Philips To Read More {c5751585 44ba 4d55 Aaf5 69d1ebe14191} Decision Support Evidence Series VITAL Study Whitepaper 452296291321 LR
User Manual: Philips to read more Early Warning Scoring tools for rapid response
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July 24, 2013
Supplement to Decision Support Evidence Series
whitepaper “Study finds benefits of spot check
monitoring with early warning scoring”
Instructions on Use and Distribution
The Decision Support Evidence Series document “Study finds benefits of spot check
monitoring with early warning scoring” summarizes background, purpose, methods, and
results of the research paper “A controlled trial of electronic automated vital signs
monitoring in general hospital wards” (“VITAL care” study). The research paper was peer-
reviewed and published in the August 2012 issue (Vol. 40, No. 8) of the medical journal
“Critical Care Medicine”.
When discussing this document with third parties or distributing it, please make sure to
convey the following:
The whitepaper is a promotional piece from Philips and may not be positioned as
being published by an objective third party.
The purpose of the whitepaper is to summarize the results of the “VITAL care”
study.
With respect to the following statement (made in the whitepaper): “The multi-
center trial found the addition of the MP5SC with EWS to the hospitals’ existing
protocol was associated with a 6.3% increase in survival rate at the end of the RRT
call among patients who received such a call. “, it is not Philips’ intent to draw
separate conclusions or make claims about the performance or capabilities of our
product (MP5SC monitor with IntelliVue Guardian Solution).
Thank you for following these instructions.
Management Monitors & Measurements, Philips Medical Systems
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Study nds benets of spot check monitoring
with early warning scoring1
Rinaldo Bellomo, MD, FRACP, FCICM; Michael Ackerman, RN, PhD; Michael Bailey, PhD, MSc; Richard Beale, MB, BS, MD,
FRCA; Greg Clancy, RN, MSN; Valerie Danesh, PhD; Andreas Hvarfner, MD, PhD; Edgar Jimenez, MD; David Konrad, MD,
PhD; Michele Lecardo, RN, BSN, CCRN; Kimberly S. Pattee, RN, BSN; Josephine Ritchie, RN; Kathie Sherman, RN; Peter
Tangkau, MD; The Vital Signs to Identify, Target, and Assess Level of Care Study (VITAL Care Study) Investigators
From the Department of Intensive Care (RB), Austin Health, Melbourne, Australia; Division of Nursing (MA), University of
Rochester Medical Center, Rochester, NY; Department of Biostatistics (MB), Australian and New Zealand Intensive Care Research
Center, Melbourne, Australia; Department of Critical Care Medicine (RB), St. Thomas’ Hospital, London, UK; Department of
Nursing (GC, KSP), Mercy Hospital, Iowa City, IA; Department of Medical Intensive Care (VD, EJ), Orlando Regional Medical
Center, Orlando, FL; Department of Intensive Care Medicine (AH), University of Lund Hospital, Lund, Sweden; Department of
Intensive Care Medicine (DK), Karolinska Hospital, Stockholm, Sweden; Division of Nursing (ML), Norwalk Hospital, Norwalk,
CT; Department of Critical Care Medicine (JR), Norwalk Hospital, Norwalk, CT; Department of Nursing (KS), Reinier Melrose-
Wakeeld Hospital, Melrose MA; Department of Intensive Care Medicine (PT), Reinier de Graaf Hospital, Delft, The Netherlands.
Decision Support
Evidence Series
Background
Patients expect the utmost care and
vigilance when admitted to a hospital.
But studies have shown that preventable,
serious adverse events are nonetheless
common among hospitalized patients.2,3,4,5,6,7
As one bulwark against avoidable adverse
events, clinicians can compare patients’ vital
signs measurements against standard criteria
to identify when a patient’s physiological
condition is in danger of worsening.
In response, hospitals have made an
effort to reduce adverse events through
early identication of patients displaying
early warning signs of deterioration,
and quick initiation of treatment.
To that end, some hospitals have deployed
a Rapid Response Team (RRT) also known
as Medical Emergency Team (MET)
or Critical Care Outreach Team that
clinicians can notify when patients show
evidence of deterioration based on early
warning sign criteria set by the hospital.
Still, studies have shown that clinician
notication is a weak link in this system,
relying on correct, timely interpretation
of accurate measurements and 24-hour
vigilance. Any deviation from this ideal can
lead to nonactivation or delayed activation
of the RRT, which is associated with
increased mortality.8,9,10,11,12,13,14,15,16,17,18
Purpose
From August 2009 to June 2010, the
authors performed a multi-centre, multi-
national, before and after controlled
trial. The study paper was peer-reviewed
and published in Critical Care Medicine in
August, 2012 (Volume 40, number 8).
