A pilot study to investigate real-time digital alerting from wearable sensors in surgical patients

Meera Joshi; Hutan Ashrafian; Sonal Arora; Mansour Sharabiani; Kenny McAndrew; Sadia N Khan; Graham S Cooke; Ara Darzi

doi:10.1186/s40814-022-01084-2

A pilot study to investigate real-time digital alerting from wearable sensors in surgical patients

Pilot Feasibility Stud. 2022 Jul 6;8(1):140. doi: 10.1186/s40814-022-01084-2.

Authors

Meera Joshi^{1

2}, Hutan Ashrafian³, Sonal Arora⁴, Mansour Sharabiani⁵, Kenny McAndrew⁴, Sadia N Khan⁴, Graham S Cooke⁶, Ara Darzi³

Affiliations

¹ Department of Surgery and Cancer, Imperial College London, 10th Floor Academic Surgical Unit, QEQM Building, St Mary's Hospital, Praed Street, Paddington, London, W2 1NY, UK. meera.joshi03@imperial.ac.uk.
² Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK. meera.joshi03@imperial.ac.uk.
³ Department of Surgery and Cancer, Imperial College London, 10th Floor Academic Surgical Unit, QEQM Building, St Mary's Hospital, Praed Street, Paddington, London, W2 1NY, UK.
⁴ Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK.
⁵ Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, UK.
⁶ Division of Infectious Diseases, Imperial College London, London, UK.

Abstract

Background: Continuous vital sign monitoring may identify changes sooner than current standard monitoring.

Objective: To investigate if the use of real-time digital alerts sent to healthcare staff can improve the time taken to identify unwell patients and those with sepsis.

Design: A prospective cohort study design.

Setting: West Middlesex University Hospital, UK.

Participants: Fifty acutely unwell surgical patients admitted to hospital.

Intervention: Patients wore a lightweight wearable sensor measuring heart rate (HR), respiratory rate (RR) and temperature every 2 min whilst standard intermittent ward monitoring of vital signs was performed by nurses. Digital alerts were sent to healthcare staff from the sensor to a smartphone device. All alerts were reviewed for recruited patients to identify the exact time on the sensor in which deterioration occurred. The time to acknowledgement was then reviewed for each action and an average time to acknowledgement calculated.

Results: There were 50 patients recruited in the pilot study, of which there were vital sign alerts in 18 patients (36%). The total number of vital sign alerts generated in these 18 patients was 51. Of these 51 alerts, there were 7 alerts for high HR (13.7%), 33 for RR (64.7%) and 11 for temperature (21.6%). Out of the 27 acknowledged alerts, there were 2 alerts for HR, 17 for RR and 8 for temperature. The average time to staff acknowledgement of the notification for all alerts was 154 min (2.6 h). There were some patients which had shown signs of deterioration in the cohort. The frequency of routine observation monitoring was increased in 2 cases, 3 patients were referred to a senior clinician and 2 patients were initiated on the sepsis pathway.

Conclusion: This study demonstrates the evaluation of digital alerts to nurses in real time. Although not all alerts were acknowledged, deterioration on the ward observations was detected and actions were taken accordingly. Patients were started on the sepsis pathway and escalation to senior clinicians occurred. Further research is required to review why only some alerts were acknowledged and the effects of digital alerting on patient outcomes.

Trial registration: ClinicalTrials.gov, NCT04638738.

Keywords: Continuous monitoring; Vital signs; Wearable sensors.

Associated data

ClinicalTrials.gov/NCT04638738

Grants and funding

Research Fellowship/Royal College of Surgeons of England