Association of Vital Sign and Laboratory Abnormalities Detected via Remote Monitoring with ICU Readmission and Mortality: An Observational Cohort Study

IF 3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety Pub Date : 2026-04-01 Epub Date: 2026-02-04 DOI:10.1016/j.jcjq.2026.02.001

Neil E. Rens MD, MBA, MSc (is Chief Resident Physician and Clinical Fellow, Department of Anesthesiology, Massachusetts General Hospital (MGH), Mass General Brigham (MGB), Boston.) , Johanna J. Rajotte (is Doctoral Candidate, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo.) , Hao Deng MD, MPH, MBA, DrPH(c) (is Assistant Investigator and Statistical Consultant, Department of Anesthesiology, MGH, MGB.), Jiawei Meng MPH (former Biostatistician, MGH, is Senior Business Analytics Manager, Privia Health.), Ariel L. Mueller MA (is Administrative Director for Research, Department of Anesthesiology, MGH, MGB.), Timothy T. Houle PhD (is Associate Professor, Department of Anesthesiology, MGH, MGB.), Jeanine P. Wiener-Kronish MD (is Emeritus Chief of Anesthesiology, MGH.), Kyan C. Safavi MD, MBA (is Attending Physician and Associate Chief Medical Officer, MGH.), Katarina J. Ruscic MD, PhD (is Attending Physician, Assistant Professor, Senior Division Director for Multispecialty Anesthesia, Department of Anesthesiology, MGH, MGB. Please address correspondence to Katarina J. Ruscic)

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引用次数: 0

Abstract

Background

Post-intensive care unit (ICU) patients remain at high risk for adverse outcomes, and early identification of instability may improve outcomes and reduce costs. This study measures the association between eight vital sign and laboratory abnormalities (“flags”) on surgical wards and the odds of ICU readmission or death in surgical patients after ICU transfer. Flags captured intuitive indications for ICU admission, including tachycardia, hypotension, hypoxemia, hyperkalemia, hyperglycemia, hypoglycemia, and anemia, which may be missed with infrequent ward evaluation.

Methods

This single-center, observational cohort study included all adult surgical patients transferred from the ICU to a general care ward between May 2017 and March 2019 pre-COVID-19 pandemic. A mixed effects model evaluated the relationship between virtual flags and adverse discharge within six hours, adjusted for demographics and confounders. Modeling was inferential and not intended for diagnostic or screening prediction.

Results

A total of 391 surgical ICU admissions were enrolled, comprising 138,623 rolling one-hour observation windows. After ICU discharge, 73 (18.7%) transfers died or were readmitted to the ICU. A flag on the wards was associated with 11.44-fold increased odds of ICU readmission or death within six hours of the flag (95% CI: 7.49-17.49) and 3.36-fold increased odds within 48 hours (95% CI: 2.23-5.05). A tachycardia flag raised the odds by 25.25 (95% CI: 13.34-47.82). Flags occurred on average every 2.6 hours per hundred ward patients monitored.

Conclusions

The presence of eight actionable vital sign and laboratory abnormalities which were detected in an automated system was strongly associated with ICU readmission or death after ICU transfer. Incorporating such monitoring on surgical wards could enable timely interventions, improve patient safety, and reduce mortality without alarm fatigue.

查看原文本刊更多论文

通过远程监测发现的生命体征和实验室异常与ICU再入院和死亡率的关系：一项观察性队列研究。

背景：重症监护病房（ICU）后患者仍处于不良结局的高风险中，早期识别不稳定可能改善预后并降低成本。本研究测量了外科病房的8个生命体征和实验室异常（“旗帜”）与外科患者在ICU转移后再入院或死亡的几率之间的关系。标志显示了ICU入院的直观适应症，包括心动过速、低血压、低氧血症、高钾血症、高血糖、低血糖和贫血，这些可能因不频繁的病房评估而被遗漏。方法：这项单中心、观察性队列研究纳入了2017年5月至2019年3月covid -19大流行前从ICU转入普通护理病房的所有成年外科患者。一个混合效应模型评估了虚拟标志与六小时内不良排放之间的关系，并根据人口统计学和混杂因素进行了调整。建模是推断性的，而不是用于诊断或筛选预测。结果：共纳入391例外科ICU入院患者，包括138,623个滚动1小时观察窗口。出院后，73例（18.7%）转患者死亡或再次入住ICU。在病房出现旗帜与6小时内ICU再入院或死亡的几率增加11.44倍相关（95% CI: 7.49-17.49）， 48小时内的几率增加3.36倍相关（95% CI: 2.23-5.05）。心动过速标志使患病几率增加25.25 （95% CI: 13.34-47.82）。每监测的100名病房患者中平均每2.6小时出现一次标志。结论：在自动化系统中检测到的8个可操作的生命体征和实验室异常与ICU再入院或ICU转移后死亡密切相关。将这种监测纳入外科病房可以实现及时干预，提高患者安全性，并在没有报警疲劳的情况下降低死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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