Aim: To report a case of an elderly patient with septic encephalopathy admitted in the wards. With the help of enhanced connected care monitoring, ICU admission was avoided. Materials and Methods: An 81-year-old gentleman who is a known diabetic & hypertensive presented to the Emergency room with complaints of generalized weakness of bilateral upper & lower limbs and a recent history of acute gastroenteritis. The patient was evaluated and admitted to wards for further management. On examination, the patient is drowsy and arousable on call and hemodynamically stable. Stool biofire was sent, which was positive for Ecoli Shiga-toxin. A provisional diagnosis of septic encephalopathy was made. Because of background conditions and multiple issues, the patient was connected to Enhanced Care Monitoring (ECC). The patient was constantly monitored by a nurse and doctor from the command center. Three days after admission, the patient had an alert for desaturation with a low saturation of 74%, and immediately nursing staff was informed by the command center team. Shortly 2 hours later, one more critical alert was generated for Tachycardia HR 178/min. The nursing staff was informed by the command center team. Immediately bedside vitals were rechecked, and the doctor was informed, and the patient improved symptomatically with the management of sepsis and was discharged home. Discussion: Remote patient monitoring can track vital signs, identify deteriorating patterns at an early stage, and alert healthcare staff, reducing ICU admissions. This is illustrated in an elderly patient with septic encephalopathy, where continuous wireless monitoring enabled avoiding ICU admission. Enhanced care monitoring was done through wearable biosensors. Vital data obtained helped identify potential emergencies. Appropriate real-time responses avoided an ICU admission. Conclusion: Wearable and implanted sensors efficiently monitor elderly patients in wards without hindering mobility. The term "immediately" might be misleading, but it's crucial to emphasize that within two hours of observing consecutive signs of deterioration in the patient, swift action was taken. Addressing these concerning signs promptly prevented the need for the patient's transfer to the ICU, showcasing successful management within the ward setting.
Brown H, Terrence J, Vasquez P, Bates DW, Zimlichman E. Continuous Monitoring in an Inpatient Medical-Surgical Unit: A Controlled Clinical Trial. The American Journal of Medicine. 2014;127(3):226–32.
2.
Thilly N, Chanliau J, Frimat L, Combe C, Merville P, Chauveau P, et al. Cost-effectiveness of home telemonitoring in chronic kidney disease patients at different stages by a pragmatic randomized controlled trial (eNephro): rationale and study design. BMC Nephrology. 2017;18(1).
3.
Craven MP, Andrews JA, Lang AR, Simblett SK, Bruce S, Thorpe S, et al. Informing the Development of a Digital Health Platform Through Universal Points of Care: Qualitative Survey Study. JMIR Formative Research. 4(11):e22756.
4.
Weenk M, van Goor H, Frietman B, Engelen LJ, van Laarhoven CJ, Smit J, et al. Continuous Monitoring of Vital Signs Using Wearable Devices on the General Ward: Pilot Study. JMIR mHealth and uHealth. 5(7):e91.
5.
Lanssens D, Vandenberk T, Lodewijckx J, Peeters T, Storms V, Thijs IM, et al. Midwives’, Obstetricians’, and Recently Delivered Mothers’ Perceptions of Remote Monitoring for Prenatal Care: Retrospective Survey. Journal of Medical Internet Research. 21(4):e10887.
6.
Runkle J, Sugg M, Boase D, Galvin SL, C. Coulson C. Use of wearable sensors for pregnancy health and environmental monitoring: Descriptive findings from the perspective of patients and providers. DIGITAL HEALTH. 2019;5.
7.
McGloin H, Adam SK, Singer M. Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable? J R Coll Phys Lond. 1999;33(3):255–9.
8.
Churpek MM, Adhikari R, Edelson DP. The value of vital sign trends for detecting clinical deterioration on the wards. Resuscitation. 2016;102:1–5.
9.
Brekke IJ, Puntervoll LH, Pedersen PB, Kellett J, Brabrand M. The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PLOS ONE. 14(1):e0210875.
10.
Sun L, Joshi M, Khan SN, Ashrafian H, Darzi A. Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis. Journal of the Royal Society of Medicine. 2020;113(6):217–24.
11.
Kinsella K, Phillips DR. Global aging: the challenge of success. Popul Bull. 2005;60:3–40.
12.
Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation*. Critical Care Medicine. 2009;37(5):1649–54.
13.
Sadighi Akha AA. Aging and the immune system: An overview. Journal of Immunological Methods. 2018;463:21–6.
14.
Welch J, Dean J, Hartin J. Using NEWS2: an essential component of reliable clinical assessment. Clinical Medicine. 2022;22(6):509–13.
15.
Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84(4):465–70.
16.
Goodacre S, Sutton L, Thomas B, Hawksworth O, Iftikhar K, Croft S, et al. Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study. Emergency Medicine Journal. 2023;40(11):768–76.
17.
Cristina ML, Spagnolo AM, Giribone L, Demartini A, Sartini M. Epidemiology and Prevention of Healthcare-Associated Infections in Geriatric Patients: A Narrative Review. International Journal of Environmental Research and Public Health. 18(10):5333.
18.
Gofton TE, Young GB. Sepsis-associated encephalopathy. Nature Reviews Neurology. 2012;8(10):557–66.
19.
Peidaee E, Sheybani F, Naderi H, Khosravi N, Jabbari Nooghabi M. The Etiological Spectrum of Febrile Encephalopathy in Adult Patients: A Cross-Sectional Study from a Developing Country. Emergency Medicine International. 2018;2018:1–8.
20.
Maddux AB, Hiller TD, Overdier KH, Pyle LL, Douglas IS. Innate Immune Function and Organ Failure Recovery in Adults With Sepsis. Journal of Intensive Care Medicine. 2019;34(6):486–94.
21.
Delano MJ, Ward PA. The immune system’s role in sepsis progression, resolution, and long‐term outcome. Immunological Reviews. 2016;274(1):330–53.
22.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801.
23.
Perner A, Gordon AC, De Backer D, Dimopoulos G, Russell JA, Lipman J, et al. Sepsis: frontiers in diagnosis, resuscitation and antibiotic therapy. Intensive Care Medicine. 2016;42(12):1958–69.
24.
Tannou T, Koeberle S, Manckoundia P, Aubry R. Multifactorial immunodeficiency in frail elderly patients: Contributing factors and management. Médecine et Maladies Infectieuses. 2019;49(3):167–72.
Citation
Copyright
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
