Continuous Monitoring in an Inpatient Medical （持续的监控住院医疗）.pdfVIP

CLINICAL RESEARCH STUDY Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial Harvey Brown, MD,a Jamie Terrence, RN,a Patricia Vasquez, RN, BSN,a David W. Bates, MD, MSc,b,c Eyal Zimlichman, MD, MScb,c aCalifornia Hospital Medical Center, a member of Dignity Health, Los Angeles; bThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women ’s Hospital, Boston, Mass; cHarvard Medical School, Boston, Mass. ABSTRACT BACKGROUND: For hospitalized patients with unexpected clinical deterioration, delayed or suboptimal intervention is associated with increased morbidity and mortality. Lack of continuous monitoring for average-risk patients has been suggested as a contributing factor for unexpected in-hospital mortality. Our objective was to assess the effects of continuous heart rate and respiration rate monitoring in a medical- surgical unit on unplanned transfers and length of stay in the intensive care unit and length of stay in the medical-surgical unit. METHODS: In a controlled study, we have compared a 33-bed medical-surgical unit (intervention unit) to a “sister” control unit for a 9-month preimplementation and a 9-month postimplementation period. Following the intervention, all beds in the intervention unit were equipped with monitors that allowed for continuous assessment of heart and respiration rate. RESULTS: We reviewed 7643 patient charts: 2314 that were continuously monitored in the intervention arm and 5329 in the control arms. Comparing the average length of stay of patients hospitalized in the inter- vention