Integrated monitoring and analysis for early warning of patient deterioration.

Recently there has been an upsurge of interest in strategies for detecting at-risk patients in order to trigger the timely intervention of a Medical Emergency Team (MET), also known as a Rapid Response Team (RRT). We review a real-time automated system, BioSign, which tracks patient status by combining information from vital signs monitored non-invasively on the general ward. BioSign fuses the vital signs in order to produce a single-parameter representation of patient status, the Patient Status Index. The data fusion method adopted in BioSign is a probabilistic model of normality in five dimensions, previously learnt from the vital sign data acquired from a representative sample of patients. BioSign alerts occur either when a single vital sign deviates by close to +/-3 standard deviations from its normal value or when two or more vital signs depart from normality, but by a smaller amount. In a trial with high-risk elective/emergency surgery or medical patients, BioSign alerts were generated, on average, every 8 hours; 95% of these were classified as 'True' by clinical experts. Retrospective analysis has also shown that the data fusion algorithm in BioSign is capable of detecting critical events in advance of single-channel alerts.

[1]  L. Tarassenko,et al.  A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients , 2006, Anaesthesia.

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

[3]  D. Goldhill,et al.  Physiological values and procedures in the 24 h before ICU admission from the ward , 1999, Anaesthesia.

[4]  M. Singer,et al.  Unexpected Deaths and Referrals to Intensive Care of Patients on General Wards – Are Some Cases Potentially Avoidable? , 1999, Journal of the Royal College of Physicians of London.

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

[6]  D. Wakefield,et al.  Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients , 1993, Journal of General Internal Medicine.

[7]  Claire Thomas,et al.  Nursing observations on ward patients at risk of critical illness. , 2002, Nursing times.

[8]  D. Goldhill,et al.  The critically ill: following your MEWS. , 2001, QJM : monthly journal of the Association of Physicians.

[9]  R. Morgan.  Outreach critical care-cash for no questions? , 2003, British journal of anaesthesia.

[10]  G. Moore,et al.  Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study , 2002, BMJ : British Medical Journal.

[11]  C. Subbe,et al.  Effect of introducing the Modified Early Warning score on clinical outcomes, cardio‐pulmonary arrests and intensive care utilisation in acute medical admissions * , 2003, Anaesthesia.

[12]  Lionel Tarassenko,et al.  BIOSIGN™ : multi-parameter monitoring for early warning of patient deterioration , 2005 .

[13]  C. Subbe,et al.  Outreach critical care-cash for no questions? , 2003, British journal of anaesthesia.

[14]  David G. Stork,et al.  Pattern Classification , 1973 .

[15]  M. Devita,et al.  Use of medical emergency team responses to reduce hospital cardiopulmonary arrests , 2004, Quality and Safety in Health Care.

[16]  F McArthur-Rouse,et al.  Critical care outreach services and early warning scoring systems: a review of the literature. , 2001, Journal of advanced nursing.

[17]  B. Cuthbertson.  Editorial II Outreach critical care—cash for no questions? , 2003 .

[18]  Charles Safran,et al.  Making ICU alarms meaningful: a comparison of traditional vs. trend-based algorithms , 1999, AMIA.

[19]  Worthington,et al.  The patient‐at‐risk team: identifying and managing seriously ill ward patients , 1999, Anaesthesia.

[20]  C. Shields.  The mechanism and physiotherapeutic relief of pain. , 1951, Lancet.

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

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

[23]  R. Jeffreys,et al.  AVOIDABLE FACTORS CONTRIBUTING TO THE DEATH OF HEAD INJURY PATIENTS IN GENERAL HOSPITALS IN MERSEY REGION , 1981, The Lancet.

[24]  A. Pittard,et al.  Out of our reach? Assessing the impact of introducing a critical care outreach service , 2003, Anaesthesia.

[25]  J. Tibballs,et al.  A prospective before‐and‐after trial of a medical emergency team , 2004, The Medical journal of Australia.

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

[27]  D. Berry,et al.  Impact of a critical care outreach team on critical care readmissions and mortality , 2004, Acta anaesthesiologica Scandinavica.

[28]  C. Subbe,et al.  Validation of a modified Early Warning Score in medical admissions. , 2001, QJM : monthly journal of the Association of Physicians.

[29]  Julie T Sharpley,et al.  Introducing an early warning scoring system in a district general hospital. , 2004, Nursing in critical care.