Continuous Monitoring for early detection of deterioration on general care units

While the 1990’s were the decade of the executive arm of RRTs, the realization that RRS are only as good as their notification system became obvious in the first decade of this century. Early approaches implemented continuous monitoring as part of RRS. With further developments of patient surveillance expanding from GCU in academic centers to community centers and patient home monitoring it has become clear that surveillance monitoring is the overarching umbrella and system under which RRS have their place. As total knee replacement surgery in the elderly becomes an outpatient procedure in patients with multiple co-morbidities who recover at home, surveillance monitoring in- and outside of health care organizations becomes increasing important; often in settings that go beyond the scope of RRT as we know them.Failure to rescue patients from inadvertent deterioration on general care units has long been associated with a combination of incomplete or infrequent patient vital signs monitoring, lack of recognition or inadequate interpretation of physiological derailment, and untimely clinical response. Fortunately the last decade has seen impressive developments in the area of continuous monitoring to reduce these adverse events and ultimately avoidable hospital mortality. Initial cost-effectiveness studies of some technologies show promise. Currently we still rely on clinical skill training, device testing and RRT responses; much progress has been made but further research is needed to find the point where the benefits outweigh the cost. The future of patient safety is envisaged as a paperless continuous charting of vital signs integrated with laboratory profiles in the EMR, greatly assisted by smart automated interpretation and decision support tools. New, innovative technologies will allow for monitors designed and intended towards the specific attributes of patients in GCUs, either wearables or contactless, allowing for accurate readings of vital signs. These continuous readings, together with other clinical data, will offer a chance to improve healthcare outcomes without replacing human intervention. The quest continues today for a suitable algorithm to maximize accuracy of early detection, and minimize transmission errors and alert fatigue so that ward-based clinical care can deliver optimal survival without serious unexpected complications and reduced need for rapid response system calls, transfers to higher levels of care, other hospital resources and ultimately preventable mortality