The purpose of the study was to assess
if, compared with standard paper-based
systems, an automated Early Warning
System (EWS) as part of a spot check
patient monitor can help to identify patients
in acute care settings (outside of the
intensive care unit) who may be experiencing
physiological instability and who are in need
of prompt clinical intervention by an RRT.
452296291321.indd 1 10/22/13 10:41 AM
2
Methods
The study looked at 10 hospitals in the
United States, Europe, and Australia,
consisting of 12 general wards and
349 beds. A total of 18,305 patients
were included in the study: 9,617 in the
control group (before the intervention)
and 8,688 after the intervention.
For the rst three months of the
study, before the intervention, the
investigators collected data on the
prevalence of serious adverse events,
RRT activation, and patient outcomes
among the control group of patients.
Electronic vital signs monitors, Philips
IntelliVue MP5SC, were then introduced
to the wards. These monitors displayed
the following patient vital signs during
nursing spot checks: temperature, blood
pressure, heart rate, and pulse oximetry.
During the spot checks, the monitors also
prompted clinicians to input information
on respiratory rate, conscious state, and
other optional parameters. See Figure 1.
Based on criteria set by each hospital,
the monitors used these measurements
to calculate an early warning score for
the patient. The MP5SC fully adopted the
existing hospital EWS protocols, which
were different and individualized for each
site. These EWS protocols were already
in place during the control phase.
The MP5SC with EWS displayed a
color-coded status for the patient
on the monitor screen—either “safe
range” (white), “observe range”
(yellow), “warning range” (orange), or
“urgent range” (red). See Figure 2.
The monitors stored measurements for
review and documentation, and could
display measurement and scoring trends.
During the three-month intervention period,
the authors collected the same types of data
as during the control period on adverse
events, RRT activation, and outcomes.
Figure 1: The exible MP5SC patient monitor with built-in IntelliVue Guardian
EWS can be used in spot-check as well as continuous monitoring mode.
452296291321.indd 2 10/22/13 10:41 AM
3
Results
The trial found that using the MP5SC
with EWS resulted in a signicant time
reduction for completing acquisition
of vital signs, clinical observations and
calculating the Early Warning Scores
required by the hospital’s EWS protocol.
Clinicians reported that the MP5SC with
EWS was easy to use and helped them
easily measure, evaluate, and document
their patients’ vital signs and EWS scores.
Conclusions
The multi-center study found that the
introduction of Philips IntelliVue MP5SC
reduced the time it took for clinicians
to obtain and record vital signs, as well
as to calculate Early Warning Scores.
The trial found the addition of the MP5SC
with EWS to the hospitals’ existing protocol
was associated with a 6.3 percent increase
in survival rate at the end of the RRT call
among patients who received such a call.
For the same patients, survival to hospital
discharge or 90 days-survival also showed a
signicant improvement. It also altered the
proportion of RRT calls initiated because
of respiratory criteria, an important early
warning sign for deteriorating condition.
All of the study sites had individualized EWS
and call escalation protocols in place before
and during the control phase, indicating that
the MP5SC with EWS can improve even an
already established manual EWS process.
Overall, the study’s ndings point to
automated monitoring as a way to increase
the safety and improve the outcomes of
patients in a hospital’s general wards.
Figure 2:
Screen display illustrating the function of the
MP5SC monitor. In this display, the patient has
abnormal respiratory rate (RR), temperature and
level of consciousness (LOC) identied by colored
circles (sub-scores). The monitor also calculates the
MEWS score (6) and displays the recommended
actions according to the institution’s EWS protocol.
EWS, early warning score; MEWS, Modied
Early Warning Score; NBP, noninvasive blood
pressure; Pleth, pulse oximetry plethysmography.
References
1. Bellomo R, Ackerman M, Bailey M, et al. A controlled
trial of electronic automated advisory vital signs
monitoring in general hospital wards. Crit Care Med.
2012;40(8):2349-2361.
2. Brennan TA, Leape LL, Laird NM, et al: Harvard
Medical Practice Study I: Incidence of adverse events
and negligence in hospitalized patients: Results of the
Harvard Medical Practice Study I. 1991. Qual Saf Health
Care 2004; 13:145-151; discussion 151.
3. Baker GR, Norton PG, Flintoft V, et al: The Canadian
Adverse Events Study: The incidence of adverse
events among hospital patients in Canada. CMAJ 2004;
170:1678-1686.
4. Vincent C, Neale G, Woloshynowych M: Adverse
events in British hospitals: Preliminary retrospective
record review. BMJ 2001; 322:517-519.
5. Buist MD, Jarmolowski E, Burton PR, et al: Recognizing
clinical instability in hospital patients before cardiac
arrest or unplanned admission to intensive care. A
pilot study in a tertiary-care hospital. Med J Aust 1999;
171:22-25.
6. Bellomo R, Goldsmith D, Uchino S, et al: A prospective
before-and-after trial of a medical emergency team.
