Remote Monitoring of Patients with Hematologic Malignancies at High-Risk of Febrile Neutropenia (Preprint)

BACKGROUND Febrile neutropenia represents one of the most common oncologic emergencies and is associated with significant, preventable morbidity and mortality. The vast majority of patients suffering a febrile neutropenia episode are hospitalized, resulting in significant economic cost. OBJECTIVE This exploratory study implemented a remote monitoring platform including a digital infrared thermometer and a pulse oximeter with the capability to notify providers in real-time of vital signs abnormalities that could suggest early clinical deterioration, and thereby improve upon clinical outcomes. METHODS The remote monitoring system was implemented versus standard of care vital signs monitoring in hospitalized patients with underlying hematologic malignancies complicated by a febrile neutropenia episode in order to assess both feasibility and validity of the system. RESULTS Intraclass correlation coefficient analysis (ICC), confirmed the high repeatability and accuracy of heart rate assessment (ICC= 0.856), acting as a supplement to sole, remote temperature assessment. While the sensitivity and specificity for capturing tachycardia above a rate of 100 was excellent (88% and 97% respectively), the sensitivity of the remote monitoring system capturing temperature greater than 100 degrees Fahrenheit and oxygen saturation less than 92% was 45% and 50% respectively. CONCLUSIONS Overall, this novel approach including temperature, heart rate and oxygen saturation assessment successfully provides real-time, clinically valuable feedback to providers. While the temperature and oxygen saturation lags in terms of sensitivity when compared to a standard in-hospital system, the heart rate data helps overcome some of this deficit, and as a whole, the system provides additional information that can be applied to a clinically vulnerable population. By transitioning its application to the high-risk patients in the outpatient setting, the novel system can help prevent additional healthcare utilization through early provider intervention and potentially improve outcomes.