Role of Wireless Monitoring in Internal Medicine Unit for Ongoing Assessment of Acute Instable Patients

NCT ID: NCT03050034

Last Updated: 2017-02-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

296 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-02-27

Study Completion Date

2018-02-27

Brief Summary

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The present study was planned to provide clinical data on the impact of acute and critically ill patients in Internal Medicine Unit activity and economic data enabling to quantify the relative cost of acute patients management during ordinary hospitalization. In these critically ill complex patients the vital parameters continuous monitoring could help in improving the quality of care. Therefore, the study will check how the wireless continuous monitoring in acute selected patients is able to reduce major complications improving the patient's outcome and the quality of care and reducing costs compared to traditional monitoring performed at regular intervals by the nursing staff.

Detailed Description

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In recent years, Internal Medicine Ward, due to epidemiological transition, takes in charge more and more an heterogeneous group of patients with serious diseases both acute and chronic and elderly, frail, poly-pathological patients, requiring intensive care. Hospitalization of medical patients in large wards without prior stratification of severity, complexity, level of dependence, comorbidities and without a proper assessment of the risk of rapid clinical deterioration, can lead to suboptimal treatment, resulting in prolonged hospital stay and increased care costs. Continuous monitoring of vital parameters may allow early detection of deterioration in acute patients not admitted in intensive care such as those hospitalized in Internal Medicine Unit, allowing the staff to immediately address the patient's needs achieving promptly the most appropriate care. As there are no studies comparing the use of wireless monitoring systems and traditional vital signs monitoring in critical acute patients, the study was designed to highlight the benefits of continuous monitoring of vital signs in the first 72 hours hospitalization to reduce the major complications and improving outcome. The study also aims to assess the reduction in hospitalization costs using as proxy the decrease in average length of stay.

Conditions

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Wireless Vital Signs Monitoring System Acutely Ill Complex and Poly-pathological Patients Internal Medicine Unit Mission

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Pilot perspective controlled randomized open-label single-center study to evaluate the management of critically ill patients hospitalized comparing vital signs wireless monitoring versus conventional monitoring in the first 72 h of hospitalization extendable to 5 days if the MEWS after 72 h is even greater than or equal to 3 and/or the NEWS is greater than or equal to 5.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Vital signs wireless monitoring system

All patients with MEWS (Modified Early Warning Score) greater than or equal to 3 and/or NEWS (National Early Warning Score) greater than or equal to 5, at admission, regardless of the reason for hospitalization and all patients with glycemic decompensation and/or severe fluid and electrolyte imbalance, regardless of MEWS/ NEWS, undergone to continuous monitoring with wireless monitoring system WIN @ Hospital.

Group Type EXPERIMENTAL

WIN @ Hospital system

Intervention Type DEVICE

WIN @ Hospital system is a wearable and wireless system (Medical Class IIA) that allows continuous and real-time vital signs monitoring, automatically calculating the NEWS score with a personalized alert system for the patient. It does not require the continuous presence of the nurse in front of the control room, but is working with alert on portable devices (ipad).

Control arm

All patients with MEWS (Modified Early Warning Score) greater than or equal to 3 and/or NEWS (National Early Warning Score) greater than or equal to 5, at admission, regardless of the reason for admission and all patients with glycemic decompensation and/or severe fluid and electrolyte imbalance, regardless of MEWS NEWS undergone to traditional monitoring performed at regular intervals by the nursing staff.

Group Type ACTIVE_COMPARATOR

Traditional monitoring

Intervention Type OTHER

Vital signs control performed by nurse staff each 6 hours or more, according to medical advice.

Interventions

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WIN @ Hospital system

WIN @ Hospital system is a wearable and wireless system (Medical Class IIA) that allows continuous and real-time vital signs monitoring, automatically calculating the NEWS score with a personalized alert system for the patient. It does not require the continuous presence of the nurse in front of the control room, but is working with alert on portable devices (ipad).

Intervention Type DEVICE

Traditional monitoring

Vital signs control performed by nurse staff each 6 hours or more, according to medical advice.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* all critical patients (with need for continuous monitoring and high technology) with MEWS ≥3 and / or NEWS≥5 at admission
* all patients with glycemic decompensation regardless of MEWS and NEWS.
* all critical patients severe fluid and electrolyte imbalance, regardless of MEWS and NEWS.

Exclusion Criteria

* MEWS \<3 and or NEWS \<5
* Lack of informed consent
* Inability to understand and want
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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ASST-Garda: Internal Medicina Unit Manerbio Hospital (BS)

UNKNOWN

Sponsor Role collaborator

University of Modena and Reggio Emilia

OTHER

Sponsor Role collaborator

Milano-Bicocca University Medical Statistic Department

UNKNOWN

Sponsor Role collaborator

Azienda Socio Sanitaria Territoriale del Garda

OTHER_GOV

Sponsor Role lead

Responsible Party

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Filomena Pietrantonio

Internal Medicin Unit Director

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Filomena Pietrantonio, MD

Role: PRINCIPAL_INVESTIGATOR

ASST GARDA

Locations

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ASST-Garda Manerbio Hospital Internal Medicine Unit

Manerbio, Brescia, Italy

Site Status

Countries

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Italy

Central Contacts

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Filomena Pietrantonio, MD

Role: CONTACT

+393291710748

Anna Bussi, MD

Role: CONTACT

+393389861423

Facility Contacts

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Filomena Pietrantonio, MD

Role: primary

+393291710748

Anna Bussi, MD

Role: backup

+393389861423

References

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Pietrantonio F, Orlandini F, Moriconi L, La Regina M. Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients. Eur J Intern Med. 2015 Dec;26(10):759-65. doi: 10.1016/j.ejim.2015.08.011. Epub 2015 Sep 11.

