% CI 1.89-4.25; P<.001) compared with those who had continuous and wireless VS monitoring. The odds of HF (OR 1.03, 95% CI 0.83-1.28; P=.77), MI (OR 1.58, 95% CI 0.77-3.47; P=.23), AKI (OR 0.74, 95% CI 0.62-1.02; P=.06), and RRT activation (OR 0.94, 95% CI 0.75-1.19; P=.62) were similar in both groups.
ConclusionsIn this propensity-matched study, medical ward patients who received standard of care intermittent VS monitoring were at nearly 3 times greater odds of transfer to the ICU or death compared with those who received continuous VS monitoring. Our study was primarily limited by the inability to match patients on admission diagnosis due to limitations in electronic health record data. Other limitations included the number of and reasons for false alarms, which can be challenging with continuous monitoring strategies. Given the limitations of this work, these observations need to be confirmed with prospective interventional trials. |
| format | Article |
| id | doaj-art-08a5043a2b6c446f9cdd7033a24972a2 |
| institution | OA Journals |
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| language | English |
| publishDate | 2025-03-01 |
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| spelling | doaj-art-08a5043a2b6c446f9cdd7033a24972a22025-08-20T01:57:55ZengJMIR PublicationsJournal of Medical Internet Research1438-88712025-03-0127e6634710.2196/66347Impact on Patient Outcomes of Continuous Vital Sign Monitoring on Medical Wards: Propensity-Matched AnalysisBradley Rowlandhttps://orcid.org/0009-0003-8616-6908Amit Sahahttps://orcid.org/0000-0002-3542-4319Vida Motamedihttps://orcid.org/0000-0001-7738-4901Richa Bundyhttps://orcid.org/0000-0002-2506-5682Scott Winsorhttps://orcid.org/0000-0002-5241-362XDaniel McNavishhttps://orcid.org/0000-0001-9394-7110William Lipperthttps://orcid.org/0000-0002-7684-7553Ashish K Khannahttps://orcid.org/0000-0002-9083-891X BackgroundContinuous and wireless vital sign (VS) monitoring on hospital wards is superior to intermittent VS monitoring at detecting VS abnormalities; however, the impact on clinical outcomes remains to be confirmed. A recent propensity-matched study of primary surgical patients found decreased odds of intensive care unit (ICU) admission and mortality in patients receiving continuous monitoring. Primary surgical patients are inherently different from their medical counterparts who typically have high morbidity, including frailty. Continuous monitoring research has been limited in primary medical patients. ObjectiveThis study aims to evaluate the clinical outcomes of primary medical patients who received either continuous or, as a contemporaneous control, intermittent vital monitoring as the standard of care using propensity matching. MethodsPropensity-matched analysis of a population-based sample of 7971 patients admitted to the medical wards between January 2018 and December 2019 at a single, tertiary United States medical center. The continuous monitoring device measures oxygen saturation, heart rate, respiratory rate, continuous noninvasive blood pressure, and either 3-lead or 5-lead electrocardiogram. Patients received either 12 hours or more of continuous and wireless VS monitoring (n=1450) or intermittent VS monitoring (n=6521). The primary outcome was the odds of a composite of in-hospital mortality or ICU transfer during hospitalization. Secondary outcomes were the odds of individual components of the primary outcome, as well as heart failure (HF), myocardial infarction (MI), acute kidney injury (AKI), and rapid response team (RRT) activations. ResultsThose who received intermittent VS monitoring had greater odds of a composite of in-hospital mortality or ICU admission (odds ratio [OR] 2.79, 95% CI 1.89-4.25; P<.001) compared with those who had continuous and wireless VS monitoring. The odds of HF (OR 1.03, 95% CI 0.83-1.28; P=.77), MI (OR 1.58, 95% CI 0.77-3.47; P=.23), AKI (OR 0.74, 95% CI 0.62-1.02; P=.06), and RRT activation (OR 0.94, 95% CI 0.75-1.19; P=.62) were similar in both groups. ConclusionsIn this propensity-matched study, medical ward patients who received standard of care intermittent VS monitoring were at nearly 3 times greater odds of transfer to the ICU or death compared with those who received continuous VS monitoring. Our study was primarily limited by the inability to match patients on admission diagnosis due to limitations in electronic health record data. Other limitations included the number of and reasons for false alarms, which can be challenging with continuous monitoring strategies. Given the limitations of this work, these observations need to be confirmed with prospective interventional trials.https://www.jmir.org/2025/1/e66347 |
| spellingShingle | Bradley Rowland Amit Saha Vida Motamedi Richa Bundy Scott Winsor Daniel McNavish William Lippert Ashish K Khanna Impact on Patient Outcomes of Continuous Vital Sign Monitoring on Medical Wards: Propensity-Matched Analysis Journal of Medical Internet Research |
| title | Impact on Patient Outcomes of Continuous Vital Sign Monitoring on Medical Wards: Propensity-Matched Analysis |
| title_full | Impact on Patient Outcomes of Continuous Vital Sign Monitoring on Medical Wards: Propensity-Matched Analysis |
| title_fullStr | Impact on Patient Outcomes of Continuous Vital Sign Monitoring on Medical Wards: Propensity-Matched Analysis |
| title_full_unstemmed | Impact on Patient Outcomes of Continuous Vital Sign Monitoring on Medical Wards: Propensity-Matched Analysis |
| title_short | Impact on Patient Outcomes of Continuous Vital Sign Monitoring on Medical Wards: Propensity-Matched Analysis |
| title_sort | impact on patient outcomes of continuous vital sign monitoring on medical wards propensity matched analysis |
| url | https://www.jmir.org/2025/1/e66347 |
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