Elena Alessi (Italy)
ASL Roma 6, Castelli Hospital Internal MedicineAuthor of 1 Presentation
CONTINUOUS WIRELESS MONITORING IN INTERNAL MEDICINE UNIT GOES FROM HOSPITAL TO THE FIELD TO IMPROVE MANAGEMENT OF COMPLEX PATIENTS: GREEN LINE H-T STUDY PRELIMINARY RESULTS
Abstract
Background and Aims
In Internal Medicine Unit (IMU) are increasing patients with serious illness, under acute exacerbation of previous diseases needing high intensity care and evaluation of clinical deterioration risk. Literature reported different results (3.5-15.1% ) about major complications (MC) in patients discharged at home, and there are no Telemedicine randomized trials.
Methods
Prospective, randomized, controlled, open-label, multi-center study for the evaluation of critically ill patients admitted in IMU and sent to subacute managed care unit or to earlier home discharge to evaluate the effectiveness of wireless monitoring of clinical conditions vs. traditional clinical monitoring on outcomes. Continuous wireless vital parameters and blood glucose monitoring are assured by WIN@Hospital and Dexcom G6 devices. Overall planned sample size is 300 patients.
Results
Since September 2019 70 patients were enrolled (M 30/F 40), mean age 76.8 (50% >80 years), Comorbidity: Cumulative Illness Rating Scale CIRS-CI: 4, CIRS SI: 1.8. About 30% scored BRASS (Blaylock Risk Assessment Screening Score) ≥20, Barthel mean value 63,2; Exton-Smith scale 15,7, Charlson Index 3,8, indicating need for step-down care. Fadoi Complimed score results are being processed. Overall major complications were 15% at 5 and 30 days of follow-up. The main complications highlighted by continuous home monitoring were cardiac arrhythmias, glycemic decompensation and drug interactions. A trend towards reduction of MC in experimental group appears to be seen.
Conclusions
Integrating hospital and field is a new challenge of Telemedicine allowing to improve patients’ management, both during hospital stay and after discharge, reducing the risk of early re-hospitalization and inappropriate access to the emergency room.