scholarly journals Physiological deterioration in the Emergency Department: The SNAP40-ED study

2021 ◽  
Vol 17 (3) ◽  
Author(s):  
Matthew J. Reed ◽  
Rachel O'Brien ◽  
Polly L. Black ◽  
Steff Lewis ◽  
Hannah Ensor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Vital Sign ◽  
Clinical Care ◽  
Ambulatory Monitoring ◽  
Vital Signs ◽  
Clinical Staff ◽  
The Novel ◽  
Open Label ◽  
Novel Device ◽  
Time To Detection

Continuous novel ambulatory monitoring may detect deterioration in Emergency Department (ED) patients more rapidly, prompting treatment and preventing adverse events. Single-centre, open-label, prospective, observational cohort study recruiting high/medium acuity (Manchester triage category 2 and 3) participants, aged over 16 years, presenting to ED. Participants were fitted with a novel wearable monitoring device alongside standard clinical care (wired monitoring and/or manual clinical staff vital sign recording) and observed for up to 4 hours in the ED. Primary outcome was time to detection of deterioration. Two-hundred and fifty (250) patients were enrolled. In 82 patients (32.8%) with standard monitoring (wired monitoring and/or manual clinical staff vital sign recording), deterioration in at least one vital sign was noted during their four-hour ED stay. Overall, the novel device detected deterioration a median of 34 minutes earlier than wired monitoring (Q1, Q3 67,194; n=73, mean difference 39.48, p<0.0001). The novel device detected deterioration a median of 24 minutes (Q1, Q3 2,43; n=42) earlier than wired monitoring and 65 minutes (Q1, Q3 28,114; n=31) earlier than manual vital signs. Deterioration in physiology was common in ED patients. ED staff spent a significant amount of time performing observations and responding to alarms, with many not escalated. The novel device detected deterioration significantly earlier than standard care.

scholarly journals The association between abnormal vital sign groups and undesirable patient outcomes

2018 ◽  
Vol 25 (3) ◽  
pp. 137-145
Author(s):  
Marina Lee ◽  
David McD Taylor ◽  
Antony Ugoni
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Patient Outcomes ◽  
Vital Sign ◽  
Odds Ratio ◽  
Medical Emergency Team ◽  
Vital Signs ◽  
Medical Emergency ◽  
Emergency Team ◽  
Abnormal Vital Sign

Introduction: To determine the association between both abnormal individual vital signs and abnormal vital sign groups in the emergency department, and undesirable patient outcomes: hospital admission, medical emergency team calls and death. Method: We undertook a prospective cohort study in a tertiary referral emergency department (February–May 2015). Vital signs were collected prospectively in the emergency department and undesirable outcomes from the medical records. The primary outcomes were undesirable outcomes for individual vital signs (multivariate logistic regression) and vital sign groups (univariate analyses). Results: Data from 1438 patients were analysed. Admission was associated with tachycardia, tachypnoea, fever, ≥1 abnormal vital sign on admission to the emergency department, ≥1 abnormal vital sign at any time in the emergency department, a persistently abnormal vital sign, and vital signs consistent with both sepsis (tachycardia/hypotension/abnormal temperature) and pneumonia (tachypnoea/fever) (p < 0.05). Medical emergency team calls were associated with tachycardia, tachypnoea, ≥1 abnormal vital sign on admission (odds ratio: 2.3, 95% confidence interval: 1.4–3.8), ≥2 abnormal vital signs at any time (odds ratio: 2.4, 95% confidence interval: 1.2–4.7), and a persistently abnormal vital sign (odds ratio: 2.7, 95% confidence interval: 1.6–4.6). Death was associated with Glasgow Coma Score ≤13 (odds ratio: 6.3, 95% confidence interval: 2.5–16.0), ≥1 abnormal vital sign on admission (odds ratio: 2.6, 95% confidence interval: 1.2–5.6), ≥2 abnormal vital signs at any time (odds ratio: 6.4, 95% confidence interval: 1.4–29.5), a persistently abnormal vital sign (odds ratio: 4.3, 95% confidence interval: 2.0–9.0), and vital signs consistent with pneumonia (odds ratio: 5.3, 95% confidence interval: 1.9–14.8). Conclusion: Abnormal vital sign groups are generally superior to individual vital signs in predicting undesirable outcomes. They could inform best practice management, emergency department disposition, and communication with the patient and family.

scholarly journals Patient Generated Health Data Earn a Seat at the Table:Clinical Adoption During the Covid-19 Transition to Telemedicine

