Surveillance of Patients in the Waiting Area of the Department of Emergency Medicine

AbstractMany patients visiting an emergency department are in reduced general condition of health and at risk of suffering further deterioration during their stay. We wanted to test the feasibility of a new monitoring system in a waiting area of an emergency department.In an observational cross-sectional single-center study, patients with acute cardiac or pulmonary symptoms or in potentially life-threatening conditions were enrolled. Monitoring devices providing vital signs via short range radio (SRR) at certain time points and compliance evaluation forms were used.Out of 230 patients, 4 wanted to terminate their participation prematurely. No data was lost due to technical difficulties. Over a median monitoring period of 178 (118–258) min per patient, 684 h of vital sign data were collected and used to assist managing those patients. Linear regression analysis between clinical symptom category groups of patients showed significant differences in the respiratory rate and noninvasive blood pressure courses. Feedback from patients and users via questionnaires showed overall very good acceptance and patients felt that they were given better care.To assist medical staff of an emergency department waiting area to rapidly response to potentially life-threatening situations of its patients, a new monitoring system proved to be feasible and safe.

[1]  C. Sprung,et al.  Clinical antecedents to in-hospital cardiopulmonary arrest. , 1990, Chest.

[2]  C. Franklin,et al.  Developing strategies to prevent inhospital cardiac arrest: Analyzing responses of physicians and nurses in the hours before the event , 1994, Critical care medicine.

[3]  Giles Morgan,et al.  Confidential inquiry into quality of care before admission to intensive care , 1998, BMJ.

[4]  A. Smith,et al.  Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey. , 1997, Resuscitation.

[5]  T. Hodgetts,et al.  Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. , 2002, Resuscitation.

[6]  K. Hillman,et al.  Duration of life-threatening antecedents prior to intensive care admission , 2002, Intensive Care Medicine.

[7]  K. Hillman.  Critical care without walls , 2002, Current opinion in critical care.

[8]  D. Goldhill.  Preventing surgical deaths: critical care and intensive care outreach services in the postoperative period. , 2005, British journal of anaesthesia.

[9]  K. Hillman,et al.  Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial , 2005, The Lancet.

[10]  J. Kline,et al.  Operational performance of validated physiologic scoring systems for predicting in-hospital mortality among critically ill emergency department patients* , 2005, Critical care medicine.

[11]  Gordon A. Harrison,et al.  Combinations of early signs of critical illness predict in-hospital death-the SOCCER study (signs of critical conditions and emergency responses). , 2006, Resuscitation.

[12]  M. Howell,et al.  Simple triage scoring system predicting death and the need for critical care resources for use during epidemics , 2007, Critical care medicine.

[13]  K. Hillman,et al.  The objective medical emergency team activation criteria: a case-control study. , 2007, Resuscitation.

[14]  R. Shelton.  The Emergency Severity Index 5-Level Triage System , 2009, Dimensions of critical care nursing : DCCN.

[15]  John Kellett,et al.  Validation of an abbreviated Vitalpac™ Early Warning Score (ViEWS) in 75,419 consecutive admissions to a Canadian regional hospital. , 2012, Resuscitation.

[16]  Michele Freeman,et al.  Early warning system scores for clinical deterioration in hospitalized patients: a systematic review. , 2014, Annals of the American Thoracic Society.