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Understanding Continuous Monitoring

What is continuous electronic monitoring or continuous monitoring?

Continuous electronic monitoring (CEM) is a type of surveillance monitoring for hospital inpatients to alert staff of a serious and sustained change to vital signs. Vital signs for hospital inpatients include heart rate, oxygen levels, blood pressure, respiratory rate and temperature. They are an incredibly important tool that can identify if a patient is systemically well or unwell, and whether they need investigating further. Originally reserved for intensive care units, improved post infection recovery times have fuelled interest to gather more specialist medical devices that can continue to advance this field beyond critical care.

In this blog post we will study why CEM is such a popular point of discussion now and what it means for the future of healthcare and for Your Cue.

Swift recognition and effective response to a deteriorating patient in a hospital bed are of paramount importance. Failure to promptly identify and address such situations constitutes a significant patient safety concern within inpatient healthcare settings. Studies suggest that as much as 10% to 13% of hospital patient deaths may be linked to inaction or a failure to recognize deterioration.

The concept of prevention-based medicine has largely replaced treatment-based medicine in the past few decades. The latter focuses on treating the symptoms whereas the former is a measure introduced to reduce the chances of clinical signs deteriorating too quickly. CEM allows healthcare providers to identify potential risks much earlier, allowing them to intervene before they become major problems. This helps to improve patient outcomes and reduce healthcare costs. CEM can also be used to identify trends and patterns in patient data, allowing healthcare providers to make better decisions about patient care. An example would be finding out what a patient's baseline oxygen levels are by monitoring over a long period. .

Image 1 - Image for illustration only. Showing examples of widely used equipment's used for monitoring vital signs of patients in hospitals.

My Experience

As a final year medical student, I have seen first hand the demands upon clinicians in recent times. Not only are staff having to care for an expanding population of older and sicker patients, but they are also having to work with limited and outdated technological equipment, making clinical decisions about patient conditions strenuous. This puts additional pressure on clinicians to be able to recognize signs of patient deterioration and act in a timely manner. This can also lead to burnout and a decrease in job satisfaction among clinicians and may have indirect consequences such as leading to increased mortality rates.

During my clinical placements across a multiple different specialities, I have become aware of the CEM facilities available at my local NHS trust hospital. In particular, There is a patient monitoring system that seems to be the most popular choice amongst the medical wards and the accident and emergency arrivals. The normal practice involves a healthcare assistant carrying the machine across different bays and beds in a routine manner ensuring that patient vital sign parameters, such as oxygen saturation, heart rate and blood pressure, were being assessed. The onus on making sure this was done on regular intervals was entirely the responsibility of the healthcare assistant, and should the ward/emergency unit be very busy there can be delays in this happening. Although the system was praised for its accurate readings, having spoken to experienced healthcare assistants I learnt that it was a very arduous task to move these machines around to each patient whilst simultaneously increasing the potential risk of infection. One staff member, Stacey (name changed) suffered from regular back spasms and cramps due to their personal medical history and dragging these machines across wards only worsened their symptoms.

It became very obvious in my conversations with members of staff that although the majority do believe in CEM, some are against the way it is currently being implemented. They are aware that adverse events are not limited to whenever the intermittent monitoring occurs, and therefore a continuous monitoring system is required. Some hospital wards that do use a continuous monitoring system have integrated alarm systems as well, however this is often not best received by staff, with many complaining that it distracts staff who are engaged in important clinical tasks and increases the risk of errors. For example, one false alarm distracting the on-call doctor means they have to be pulled away from other clinical duties such as advising colleagues or treating another patient. Moreover, a system that lacks efficiency and sounds the alarm at a routine/normal reduction of respiratory rate during the night may cause more of a distraction and may take the attention of healthcare professionals away from patients who are in greater need of care. An efficient system needs to be developed that is intelligent enough to differentiate an obvious clinical deterioration due to infection from routine changes in patient physiology and luckily for patients in wards, a few companies are already working on it.

The Cue Ring

Your Cue is building new patient monitoring technology called the Cue ecosystem, a hardware enabled software solution, powered by the Cue Ring. It is being developed based on the NEWS2* protocols and enables in depth, continuous monitoring of all patient vital signs. It will come with built in AI that will calculate the severity of changes in a patient's condition and raise real-time alerts to healthcare professionals about a patient's condition.

Your Cue is working on a goal of personalizing care for every patient on every ward. Embracing their technology will eventually lead to shorter hospital stays, mortalities and reduced chances of readmission.

*National Early Warning Score is a system for scoring the physiological measurements that are routinely recorded at the patient's bedside.

Image 2- NEWS vital sign assessment chart.

-Pegin Poulose


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