JAMIA Open ◽  
2021 ◽  
Author(s):  
Benjamin I Rosner ◽  
Joseph C Kvedar ◽  
Julia Adler-Milstein
Keyword(s):  
Vital Sign ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Vital Signs ◽  
Application Programming Interface ◽  
Health Data ◽  
Health Concern ◽  
Clinical Use ◽  
Interrupted Time Series Analysis ◽  
Potential Value

Abstract Background Patient generated health data (PGHD) have not achieved widespread clinical adoption. However, the COVID-induced shift to telemedicine may have created opportunities for PGHD as surrogates for vital signs collected in-person. We assessed whether this shift was associated with greater ambulatory care PGHD use. Methods We conducted an interrupted time series analysis of physician enrollment in, and patient-initiated vital sign transmission of non-COVID associated PGHD through, a national PGHD platform (Validic). Results Ten health systems, 4,695 physicians, and 51,320 patients were included. We found a significant increase in physician enrollment (slope change of 0.86/week, P=.02). Platform application programming interface calls continued their pre-COVID upward trend, despite large reductions in overall encounters. Discussion These findings suggest significantly greater pandemic-associated clinical demand for PGHD, and patient supply disproportionate to encounter rates. Conclusion Increasing clinical use and ongoing efforts to reduce barriers, could help seize current adoption momentum to realize PGHD’s potential value. Lay Summary Patient generated health data (PGHD) - health-related data created and recorded by or from patients outside of the clinical setting to help address a health concern—have not yet achieved widespread adoption in routine clinical care. The COVID-19 pandemic precipitated a rapid transition of outpatient encounters to telemedicine in which healthcare providers lacked access to vital signs routinely collected during in-person visits. We conducted an analysis to determine whether the transition to telemedicine increased patient transmission of, and provider adoption of vital sign-related PGHD as surrogates for their in-person equivalents. We found that the number of healthcare providers enrolling on a national PGHD platform increased significantly following the transition to telemedicine, and that the amount of PGHD transmission continued the upward trajectory that it was already experiencing, substantially outpacing the dramatic decline in overall encounters that occurred early in the pandemic. While adoption challenges persist, including questions about accuracy of PGHD, liability, reimbursement, and the potential for exacerbating disparities, these findings suggest an increasing willingness of patients and healthcare providers to use vital sign-related PGHD to supplement telemedicine encounters. Increasing clinical use and ongoing efforts to reduce barriers, could help seize current adoption momentum to realize PGHD’s potential value.

Digital Connectivity: The Sixth Vital Sign

2021 ◽  
pp. 193229682110152
Author(s):  
David C. Klonoff ◽  
Trisha Shang ◽  
Jennifer Y. Zhang ◽  
Eda Cengiz ◽  
Chhavi Mehta ◽  
...  
Keyword(s):  
Vital Sign ◽  
Pressure Pulse ◽  
Digital Health ◽  
Clinical Care ◽  
Vital Signs ◽  
Personal Data ◽  
Skills Training ◽  
Digital Data ◽  
Digital Monitoring ◽  
Continuous Glucose Monitors

Digital health and telehealth connectivity have become important aspects of clinical care. Connected devices, including continuous glucose monitors and automated insulin delivery systems for diabetes, are being used increasingly to support personalized clinical decisions based on automatically collected data. Furthermore, the development, demand, and coverage for telehealth have all recently expanded, as a result of the COVID-19 pandemic. Medical care, and especially diabetes care, are therefore becoming more digital through the use of both connected digital health devices and telehealth communication. It has therefore become necessary to integrate digital data into the electronic health record and maintain personal data confidentiality, integrity, and availability. Connected digital monitoring combined with telehealth communication is known as virtual health. For this virtual care paradigm to be successful, patients must have proper skills, training, and equipment. We propose that along with the five current vital signs of blood pressure, pulse, respiratory rate, temperature, and pain, at this time, digital connectivity should be considered as the sixth vital sign. In this article, we present a scale to assess digital connectivity.

scholarly journals Feasibility and Accuracy of a Wearable Biosensor Device for Vital Sign Monitoring in Septic Emergency Department Patients in Rwanda

2019 ◽  
Vol 34 (s1) ◽  
pp. s85-s86
Author(s):  
Stephanie Garbern ◽  
Gabin Mbanjumucyo ◽  
Christian Umuhoza ◽  
Vinay Sharma ◽  
James Mackey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Vital Signs ◽  
Correlation Coefficients ◽  
University Teaching ◽  
Suspected Sepsis ◽  
The Impact ◽  
Biosensor Device