Med J Aust 2003; 179:283-287.
7. Buist M, Harrison J, Abaloz E, et al: Six year audit of
cardiac arrests and medical emergency team calls in an
Australian outer metropolitan teaching hospital. BMJ
2007; 335:1210-1212.
8. Buist M, Bellomo R: MET: The emergency medical team
or the medical education team? Crit Care Resusc 2004;
6:88-91.
9. Devita MA, Bellomo R, Hillman K, et al: Findings of
the rst consensus conference on medical emergency
teams. Crit Care med 2006; 34:2463-2478.
10. England K, Bion JF: Introduction of medical emergency
teams in Australia and New Zealand: A multicenter
study. Crit Care 2008; 12:151.
11. Casamento AJ, Dunlop C, Jones DA, et al: Improving
the documentation of medical emergency team reviews.
Crit Care Resusc 2008; 10:29.
12. Cretikos MA, Chen J, Hillman KM, et al: MERIT Study
Investigators: The effectiveness of implementation of
the medical emergency team (MET) system and factors
associated with use during the MERIT study. Crit Care
Resusc 2007; 9:206-212.
13. Jones D, Bellomo R, Bates S, et al: Patient monitoring
and the timing of cardiac arrests and medical emergency
team calls in a teaching hospital. Intensive Care Med
2006; 32:1352-1356.
14. Downey AW, Quach JL, Haase M, et al: Characteristics
and outcomes of patients receiving a medical emergency
team review for acute change in conscious state or
arrhythmias. Crit Care Med 2008; 36:477-481.
15. Quach JL, Downey AW, Haase M, et al: Characteristics
and outcomes of patients receiving a medical emergency
team review for respiratory distress or hypotension. J
Crit Care 2008; 23:325-331.
16. MERIT study investigators: Introduction of the medical
emergency team (RRT) system: A cluster-randomised
controlled trial. Lancet 2005; 365:2091-2097.
17. Chen J, Bellomo R, Flabouris A, et al: MERIT Study
Investigators for the Simpson Centre ANZICS
Clinical Trials Group: The relationship between early
emergency team calls and serious adverse events. Crit
Care Med 2009; 37:148-153.
18. Cretikos M, Chen J, Hillman K, et al: MERIT study
investigators: The objective medical emergency team
activation criteria: A case-control study. Resuscitation
2007; 73:62-72.
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4522 962 91321 * AUG 2013
Descriptors of monitoring and process of care in relation to all rapid response team calls*
Descriptor Control Intervention p
Rapid response team dose (calls / 1000 admissions) 21.3/1,000 24.1/1,000 0.21
Age 68.0 (16.7) 69.4 (16.0) 0.39
Male 106 (53%) 106 (52%) 0.75
Number of vitals sets 24hr before call 5.2 (3.5) 5.7 (4.1) 0.19
Number of vitals sets 48hr before call 9.9 (6.4) 10.2 (6.8) 0.68
Number of abnormal vital signs at the
time of rapid response team call
4 [2-6] 3 [1-5] 0.029
Emergency admission to intensive care unit 55 (27%) 61 (29%) 0.64
Transfer to higher acuity ward 75 (41%) 96 (49%) 0.13
Do-not-attempt-resuscitation orders before call 19 (11%) 24 (12%) 0.68
Do-not-attempt-resuscitation orders after call 19 (11%) 33 (17%) 0.10
Surgical emergency admission 49 (25%) 52 (25%) 0.96
Surgical elective admission 35 (18%) 28 (14%) 0.24
Medical emergency admission 110 (56%) 125 (61%) 0.35
Medical elective admission 2 (1%) 0 (0%) 0.24
Triggered by respiratory signs 37 (21%) 61 (31%) 0.029
Triggered by hypotension 32 (18%) 35 (18%) 0.92
Triggered by neurological change 14 (8%) 10 (5%) 0.26
Triggered by arrhythmia 22 (12%) 29 (15%) 0.53
Triggered by staff concern 23 (13%) 17 (9%) 0.17
Triggered by other factors 17 (10% 24 (12%) 0.44
Triggered by multiple factors 32 (18%) 22 (11%) 0.06
Table 1
RRT, rapid response team
The time between documented presence of an
institutionally sanctioned calling criterion and actual RRT
attendance is expressed as mean with range; Vitals =
vital signs (respiratory rate, heart rate, blood pressure,
temperature, pulse oximetry, conscious state); DNR = do
not attempt resuscitation; Elective = planned admission;
Emergency = unplanned hospital admission. End of RRT
intervention = the time when the RRT left the patient’s
bedside.
* Data for individual hospitals is presented in a Tables
Appendix 2, Bellomo R, Ackerman
M, Bailey M, et al. A controlled trial of electronic automated
advisory vital signs monitoring in
general hospital wards. Crit Care Med. 2012;40(8):2349-2361.
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