JMIR Publications

ABSTRACT

Background:

Frequent monitoring of vital signs (VS) is essential to high-quality inpatient care and early detection of clinical deterioration. VS are manually collected every four hours (Q4), a longstanding practice that can disrupt patient sleep, contribute to dissatisfaction, and fail to detect early physiologic changes. Patients consistently rank overnight VS checks among the top contributors to poor sleep quality. Continuous vital signs monitoring (CVSM) using wearable remote patient monitoring (RPM) devices offers a novel alternative, enabling near real-time, high-frequency VS collection while reducing manual documentation burden and preserving patient rest.

Objective:

This paper describes the structured, phased implementation of CVSM using a wearable RPM device across general inpatient units within a large, eight-hospital health system. The initiative aimed to: (1) enable earlier detection of patient deterioration through continuous, algorithm-driven monitoring; (2) improve nursing workflow by reducing reliance on manual VS checks; and (3) minimize nighttime disruptions to support patient recovery and rest.

Methods:

The program was designed and executed as a multi-phase quality improvement initiative from Q1 2022 to Q1 2024. Planning efforts included stakeholder engagement, vendor evaluation, development of a centralized monitoring infrastructure, Epic integration, staff training, and supply chain coordination. Implementation occurred across eight hospitals using a staggered four phase approach: strategic program design, detailed planning, go-live preparation, and implementation and optimization. Unit groups of one to four followed an 8-week rollout playbook, with successive go-lives launched at three-week intervals to allow for iterative learning and optimization. A centralized Virtual Operations Center (VOC) provided 24/7 monitoring and clinical escalation.

Results:

The phased implementation was feasible and scalable across diverse hospital settings. Initial operational challenges, such as device pairing, staff familiarity, and alert thresholds, were resolved through real-time feedback and collaboration with frontline staff and the vendor. Several units transitioned from Q4 to Q8 VS collection overnight. Early clinical wins and time savings helped drive adoption, and staff reported increased availability for direct patient care tasks.

Conclusions:

The successful system-wide implementation of CVSM was enabled by multi-year planning, early strategic alignment, phased execution, and continuous optimization. This initiative highlights the feasibility of using wearable RPM technology to modernize inpatient monitoring practices and improve both staff efficiency and patient experience. Future research will assess the clinical impact of RPM on post-discharge outcomes and explore its broader role in supporting chronic disease management across care settings.