Cardona-Morrell M, Prgomet M, Turner R M, Nicholson M, Hillman K
The Simpson Centre for Health Services Research, South Western Sydney Clinical School and The Ingham Institute for Applied Medical Research, The University of NSW, Sydney, NSW, Australia.
Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
Int J Clin Pract. 2016 Oct;70(10):806-824. doi: 10.1111/ijcp.12846. Epub 2016 Aug 31.
Vital signs monitoring is an old hospital practice for patient safety but evaluation of its effectiveness is not widespread. We aimed to identify strategies to improve intermittent or continuous vital signs monitoring in general wards; and their effectiveness in preventing adverse events on general hospital wards.
Publications searched between 1980 and June 2014 in five databases. Main outcome measures were in-hospital death, cardiac arrest, intensive care unit (ICU) transfers, length of stay, identification of physiological deterioration and activation of rapid response systems.
Twenty-two studies assessing the effect of continuous (9) or intermittent monitoring (13) and reporting outcomes on 203,407 patients in-hospital wards across 13 countries were included in this review. Both monitoring practices led to early identification of patient deterioration, increased rapid response activations and improvements in timeliness or completeness of vital signs documentation. Innovative intermittent monitoring approaches are associated with modest reduction in in-hospital mortality over intermittent vital signs monitoring in 'usual care'. However, there was no evidence of significant reduction in ICU transfers or other adverse events with either intermittent or continuous monitoring.
This review of heterogeneous monitoring approaches found no conclusive confirmation of improvements in prevention of cardiac arrest, reduction in length of hospital stay, or prevention of other neurological or cardiovascular adverse events. The evidence found to date is insufficient to recommend continuous vital signs monitoring in general wards as routine practice. Future evaluations of effectiveness need to be undertaken with more rigorous methods and homogeneous outcome measurements.
生命体征监测是医院保障患者安全的一项古老做法,但对其有效性的评估并不普遍。我们旨在确定改善普通病房中间歇性或连续性生命体征监测的策略;以及这些策略在预防综合医院病房不良事件方面的有效性。
检索了1980年至2014年6月期间五个数据库中的文献。主要结局指标包括住院死亡、心脏骤停、重症监护病房(ICU)转入、住院时间、生理状况恶化的识别以及快速反应系统的启动。
本综述纳入了22项评估连续性(9项)或间歇性监测(13项)效果并报告13个国家203,407名住院患者结局的研究。两种监测方法均能早期识别患者病情恶化,增加快速反应的启动次数,并改善生命体征记录的及时性或完整性。与“常规护理”中间歇性生命体征监测相比,创新的间歇性监测方法与住院死亡率适度降低相关。然而,没有证据表明间歇性或连续性监测能显著减少ICU转入或其他不良事件。
对多种监测方法的综述未发现确凿证据证实预防心脏骤停、缩短住院时间或预防其他神经或心血管不良事件方面有改善。迄今为止发现的证据不足以推荐在普通病房常规进行连续性生命体征监测。未来需要采用更严格的方法和统一的结局测量指标进行有效性评估。