Introduction:Low and middle-income countries (LMICs) bear a disproportionately high burden of sepsis, contributing to an estimated 90% of global sepsis-related deaths. Critical care capabilities needed for septic patients, such as continuous vital sign monitoring, are often unavailable in LMICs.Aim:This study aimed to assess the feasibility and accuracy of using a small wireless, wearable biosensor device linked to a smartphone, and a cloud analytics platform for continuous vital sign monitoring in emergency department (ED) patients with suspected sepsis in Rwanda.Methods:This was a prospective observational study of adult and pediatric patients (≥ 2 months) with suspected sepsis presenting to Kigali University Teaching Hospital ED. Biosensor devices were applied to patients’ chest walls and continuously recorded vital signs (including heart rate and respiratory rate) for the duration of their ED course. These vital signs were compared to intermittent, manually-collected vital signs performed by a research nurse every 6-8 hours. Pearson’s correlation coefficients were calculated over the study population to determine the correlation between the vital signs obtained from the biosensor device and those collected manually.Results:42 patients (20 adults, 22 children) were enrolled. Mean duration of monitoring with the biosensor device was 34.4 hours. Biosensor and manual vital signs were strongly correlated for heart rate (r=0.87, p<0.001) and respiratory rate (r=0.74 p<0.001). Feasibility issues occurred in 9/42 (21%) patients, although were minor and included biosensor falling off (4.8%), technical/connectivity problems (7.1%), removal by a physician (2.4%), removal for a procedure (2.4%), and patient/parent desire to remove the device (4.8%).Discussion:Wearable biosensor devices can be feasibly implemented and provide accurate continuous vital sign measurements in critically ill pediatric and adult patients with suspected sepsis in a resource-limited setting. Further prospective studies evaluating the impact of biosensor devices on improving clinical outcomes for septic patients are needed.

scholarly journals Validating Emergency Department Vital Signs Using a Data Quality Engine for Data Warehouse

2013 ◽  
Vol 7 (1) ◽  
pp. 34-39 ◽  
Author(s):  
N Genes ◽  
D Chandra ◽  
S Ellis ◽  
K Baumlin
Keyword(s):  
Emergency Department ◽  
Information System ◽  
Data Warehouse ◽  
Vital Sign ◽  
Vital Signs ◽  
Error Rates ◽  
Free Text ◽  
Broad Array ◽  
Physiologic Parameters ◽  
Age Range

Background: Vital signs in our emergency department information system were entered into free-text fields for heart rate, respiratory rate, blood pressure, temperature and oxygen saturation. Objective: We sought to convert these text entries into a more useful form, for research and QA purposes, upon entry into a data warehouse. Methods: We derived a series of rules and assigned quality scores to the transformed values, conforming to physiologic parameters for vital signs across the age range and spectrum of illness seen in the emergency department. Results: Validating these entries revealed that 98% of free-text data had perfect quality scores, conforming to established vital sign parameters. Average vital signs varied as expected by age. Degradations in quality scores were most commonly attributed logging temperature in Fahrenheit instead of Celsius; vital signs with this error could still be transformed for use. Errors occurred more frequently during periods of high triage, though error rates did not correlate with triage volume. Conclusions: In developing a method for importing free-text vital sign data from our emergency department information system, we now have a data warehouse with a broad array of quality-checked vital signs, permitting analysis and correlation with demographics and outcomes.

scholarly journals Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Gideon H. P. Latten ◽  
Judith Polak ◽  
Audrey H. H. Merry ◽  
Jean W. M. Muris ◽  
Jan C. Ter Maaten ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Rate ◽  
Early Warning ◽  
Vital Sign ◽  
Vital Signs ◽  
Early Warning Score ◽  
Suspected Infection ◽  
Prospective Multicentre Study ◽  
Clinical Rules ◽  
Clinical Rule

