Wearables for continuous patient monitoring on COVID-19 isolation wards
Cristian Roman; Sarah Vollam; Peter Watkinson; Lionel Tarassenko
Abstract
An ambulatory monitoring system for the continuous monitoring of heart rate, respiratory rate and oxygen saturation, using wearable devices was implemented at the start of the COVID-19 pandemic on selected isolation wards in a large UK hospital. We have retrospectively analysed the data from two groups of patients on these wards: those whose care was escalated so that they were admitted to the ICU; and those who were discharged home (or to a non-isolation ward).
The analysis of the data provides evidence for the value of wearable monitoring for the early identification of physiological deteriorations in COVID-19 patients. The continuous data from the finger-worn pulse oximeter reveals clinically significant changes between 2 and 3 hours ahead of the regular vital-sign observations by the nursing staff. We also show how a hybrid score (calculated from a mixture of continuous and intermittent vital-sign data) can provide early warning of deterioration for high-risk patients. With this in mind, we are currently in the early stages of a randomized controlled trial whose aim is to test this hypothesis, using real-time wearable monitoring as described in this paper, but with additional alerting based on the real-time computation of the hybrid early warning score.
Clinical Relevance - Clinical deterioration is often preceded by deviations in physiological parameters. Episodes of desaturation, including silent hypoxia, in hospitalized patients with SARS-COV-2 infection are common and often not detected by routine vital-sign observations. Evidence is provided to show that continuous remote monitoring using wearable devices is able to identify patient deterioration early.
Keywords: Wearable monitoring; ICU admission; COVID-19; Patient safety; SpO2 desaturations
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