Alert burden when monitoring patients’ vital signs continuously at home

Purpose Continuous monitoring of vital signs after hospital discharge aims to detect clinical deterioration. However, the utility may be challenged by high alert frequencies. The current study aimed to assess the impact of evidence-based augmented algorithms on alert frequency and the ability to detect complications. Methods Adult patients (≥ 18 years) discharged after acute medical admission were monitored continuously using wearable devices that measured heart rate, respiratory rate, blood pressure, and oxygen saturation. The primary outcome was the number of alerts per patient per day. We compared outcomes across three filtering strategies: (1) no filtering, (2) artefact removal, and (3) filtering with artefact removal and clinical criteria based upon severity and duration. Results Ninety-eight patients were enrolled; the total vital sign alert frequency was reduced from a median of 67 [IQR 33–103] alerts/patient/day after artefact removal to 5 [IQR 1–13] alerts/patient/day following application of the clinical criteria filters (p < 0.001). The number of any vital sign alert following the three filtering approaches was 74 [IQR 36–125], 67 [IQR 33–103], and 5 [IQR 1–13] alerts/patient/day, respectively, p < 0.001. Conclusions Artefact removal and the application of filters based on severity and event duration significantly reduced the frequency of alerts by 84% in patients continuously monitored at home after hospital discharge.