Abstract Background For emergency department (ED) patients with suspected infection, a vital sign-based clinical rule is often calculated shortly after the patient arrives. The clinical rule score (normal or abnormal) provides information about diagnosis and/or prognosis. Since vital signs vary over time, the clinical rule scores can change as well. In this prospective multicentre study, we investigate how often the scores of four frequently used clinical rules change during the ED stay of patients with suspected infection. Methods Adult (≥ 18 years) patients with suspected infection were prospectively included in three Dutch EDs between March 2016 and December 2019. Vital signs were measured in 30-min intervals and the quick Sequential Organ Failure Assessment (qSOFA) score, the Systemic Inflammatory Response Syndrome (SIRS) criteria, the Modified Early Warning Score and the National Early Warning Score (NEWS) score were calculated. Using the established cut-off points, we analysed how often alterations in clinical rule scores occurred (i.e. switched from normal to abnormal or vice versa). In addition, we investigated which vital signs caused most alterations. Results We included 1433 patients, of whom a clinical rule score changed once or more in 637 (44.5%) patients. In 6.7–17.5% (depending on the clinical rule) of patients with an initial negative clinical rule score, a positive score occurred later during ED stay. In over half (54.3–65.0%) of patients with an initial positive clinical rule score, the score became negative later on. The respiratory rate caused most (51.2%) alterations. Conclusion After ED arrival, alterations in qSOFA, SIRS, MEWS and/or NEWS score are present in almost half of patients with suspected infection. The most contributing vital sign to these alterations was the respiratory rate. One in 6–15 patients displayed an abnormal clinical rule score after a normal initial score. Clinicians should be aware of the frequency of these alterations in clinical rule scores, as clinical rules are widely used for diagnosis and/or prognosis and the optimal moment of assessing them is unknown.

scholarly journals Improving the prioritization of children at the emergency department: Updating the Manchester Triage System using vital signs

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246324
Author(s):  
Joany M. Zachariasse ◽  
Ian K. Maconochie ◽  
Ruud G. Nijman ◽  
Susanne Greber-Platzer ◽  
Frank J. Smit ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Vital Signs ◽  
Electronic Health Record Data ◽  
Triage System ◽  
Capillary Refill ◽  
Manchester Triage System ◽  
High Urgency

Background Vital signs are used in emergency care settings in the first assessment of children to identify those that need immediate attention. We aimed to develop and validate vital sign based Manchester Triage System (MTS) discriminators to improve triage of children at the emergency department. Methods and findings The TrIAGE project is a prospective observational study based on electronic health record data from five European EDs (Netherlands (n = 2), United Kingdom, Austria, and Portugal). In the current study, we included 117,438 consecutive children <16 years presenting to the ED during the study period (2012–2015). We derived new discriminators based on heart rate, respiratory rate, and/or capillary refill time for specific subgroups of MTS flowcharts. Moreover, we determined the optimal cut-off value for each vital sign. The main outcome measure was a previously developed 3-category reference standard (high, intermediate, low urgency) for the required urgency of care, based on mortality at the ED, immediate lifesaving interventions, disposition and resource use. We determined six new discriminators for children <1 year and ≥1 year: “Very abnormal respiratory rate”, “Abnormal heart rate”, and “Abnormal respiratory rate”, with optimal cut-offs, and specific subgroups of flowcharts. Application of the modified MTS reclassified 744 patients (2.5%). Sensitivity increased from 0.66 (95%CI 0.60–0.72) to 0.71 (0.66–0.75) for high urgency patients and from 0.67 (0.54–0.76) to 0.70 (0.58–0.80) for high and intermediate urgency patients. Specificity decreased from 0.90 (0.86–0.93) to 0.89 (0.85–0.92) for high and 0.66 (0.52–0.78) to 0.63 (0.50–0.75) for high and intermediate urgency patients. These differences were statistically significant. Overall performance improved (R2 0.199 versus 0.204). Conclusions Six new discriminators based on vital signs lead to a small but relevant increase in performance and should be implemented in the MTS.

EFFICACY OF A NOVEL DEVICE TO DETECT, ALERT AND RESOLVE NEONATAL APNEA - PILOT STUDY

2019 ◽  
Vol 9 (9) ◽  
pp. 608-613
Author(s):  
Dr. Swapna Lingaldinna,Dr. Himabindu Singh,Mona Sharma*
Keyword(s):  
Newborn Care ◽  
Standard Of Care ◽  
The Novel ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Care Community ◽  
Novel Device ◽  
Sick Newborn ◽  
Central Apneas ◽  
Neonatal Apnea

Objective: To measure the accuracy of a novel device in detecting Bradycardia andDesaturation (B&D) events and to determine its efficacy in resolving apneas innewborns with comparison to standard monitor (which only detects B&D eventsand alerts).Design: This was a prospective observational study.Setting: Sick Newborn Care Unit of a large tertiary referral hospital in Hyderabad,India.Methods: 31 newborns were provided with a novel device, which monitored oxygensaturation and pulse rate and alarmed when values dropped below a set thresholdwhich is referred as an event, henceforth. The novel device also provided footstimulation in response to above-mentioned events. When the monitor alarmed, anurse attended to the baby to confirm whether the baby was breathing and whetherthe event had been resolved by the device. If the event had not resolved, appropriateaction as per the standard-of-care was performed.Results: The novel device “ApneBootTM” positively detected B&D events 94.03% oftimes as compared to the standard reference monitor. 56 of 67 observed B&D eventswere visually confirmed to be apneas, indicating that 83.6% of B&D eventscoincided with apneas. Of the 56 apneic events, 50 were central apneas, of which 35were resolved by the novel device, making the device’s efficacy of apnea resolution70%.Conclusion: The results of the study indicate that this novel device “ApneBootTM”is very effective in detecting and alarming B&D events, which coincides with theapnea, and resolving it by providing foot stimulation.Keywords: Novel Device, Neonatal Apnea, Low Birth Weight, Body Temperature,Kangaroo Mother Care, Community Health,

