Journal Article

Effectiveness of Remote Patient Monitoring Equipped With an Early Warning System in Tertiary Care Hospital Wards: Retrospective Cohort Study

Lakshman, Pavithra, Khurdi, Sheen, Gopal, Priyanka T

2025

Overview

Monitoring vital signs in hospitalized patients is crucial for evaluating their clinical condition. While early warning scores like the modified early warning score (MEWS) are typically calculated 3 to 4 times daily through spot checks, they might not promptly identify early deterioration. Leveraging technologies that provide continuous monitoring of vital signs, combined with an early warning system, has the potential to identify clinical deterioration sooner. This approach empowers health care providers to intervene promptly and effectively. This study aimed to assess the impact of a Remote Patient Monitoring System (RPMS) with an automated early warning system (R-EWS) on patient safety in noncritical care at a tertiary hospital. R-EWS performance was compared with a simulated Modified Early Warning System (S-MEWS) and a simulated threshold-based alert system (S-Threshold). Patient outcomes, including intensive care unit (ICU) transfers due to deterioration and discharges for nondeteriorating cases, were analyzed in Ramaiah Memorial Hospital's general wards with RPMS. Sensitivity, specificity, chi-square test for alert frequency distribution equality, and the average time from the first alert to ICU transfer in the last 24 hours was determined. Alert and patient distribution by tiers and vitals in R-EWS groups were examined. Analyzing 905 patients, including 38 with deteriorations, R-EWS, S-Threshold, and S-MEWS generated more alerts for deteriorating cases. R-EWS showed high sensitivity (97.37%) and low specificity (23.41%), S-Threshold had perfect sensitivity (100%) but low specificity (0.46%), and S-MEWS demonstrated moderate sensitivity (47.37%) and high specificity (81.31%). The average time from initial alert to clinical deterioration was at least 18 hours for RPMS and S-Threshold in deteriorating participants. R-EWS had increased alert frequency and a higher proportion of critical alerts for deteriorating cases. This study underscores R-EWS role in early deterioration detection, emphasizing timely interventions for improved patient outcomes. Continuous monitoring enhances patient safety and optimizes care quality.

• Publisher: Journal of Medical Internet Research,Gunther Eysenbach MD MPH, Associate Professor,JMIR Publications
• Subject: Aged / Analysis / Blood pressure / Chi-square test / Clinical Deterioration / Clinical outcomes / Cohort analysis / Decision making / Deterioration / Distant early warning system / E-health / Early Warning Score / Emergency communications systems / Equality / Female / Frequency distribution / Health care / Health care industry / Health services / Heart rate / Hospital wards / Hospitalized / Humans / Intensive care / Intensive Care Units / Male / Medical personnel / Medical research / Medicine, Experimental / Methods / Middle Aged / Monitoring systems / Monitoring, Physiologic - methods / Original Paper / Oxygen saturation / Patient monitoring equipment / Patient safety / Patients / Quality of care / Remote Patient Monitoring / Retrospective Studies / Safety / Signs / Technology application / Tertiary Care Centers / Thresholds / Trends / Vital Signs