Objective:

The article describes the implementation and first-year experience of wearable-based remote monitoring for selected non-ICU patients, with intensivists responsible for patient selection and ICU staff reviewing vital-sign trends.

Approach:

• Patient selection: Intensivists selected cooperative patients who did not require ICU admission but were considered at risk of deterioration expected to develop over more than 2 hours, with ward care demands remaining manageable.
• Monitoring: An ICU nurse reviewed wearable trends every 2 hours and visited each patient once per shift; an ICU physician reviewed trends every 4 hours and visited daily. Ward staff continued MEWS assessments every 4 hours.
• Measures: Wearables continuously recorded oxygen saturation, 3-lead ECG, and respiratory rate; non-invasive blood pressure was measured hourly. Alarms were deactivated.

Key Findings:

• From December 2024 to March 2026, 92 patients were monitored for 1,797 hours, with a 95.4% data capture rate; monitoring covered 19 wards and used no more than three wearables concurrently.
• Severe infection (37 patients), pulmonary embolism (15), and COPD (9) were the most frequent indications. Median monitoring duration was 1 day.
• Remote monitoring identified deterioration in 11 patients who subsequently required ICU admission. Seven additional ICU admissions were not detected by monitoring and occurred for other clinical or care-related reasons.
• Four patients received ward treatment, including diuretics, anti-arrhythmics, or naloxone. The naloxone case involved unconsciousness without vital-sign abnormalities and was not detected by monitoring.
• There were no in-hospital cardiac arrests, Rapid Response Team calls, emergency ICU admissions, or other ward-based interventions in the monitored cohort.
• The authors report that vital-sign abnormalities were absent in 39% of deterioration cases, highlighting the role of patient visits alongside trend monitoring.
• Initial equipment and installation costs were €52,332 for the central monitoring system and workstations, plus €22,020 for four reusable wearables; annual technical support cost €4,477. No additional staff were required.

Interpretation:

The authors describe ICU-led remote monitoring as a hospital-wide approach for selected patients, with bedside assessment remaining necessary because deterioration may occur without vital-sign abnormalities. They note potential advantages and disadvantages, including preserving ICU beds and avoiding handovers, but also the possibility of delayed ICU admission and dispersing near-critical patients across wards.

Limitations:

• Single-hospital experience limits transferability.
• The retrospective evaluation has inherent limitations, and indications and outcomes may change over time.
• Adherence to scheduled reviews and patient visits was not measured.
• Selection was at the individual intensivist’s discretion and may have been influenced by ICU-bed occupancy.
• Only monitored patients were evaluated; patients not selected for monitoring were not assessed.

Conclusion:

The authors state that broader evaluation is needed to understand the efficiency and usefulness of this monitoring approach.

Sources:

• Article context provided