Interventions to change clinician behaviour in relation to suicide prevention care in the emergency department: A scoping review protocol

2020 ◽  
Author(s):  
Hwayeon Danielle Shin ◽  
Christine Cassidy ◽  
Janet Curran ◽  
Lori Weeks ◽  
Leslie Anne Campbell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Suicide Prevention ◽  
Behaviour Change ◽  
Clinical Care ◽  
Grey Literature ◽  
Allied Health Professionals ◽  
Wide Range ◽  
Knowledge And Attitude ◽  
Clinician Behaviour ◽  
Google Search

Objective: This review aims to explore, characterize, and map the literature on interventions implemented to change emergency department (ED) clinicians’ behaviour related to suicide prevention using the Behaviour Change Wheel (BCW) as a guiding theoretical framework. Introduction: An ED is a critical place for suicide prevention. Yet, many patients who present with suicide-related thoughts and behaviours are discharged without proper assessment or appropriate treatment. Supporting clinicians (who provide direct clinical care, including nurses, physicians, allied health professionals) to make the desired behaviour change following evidence-based suicide prevention care is an essential step toward improving patient outcomes. However, reviews to date have yet to take a theoretical approach to investigate interventions implemented to change clinicians’ behaviour. Inclusion criteria: This review will consider literature that includes interventions that target ED clinicians’ behaviour change related to suicide prevention. Behaviour change refers to observable practice changes as well as proxy measures of behaviour change including knowledge and attitude. There are many ways in which an intervention can change clinicians’ behaviour (e.g., education, altering service delivery). This review will include a wide range of interventions that target behaviour change regardless of the type but exclude interventions that exclusively target patients.Methods: Multiple databases will be searched: PubMed, PsycInfo, CINAHL and Embase. We will also include grey literature, including Google search, ProQuest Dissertations and Theses Global, and Scopus conference papers. Full text of included studies will be reviewed, critically appraised and extracted. Extracted data will be coded to identify intervention functions using the BCW. Findings will be summarized in tables accompanied by narrative reports.

Measuring Earwax Cortisol Concentration Using a Non-Stressful Method (Preprint)

2020 ◽  
Author(s):  
Andrés Herane-Vives
Keyword(s):  
Cortisol Level ◽  
Local Stress ◽  
Extraction Methods ◽  
Cortisol Concentration ◽  
The Novel ◽  
Sampling Device ◽  
Related Factors ◽  
Novel Device ◽  
Cortisol Levels ◽  
The Right

BACKGROUND “Short-term” samples are not the most appropriate for reflecting Chronic Cortisol Concentration (CCC). Although hair is used for reflecting the systemic cortisol level over “long-term”, its use appears clinically problematic. Local stress and non-stress related factors may release a circumscribed cortisol secretion that is accumulated in hair. Non-stressful earwax extraction methods may provide a more accurate specimen to measure CCC. OBJECTIVE Correlate cortisol levels using hair, serum and earwax samples METHODS Earwax from both ears of 37 controls were extracted using a clinical procedure commonly associated with local pain. One month later, earwax from the left ear side was extracted using the same procedure, and earwax from the right ear side was comfortably extracted, using an earwax self-sampling device. Participants also provided one centimetre of hair that represented the retrospective month of cortisol output, and one serum sample that reflected the effect of systemic stressors on cortisol levels. Earwax (ECC), Hair (HCC) and Serum (SCC) Cortisol Concentration were correlated and compared. Confounders´ effect on cortisol levels were studied. RESULTS Serum showed the largest and hair the lowest cortisol concentration (p<0.01). Left-ECC was larger than Right-ECC (p=0.03). Right-ECC was the only sample unaffected by confounders (all p>0.05). Right-ECC and HCC showed the only significant association (r=0.39; p=0.03). CONCLUSIONS The self-sampling device did not represent a local stressor for the ceruminous glands. It provided the cortisol level with the least likely to be affected by confounding factors over the previous month. ECC using the novel device may constitute another accurate, but more suitable and affordable specimen for measuring CCC.

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