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Eur J Anaesthesiol. 2018 May;35(5):325-333. doi: 10.1097/EJA.0000000000000798.

Improving detection of patient deterioration in the general hospital ward environment.

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From the Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium (J-LV), Intensive Care Unit, Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel (SE), Adult Critical Care Unit, Royal London Hospital, London, UK (RP), Department of Critical Care Medicine and Anaesthesiology, Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France (SJ), Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, Würzburg, Germany (PK), Department of Anaesthesiology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA (FJO), Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK (DKW), Department of Intensive Care, Henares University Hospital, Coslada (FG), Health Science School, Francisco de Vitoria University, UFV, Pozuelo de Alarcón, Madrid, Spain (FG), Department of Anaesthesiology, Leiden University Medical Center, Leiden, The Netherlands (AD) and Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany (AH).


: Patient monitoring on low acuity general hospital wards is currently based largely on intermittent observations and measurements of simple variables, such as blood pressure and temperature, by nursing staff. Often several hours can pass between such measurements and patient deterioration can go unnoticed. Moreover, the integration and interpretation of the information gleaned through these measurements remains highly dependent on clinical judgement. More intensive monitoring, which is commonly used in peri-operative and intensive care settings, is more likely to lead to the early identification of patients who are developing complications than is intermittent monitoring. Early identification can trigger appropriate management, thereby reducing the need for higher acuity care, reducing hospital lengths of stay and admission costs and even, at times, improving survival. However, this degree of monitoring has thus far been considered largely inappropriate for general hospital ward settings due to device costs and the need for staff expertise in data interpretation. In this review, we discuss some developing options to improve patient monitoring and thus detection of deterioration in low acuity general hospital wards.

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