Reference Type BACKGROUND
PMID: 26365373 (View on PubMed)

Pietrantonio F, Scotti E. Internal medicine network: Is it a newsworthy idea? Eur J Intern Med. 2016 Nov;35:e18-e19. doi: 10.1016/j.ejim.2016.07.024. Epub 2016 Aug 4. No abstract available.

Reference Type BACKGROUND
PMID: 27499176 (View on PubMed)

Vincent C, Amalberti R. Safer Healthcare: Strategies for the Real World [Internet]. Cham (CH): Springer; 2016. No abstract available. Available from http://www.ncbi.nlm.nih.gov/books/NBK481869/

Reference Type BACKGROUND
PMID: 29465922 (View on PubMed)

Miglioramento della qualità della vita dei pazienti e riduzione del costo per il SSN attraverso l'uso di un sistema wireless di monitoraggio multi-parametrico dei parametri fisiologici. Case study sull'adozione del sistema di monitoraggio fisiologico WIN@Hospital presso l'Ospedale Campo di Marte, Lucca. Cangemi A, Turchetti B. Europe Health Summit Berlino (4-8 Maggio 2014)

Reference Type BACKGROUND

Pannick S, Wachter RM, Vincent C, Sevdalis N. Rethinking medical ward quality. BMJ. 2016 Oct 18;355:i5417. doi: 10.1136/bmj.i5417. No abstract available.

Reference Type RESULT
PMID: 27756729 (View on PubMed)

E. Scotti, F. Pietrantonio. The Hospital Internal Medicine Specialist today: a literature review and the SWOT analysis to elaborate a working proposal. Italian Journal of Medicine, vol 7, n.4 2013. 278-286. 1.08.2013

Reference Type RESULT

F. Pietrantonio, L. Piasini, F. Spandonaro. Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis. . Italian Journal of Medicine Italian Journal of Medicine DOI: 10.4081/itjm.2016.674, vol 10, Issue 2, 2016

Reference Type RESULT

Royal College of Physicians. National Early Warning Score (NEWS) Standardising the assessment of acute-illness severity in NHS. Report of a working party, July 2012.

Reference Type RESULT

Orlandini F, Pietrantonio F, Moriconi L, La Regina M, Mazzone A, Campanini M. A model to improve the appropriateness in the management of acute poly-pathological patients: the acute complex care model http://dx.doi.org/10.4081/itjm.2016.697

Reference Type RESULT

Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001 Oct;94(10):521-6. doi: 10.1093/qjmed/94.10.521.

Reference Type RESULT
PMID: 11588210 (View on PubMed)

Giovanna Bollini, Fabrizio Colombo. L'intensità assistenziale e la complessità clinica. Un progetto di ricerca della regione Lombardia. 2011

Reference Type RESULT

Mongardi M, Bassi E, Di Ruscio E. Ospedale per Intensità di cura: strumenti per la classificazione dei pazienti. DGSPS, Servizio Presidi Ospedalieri, Regione Emilia-Romagna, Febbraio 2015

Reference Type RESULT

Tartaglia R, Albolino S, Bellandi T, Bianchini E, Biggeri A, Fabbro G, Bevilacqua L, Dell'erba A, Privitera G, Sommella L. [Adverse events and preventable consequences: retrospective study in five large Italian hospitals]. Epidemiol Prev. 2012 May-Aug;36(3-4):151-61. Italian.

Reference Type RESULT
PMID: 22828228 (View on PubMed)

Charles V. Sicurezza del paziente. Edizione italiana a cura di Tartaglia R, Albolino S, Bellandi T. Milano, Springer-Verlag Italia, 2012.

Reference Type RESULT

Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000. Available from http://www.ncbi.nlm.nih.gov/books/NBK225182/

Reference Type RESULT
PMID: 25077248 (View on PubMed)

Bellocco A. Risk management in ospedale. Risk News CINEAS (Consorzio Universitario per l'Ingegneria nelle Assicurazioni) 2002;23.

Reference Type RESULT

Programma Integrato di Miglioramento dell'Organizzazione (PIMO, Deliberazione N° X / 3652 Seduta del 05/06/2015)

Reference Type RESULT

Sensium Science MF06-01, April 2015

Reference Type RESULT

Related Links

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http://www.consort-statement.org

Moher D, Hopewell S, Shulz KF, et al . The CONSORT statement: revised reccomendations for improving the quality of reports of parallel-group randomized trials.Evidence 2012; 4 (7): e1000024 www.consort-statement.org

Other Identifiers

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LIMS2017

Identifier Type: -

Identifier Source: org_study_id

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