Continuous monitoring beyond the ICU

Melanie Grably

Post-operative & post-acute care

Continuous monitoring of patients is primarily associated with intensive care units (ICUs). Patients are physically connected by wires and pads to cumbersome health monitors that read their vitals 24/7. Once stabilized, they are discharged to post-operative and other relevant wards where patient to nurse ratios can reach 6:1. There, patients are manually monitored, or spot-checked every four-eight hours by an often-understaffed ward. The time-lapse between clinical assessments is crucial since warning signs in deteriorating health condition may occur before symptoms appear and medical staff is made aware, possibly causing health complications, or relapse and readmission to the ICU in the best-case scenario. Since fluctuations in vital signs occur before adverse events, it is imperative to detect them in a timely manner to enable early and adequate intervention.  

Keeping track of vitals around the clock in general hospital wards, not just ICU, enables medical staff to be ahead of the game. Health trends, only possible with continuous monitoring, provide medical staff with clinical insights into the patient’s health status and medical progression. Indeed, recent studies in neonates suggest that analysis of continuously monitor-recorded vital signs trends can predict imminent clinical deterioration or disease such as sepsis and may also predict long-term neurological or respiratory outcomes. Respiratory rate, heart rate, age, and systolic blood pressure are considered the most important predictor variables in detecting health decline.

Patient to nurse ratios can reach 6:1 in post-operative and other hospital wards.

Predictor variables

Respiratory rate (RR) is commonly used as a screening tool to detect lower respiratory tract infections in clinical settings. Deviations in RR are often a manifestation of pathological conditions, and the resulting change in respiratory rate is the physiological adjustment to the disease state. RRs above the norm (20 respirations per minute) are termed tachypnea. With the emergence of COVID-19, Miller, D.J. et al. suggest RR as an indicator of infection. The findings of their work indicate that the early stages of the infection may have a signature that could help identify individuals who should self-isolate and seek testing. High respiratory rates are indicative of anxiety, fever, respiratory disease, heart problems, and dehydration. Low respiratory rates may suggest drug overdose, obstructive sleep apnea, and head injury.

Although heart rate (HR) varies with age, our heart rate tends to fluctuate regularly. However, tachycardia, or increased HR in the long run may have an underlying cause of anemia, congenital heart disease, hyperthyroidism or a heart disease that is affecting blood flow. Bradycardia, a decreased HR, may be indicative of congenital heart disease, damage to the heart, hypothyroidism, inflammatory diseases, or a heart infection. If left untreated, long-term inconsistencies in HR may lead to blood clots, heart failure or cardiac arrest.

Blood pressure (BP) is gender, age and genetics related. Underlying diseases of high BP (hypertension) are sleep apnea, high cholesterol (linked to cardiovascular disease), and diabetes. If left untreated, hypertension, also termed the silent killer, can lead to stroke, heart failure, vision loss, and heart attack. Hypotension, or low BP may be indicative of endocrine (hormonal) mal regulations, severe infection, and nutritional deficiencies.  

Getting a heads-up on patient trends

The three predictor variables mentioned above are difficult to detect through routine visits where spot-checking is commonly deployed. Spot-checking does not provide a full picture on the subject’s health state, nor does it capture trends that foretell impending pathophysiology. However, it is crucial for triage and safety measures in public venues for example, where the general health status of the person can be assessed at any given time.

Chronic disease management

Chronic disease is the most common cause of death and disability worldwide. According to the Centers for Disease Control and Prevention, chronic disease affects an estimated six out of ten adults in the US alone and costs the nation 3.8 trillion dollars in related costs. However, these numbers dramatically change with age. Research from the National Council on Aging shows that a staggering 80% of older adults suffer from a chronic disease and 90% of adults 55 years of age and above are susceptible to suffer from hypertension or high blood pressure. The long-term nature and frequent need for monitoring in chronic disease makes deployment of continuous remote monitoring systems capable of robust, efficient, and straightforward measurement of vitals imperative to track trends of the patient’s condition. The use of such monitors ultimately leads to better care and personalized treatment, and saves money for healthcare.

Aging in place

The US Census Bureau projects that the American population 65+ will nearly double from 2016 and reach 95 million by 2060. The unprecedented turn of events in 2020 has encouraged the elderly to accept remote patient management to minimize risk of infection. In fact, a study conducted by the Centers for Medicare & Medicaid Services indicates that telehealth services increased to 1.7 million (from just 13,000) during 2020. As the aging population is on a steady rise, many are choosing the comfort of their own home as opposed to a nursing home. Thus, constant health monitoring is an ideal support system for those seeking to age at home while maintaining their independence and ensuring high quality of care.

Neteera and continuous monitoring

Early detection of deteriorating health requires continuous monitoring. Keeping constant tabs on variables for trend analysis and clinical insights is a core feature of Neteera’s microsensor, in addition to allowing for spot checking as needed. The Neteera microsensor is suitable for the home as well as hospitals and care facilities. It presents a contact-free, hands-free, cable-free, and disposables-free approach to safely facilitate rapid and accurate detection of fluctuations in health condition in real time, thereby safeguarding and improving lives.