JMIR Publications

ABSTRACT

Background:

Vital signs monitoring (VSM) is used in clinical acuity scoring systems (APACHE, NEWS2, SOFA) to predict patient outcomes for early intervention. Current advances in technology enable convenient remote VSM. While the role of VSM in ill patients treated in hospital wards is clear, its role in the community for acutely ill patients in the hospital at home (HAH) setting or post-acute phase patients who have just been discharged from an acute hospital stay and at increased risk of deterioration is less well defined.

Objective:

This study aims to assess the efficacy of remote VSM for patients in the HAH or post-acute setting.

Methods:

A systemic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. A search was conducted in PubMed (MEDLINE), Embase, and Scopus databases. Studies focused on the post-acute phase were included as there were only 2 case series specific to the HAH setting. Risk of bias was evaluated using the Cochrane Risk of Bias Tool for randomised controlled trials, Newcastle-Ottawa scale for observational studies and the case methods outlined by Murad et al. for case reports. The GRADE framework was used to assess certainty of evidence. Outcome of interest included emergency department representations, hospital readmissions, mortality, patient’s satisfaction and compliance. Risk ratios were used to measure effect sizes for readmission and mortality, with patient satisfaction and compliance reported descriptively.

Results:

The search yielded 5851 records, with 28 studies meeting eligibility criteria (8 randomised controlled trials, 7 cohort studies, 13 case series). 2 studies focused on HAH with 26 studies on post-acute phase. 19 studies looked at heart failure, 3 studied respiratory conditions, 6 studies studied other conditions. Meta-analysis was done on 6 studies looking at hospital readmission within 60 days and 4 studies on mortality within 30 days. There was no significant reduction of hospital readmission within 60 days (Relative Risk [RR] 0.81, 95% Confidence interval [Cl] (0.61 – 1.09), p=0.16). Significant heterogeneity was observed for hospital readmissions within 60 days (I2 = 58%). Conversely, there was a significant reduction of mortality rates within 30 days (RR 0.65, 95% CI 0.42 – 0.99) p=0.04). There was no significant heterogeneity noted for mortality within 30 days (I2=0%). There was high heterogeneity in the study populations, interventions and outcomes measured. Many studies were of poor quality.

Conclusions:

Published data on the effects of remote VSM in acutely ill patients at home remains scarce. There is a need for future studies to evaluate all common vital signs (heart rate, blood pressure, oxygen saturation, temperature) with consistent monitoring frequencies and clear intervention protocols to better understand how to integrate remote VSM into HAH programmes. Clinical Trial: This systematic review was registered in PROSPERO (CRD42023388827) on 17-January-2023.