Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, USA.
Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
Surg Endosc. 2017 Dec;31(12):5457-5462. doi: 10.1007/s00464-017-5625-7. Epub 2017 Jun 7.
Early mobilization after major abdominal surgery decreases postoperative complications and length of stay, and has become a key component of enhanced recovery pathways. However, objective measures of patient movement after surgery are limited. Real-time location systems (RTLS), typically used for asset tracking, provide a novel approach to monitoring in-hospital patient activity. The current study investigates the feasibility of using RTLS to objectively track postoperative patient mobilization.
The real-time location system employs a meshed network of infrared and RFID sensors and detectors that sample device locations every 3 s resulting in over 1 million data points per day. RTLS tracking was evaluated systematically in three phases: (1) sensitivity and specificity of the tracking device using simulated patient scenarios, (2) retrospective passive movement analysis of patient-linked equipment, and (3) prospective observational analysis of a patient-attached tracking device.
RTLS tracking detected a simulated movement out of a room with sensitivity of 91% and specificity 100%. Specificity decreased to 75% if time out of room was less than 3 min. All RTLS-tagged patient-linked equipment was identified for 18 patients, but measurable patient movement associated with equipment was detected for only 2 patients (11%) with 1-8 out-of-room walks per day. Ten patients were prospectively monitored using RTLS badges following major abdominal surgery. Patient movement was recorded using patient diaries, direct observation, and an accelerometer. Sensitivity and specificity of RTLS patient tracking were both 100% in detecting out-of-room ambulation and correlated well with direct observation and patient-reported ambulation.
Real-time location systems are a novel technology capable of objectively and accurately monitoring patient movement and provide an innovative approach to promoting early mobilization after surgery.
大腹部手术后的早期活动可减少术后并发症和住院时间，已成为加速康复路径的关键组成部分。然而，术后患者活动的客观测量方法有限。实时定位系统（RTLS）通常用于资产跟踪，为监测住院患者活动提供了一种新颖的方法。本研究探讨了使用 RTLS 客观跟踪术后患者活动的可行性。
实时定位系统采用红外和 RFID 传感器和探测器的网状网络，每 3 秒采样一次设备位置，每天产生超过 100 万个数据点。RTLS 跟踪在三个阶段进行了系统评估：（1）使用模拟患者场景评估跟踪设备的灵敏度和特异性，（2）回顾性被动分析与患者相关的设备运动，（3）前瞻性观察分析与患者相关的跟踪设备。
RTLS 跟踪检测到模拟离开房间的运动，灵敏度为 91%，特异性为 100%。如果离开房间的时间少于 3 分钟，特异性降低至 75%。18 名患者的所有 RTLS 标记的与患者相关的设备均被识别，但仅检测到 2 名患者（11%）与设备相关的可测量的患者运动，每天有 1-8 次离房行走。10 名接受大腹部手术后的患者使用 RTLS 徽章进行了前瞻性监测。使用患者日记、直接观察和加速度计记录患者的运动情况。RTLS 患者跟踪的灵敏度和特异性均为 100%，可准确检测离房活动，并与直接观察和患者报告的活动密切相关。
实时定位系统是一种新颖的技术，能够客观准确地监测患者的活动，为术后早期活动提供了一种创新的方法。
