Continuous vital sign monitoring on general hospital wards enables more frequent, earlier clinical interventions to avert patient deterioration. These interventions can affect clinical outcomes and may themselves serve as markers of impending decline. The present study examines the associations among these clinical actions, established clinical endpoints, and abnormal vital signs. This prospective cohort study included all patients receiving continuous vital sign monitoring on the gastrointestinal and oncological surgery ward and the internal medicine ward of a Dutch academic hospital between 1 August 2018 and 31 July 2019 (METC 2018-4330, NCT04189653). Clinical actions documented in the electronic medical records were evaluated for their correlations with patient outcomes, hospital length of stay, and duration of alarming monitoring periods.
In total, 1529 patients were enrolled, among whom 68 experienced a negative clinical endpoint. Overall, 2749 clinical actions were documented. These actions showed significant correlations with negative clinical endpoints (ρ = 0.259; P < 0.001; OR: 3.4-79.5) and with length of stay (ρ = 0.560; P < 0.001). Deviations in vital signs were also associated with clinical actions (ρ = 0.025–0.056; P < 0.001–p = 0.018). In the final 72 h before a clinical endpoint, the correlation between alarming minutes and clinical actions became markedly stronger (ρ = 0.340, P < 0.001). Specific clinical actions performed on general ward patients were associated with negative clinical outcomes, longer hospital stays, and episodes of abnormal vital signs—particularly in the period immediately preceding serious deterioration. Clinical actions, therefore, hold promise as an intermediate indicator of clinical decline.
