Boer, Touw and Loer describe the concept of continuous, remote vital sign monitoring and the current level of evidence for it's proposed benefit.

We know that...

• Post-operative complications occur in 25-40% of patients, making this the most important focus for improving perioperative outcomes.
• Failure to rescue is a common problem, and few postoperative patients actually experience sudden deterioration, instead hindsight shows a slow and steady decline leading to the critical event that generates an emergency response.

Continuous remote vital sign monitoring on surgical wards may improve early recognition of deterioration.

• Remote monitoring uses medical-grade biosensors wirelessly linked to a central receiver, integrated with an electronic patient record, allowing patients free movement.
• The handful of currently available systems monitor combinations of heart rate ± variability, ECG, respiratory rate, pulse oximetry, blood pressure, temperature, posture and activity.
• Continuous monitoring may then be integrated with systems that calculate an Early Warning Score, automatically notify staff of early deterioration, or in more advanced future systems, allow prediction of deterioration.
• Although feasible, all current systems suffer from practical and technical issues that can limit their sensitivity and specificity.

So, any real evidence?

• Evidence of benefit is still very patchy, although data suggests that automated notification of deterioration leads to earlier responses by treating teams, with small interventions, reducing the burden on rapid response / MET systems.
• No actual morbidity or mortality outcome data is yet available.

Be cautious...

While the hope is that remote monitoring can improve patient safety, it could disingenuously be used to justify reduced ward staffing and hospital stay length by normalizing the risk of our current postoperative harm status quo.

summary

• Christa Boer, Hugo R Touw, and Stephan A Loer.
• Department of Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
• Curr Opin Anaesthesiol. 2018 Dec 1; 31 (6): 716-722.

Purpose Of ReviewThis narrative review summarizes recent insights into the role of remote monitoring of vital signs in the postoperative period in surgical wards.Recent FindingsDespite recent improvements in the safety of anesthesia and surgical procedures, postoperative complication rates are still unacceptably high. This is partly attributable to the intermittent provision of personal care to patients by nurses and ward physicians. Continuous remote monitoring of vital functions in the early postoperative period may reduce these complication rates. There are several medical-grade remote monitoring platforms available that integrate a biosensor signal with electronic patient records, enabling automated prediction or notification of patient deterioration. Most available platforms have technical limitations with respect to the accuracy of respiratory rate measurements. Of note, although the implementation of automated notifications of patient deterioration is associated with a reduced activation of acute response teams, the involvement of ward physicians in the early diagnosis and treatment of subtle changes in vital functions is increased.SummaryRemote monitoring of vital signs in the surgical ward may contribute to prevention of severe complications and reduction in failure-to-rescue rates, although evidence for this association is still lacking. Anesthesiologists should contribute their knowledge and skills with respect to perioperative abnormalities in vital functions to improve patient safety during the postoperative period.

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