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Rapid response teams (RRTs) have been adopted by hospitals to provide urgent critical care to hospitalized patients who require quick intervention to prevent further deterioration. Early warning scores (EWS) serve as a method to identify patients requiring RRT assessment by analyzing routinely collected data such as vital signs and laboratory results. The Visensia Safety Index (VSI) is an EWS that uses continuous vital sign monitoring and machine learning to identify the likelihood of deterioration and can be integrated with existing hospital data infrastructure. Initial studies of the VSI have both validated the system and found that patients monitored using VSI had a shorter duration of any instability and fewer episodes of serious and persistent instability. The investigators' recent retrospective analysis at The Ottawa Hospital (TOH) identified that implementation of an EWS could have detected earlier deterioration in over half of the patients identified, potentially preventing subsequent ICU admission, severity of illness, and/or mortality. Thus, this study aims to determine the feasibility and potential impact of implementing a portable continuous monitoring system with a VSI trigger at TOH to identify patients at high risk of deterioration.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention Arm | Experimental | The Visensia Safety Index (VSI) will be used to alert RACE staff of patient deterioration. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Visensia Safety Index (VSI) | Device | Enrolled patients will undergo continuous vital sign monitoring, to be used by the Visensia Safety Index (VSI) to identify early deterioration. If early deterioration is identified, the VSI will produce an alert to notify the RACE team. |
| Measure | Description | Time Frame |
|---|---|---|
| Evaluate technical feasibility of collecting greater than 80% of continuous data | Feasibility of continuous data collection will be evaluated by determining if greater than 80% of continuous data can be collected | Upon study completion, 10 months after study initiation |
| Evaluate technical feasibility of feeding greater then 80% of continuous data to the predictive tool | Feasibility of feeding continuous data to the predictive tool will evaluated by determining if greater than 80% of continuous data can be fed to the predictive tool | Upon study completion, 10 months after study initiation |
| Evaluate technical feasibility of updating the predictive tool on a regular basis greater than 80% of the time | Feasibility of updating the predictive tool on a regular basis will be evaluated by determining if greater than 80% of the time the predictive tool can be updated on a regular basis | Upon study completion, 10 months after study initiation |
| Evaluate technical feasibility of reporting greater then 80% of triggers to the RACE team | Feasibility of reporting triggers to the RACE team will be evaluated by determining if greater than 80% of triggers are reported to the RACE team | Upon study completion, 10 months after study initiation |
| Evaluate clinical feasibility by assessing MD opinions of the VSI | Clinical feasibility will be evaluated by assessing MD opinions regarding understanding of the predictive tool, ease of use, perceived strengths and limitations, and perceived enablers and barriers to effective usage through post-encounter surveys and interviews | Upon study completion, 10 months after study initiation |
| Measure | Description | Time Frame |
|---|---|---|
| Evaluate potential clinical impact of the VSI | The potential clinical impact of the VSI will be evaluated by comparing the prognostic accuracy of the VSI trigger to clinical gestalt using statistical analysis of performance measures including sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve. | Upon study completion, 10 months after study initiation |
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Inclusion Criteria:
Adult patient (greater than or equal to 18 years of age) designated for the most aggressive levels of potential intervention (Category 1 status - Full Care and Category 2 status - Full Care except CPR) who belong to one of the following groups:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Andrew JE Seely, MD, PhD, FRCSC | Contact | 613-737-8899 | 74052 | aseely@toh.ca |
| Name | Affiliation | Role |
|---|---|---|
| Andrew JE Seely, MD, PhD, FRCSC | The Ottawa Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Ottawa Hospital | Recruiting | Ottawa | Ontario | K1H 8L6 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40742731 | Derived | Tran A, Ramchandani R, Brehaut J, Hudek N, Haines J, Watpool I, Porteous R, Kusevic D, Bucciero K, Kyeremanteng K, Hartwick M, Thavorn K, Hooper J, Kubelik D, Herry C, Scales N, Hryciw B, Abou-Khalil J, Perry J, Bredeson C, Seely A. Assessing Clinical Impressions of Early Warning Score Integration With the Rapid Response Team: Protocol for a Prospective Cohort Study. JMIR Res Protoc. 2025 Jul 31;14:e65360. doi: 10.2196/65360. |
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| ID | Term |
|---|---|
| D000075902 | Clinical Deterioration |
| ID | Term |
|---|---|
| D018450 | Disease Progression |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Evaluate clinical feasibility by assessing RN opinions of the VSI | Clinical feasibility will be evaluated by assessing RN opinions regarding understanding of the predictive tool, ease of use, perceived strengths and limitations, and perceived enablers and barriers to effective usage through post-encounter surveys and interviews | Upon study completion, 10 months after study initiation |
| Evaluate clinical feasibility by assessing RT opinions of the VSI | Clinical feasibility will be evaluated by assessing RT opinions regarding understanding of the predictive tool, ease of use, perceived strengths and limitations, and perceived enablers and barriers to effective usage through post-encounter surveys and interviews | Upon study completion, 10 months after study initiation |
| Evaluate financial feasibility of implementing the VSI system | Financial feasibility of implementing the VSI system will be evaluated by identifying the costs related to implementation and maintenance of the portable continuous monitoring system through health economic evaluation | Upon study completion, 10 months after study initiation |
| Evaluate potential financial impact of the VSI | The potential financial impact of the VSI will be evaluated by estimating the potential cost savings related to earlier detection of potential deterioration with comparison to historical RACE cohort | Upon study completion, 10 months after study initiation |