Patient Status Engine for wireless monitoring of vital signs

Level of innovation

Two experts thought the PSE is novel in its reliable measurement of continuous vital signs using wireless sensors. One expert noted that using an accelerometer to monitor patient movement was also novel, because this is rarely recorded in hospital inpatients. Another expert believed the PSE was innovative because it uses cheap upgradeable tablets instead of expensive bedside or mobile monitors. One expert commented that the PSE was not novel but was advancing an existing procedure. All experts noted there are other technologies offering continuous vital signs monitoring, but the PSE monitors a larger range of vital signs. It can also easily integrate into hospital information systems and can be used across health and social care settings. One expert noted that not all systems measure the vital signs needed to calculate an early warning score.

Potential patient impact

Potential patient benefits from using the PSE included: more rich patient data for people monitored on hospital wards, earlier detection of clinical deterioration or improvement, individualised targets and treatment, improved patient self-management, and improved patient outcomes. All experts reported high patient acceptance and preference for wireless monitoring. They believed that all people at risk of deterioration would benefit from the technology. Specific patient groups thought to particularly benefit included: critical care step down, postoperative care, acute admissions and ward-based patients with serially elevated early warning scores, fetal monitoring in high-risk pregnancies, and home care.

Two experts stated it was unclear how continuous monitoring using the PSE would affect clinical outcomes compared with standard care. One expert noted that it was uncertain how much the PSE improved the early detection of deterioration or improvement in adult inpatients. Another noted that there is a lack of understanding of the effect of continuous monitoring on rates of activation of hospital rapid response systems if the technology is applied widely on hospital wards. One expert stated that for the technology to be useful, it needs to be appropriately integrated into the rapid response system.

Two experts reported that adverse events from the use of the PSE included minor skin reaction or redness from the electrocardiogram (ECG) stickers. This occurred in less than 1% of people and was reduced with frequent changes. Other very rare potential harms could include injury or discomfort from the pressure of the continuous pulse oximetry finger probe or repeated blood pressure cuff inflation. One expert reported experience of missing data capture resulting in false negative reports and missed deterioration. There is also a potential risk of over assessment and treatment because of false alarms. One expert commented that healthcare professionals may experience alarm fatigue if the trigger thresholds for alerts were not set in line with patient needs.

Potential system impact

Two experts stated the PSE had the potential to change the current care pathway by replacing standard monitoring with continuous wireless monitoring and electronic patient records. One expert stated the PSE would not replace standard care but would supplement and improve continuous monitoring of people at risk of deterioration. They added this would be a major advantage to rapid response teams as the alerts would allow them to quickly respond to deterioration and changes in a person's condition. Two experts believed the PSE would reduce the time to take vital signs but one added that it would not replace bedside assessment. One expert noted the importance of healthcare professional-patient interaction to verify a person's clinical state.

The experts all believed the PSE could be cost saving compared with standard care but there were some uncertainties of the cost impact. One expert felt it was likely to cost the same as standard care but could lead to improvements in quality of care. Resource needs included reliable Wi-Fi coverage or 3G or 4G connectivity and access to server space. One expert stated that the automated blood pressure cuff and wrist mounted pulse oximeter require a supply of disposable batteries that typically need to be changed every 48 hours. High quality ECG electrodes are also needed to secure the Lifetouch ECG sensor. One expert commented that the Lifetouch and Lifetemp sensors expire after about 6 months, which should be considered when keeping a large amount of stock for widespread use. All experts agreed that training was needed to use the PSE.

General comments

All experts stated the PSE is not widely used in the NHS. All experts stated the PSE could be used in most or all district general hospitals. They also described potential use in community and social care settings. Two experts felt uptake within the NHS would be slow. One expert noted this was because of the costs of widespread implementation and the lack of trial evidence that continuous monitoring offers tangible benefits over traditional monitoring in hospital inpatients. They added that the system would need changes to governance procedures, rapid response teams, and escalation pathways.

Some usability issues raised included the need to configure alarms within existing technological systems, unreliable Bluetooth connectivity between sensors and the Patient Gateway, and uncertainty as to how to incorporate axillary skin temperature measurements from the Lifetemp sensor into early warning score algorithms. All experts stated that additional research about the PSE was needed, including efficacy trials in adults and fetal monitoring during pregnancy, research about its use in home care, and comparison of the PSE with traditional vital signs monitoring in ward-based settings.