Oct 23, 2018

How to Better Monitor Respiratory Rate, ‘the Most Neglected Vital Sign’

How to Better Monitor Respiratory Rate, ‘the Most Neglected Vital Sign’Particularly in post-acute settings, patient monitoring is crucial to preventing adverse events and rehospitalizations. And among the widely acknowledged five most important patient vital signs — body temperature, heart rate, blood pressure, respiratory rate, and SpO2 — researchers agree that respiratory rate may be the most important.

Unfortunately, however, it may also be the most neglected.

The United Kingdom’s National Institute for Clinical Excellence (NICE) has pinpointed respiratory rate (RR) as “the most sensitive marker of a deteriorating patient and the first observation to indicate a problem,” write the authors of a 2015 study on the accuracy of respiratory rate assessment published in the Journal of Clinical Monitoring and Computing (JCMC).1

“Research has shown that abnormalities in RR predict serious adverse events including cardiac arrest and ITU admission,” the authors continue, adding that measurement of respiratory rate “has multiple clinical applications,” including:

  • Recognizing acute changes in a patient’s condition
  • Detecting deterioration and the potential onset of sepsis
  • Detecting otherwise difficult-to-assess fluctuations in condition
  • Recognizing the need for escalation


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Among patients discharged from the emergency department, those who showed the most deterioration also displayed “a significantly higher respiratory rate” than those who didn’t, write the authors of a 2017 study published in Acute Medicine & Surgery (AMS).2

And as a comprehensive Medical Journal of Australia (MJA) article entitled “Respiratory rate: the neglected vital sign” (and which cites data not just from that country, but also from the United States and the UK) puts it, “respiratory rate is an important indicator of a severe derangement in many body systems, not just the respiratory system, and is therefore a key predictor of adverse events.”3

Respiratory Rate Monitoring: The Neglected Vital Sign

Yet despite this series of findings on the importance of monitoring respiratory rate, this indicator is often “less frequently recorded than other vital signs,” the AMS study authors write.2

“The level of documentation of vital signs in many hospitals is extremely poor, and respiratory rate, in particular, is often not recorded, even when the patient’s primary problem is a respiratory condition,” the MJA authors add.3

The JCMC study authors agree, finding that the “methods of RR assessment currently used by doctors are inaccurate … to the extent that the majority of doctors were unable to reliably identify abnormal RR.” This inaccuracy “is likely to have negative implications for patient care, and subsequently patient outcomes,” they add.1

And this leads to a situation where “valuable clinical information is not being used that could prompt both rapid identification and response to clinical need,” they continue. “Arguably, beyond simply delaying care, inaccurate recordings may provide false assurance that a respiratory rate is normal, when in fact it is not, and therefore actively delay care and lead to inappropriate clinical decisions.”1

Damaging though this oversight can be, it’s also readily corrected. “It is possible for hospitals to systematically improve the frequency of recording of respiratory rates,” the MJA authors point out.3

“Measurement of the respiratory rate does not require complex technology,” they add. “Hospital systems that encourage appropriate responses to an elevated respiratory rate and other abnormal vital signs can be rapidly implemented. Such systems help to raise and sustain awareness of the importance of vital signs.”3

Monitoring Respiratory Rate with CFCM Technology

Contact-free continuous monitoring is one such system. By monitoring respiratory rate in an unobtrusive way, 24 hours a day — along with the patient’s heart rate and range of motion — the technology gives clinical staff a higher level of visibility into their patients’ condition, and earlier warnings of potential adverse events.

“Contact-free continuous monitoring (CFCM) solutions transmit real-time data on heart rate, respiratory rate, and level of movement captured at the patient’s bed directly to the patient care staff, and instantly alerts when values fall outside of pre-set parameters,” explain the authors of a white paper on the benefits of CFCM in the post-acute care setting.

CFCM systems like those offered by EarlySense can also be configured “to alert clinicians on their mobile devices when both heart and respiration rates are above predefined thresholds that the facility has established for its systemic inflammatory response syndrome (SIRS) or sepsis protocols,” the authors continue. “These types of parameters can be adjusted to the needs of individual patients over time as staff becomes more knowledgeable of their condition and habits.”

More than just monitoring respiratory rate, EarlySense’s CFCM solution puts the data it gathers into context for nurses and clinicians, with software that generates insight into high-level trends. It also offers “both visible and audible alarms, and the high and low threshold of each parameter can be adjusted for each patient,” reports a 2016 NICE briefing paper on EarlySense monitoring technology.

That briefing paper also points out that the accuracy of EarlySense CFCN technology in monitoring respiratory rate as 93.1% for adults and 91.8% for children as compared to “standard” systems that typically measure respiratory rate on a much less frequent basis — sometimes just once or twice per day.

Boosting Competitive Advantage with Contact-Free Continuous Monitoring

Important as respiratory rate monitoring is for the early detection and prevention of patient deterioration and adverse events like sepsis and cardiac arrest, the implementation of CFCM can also provide the means to expand a facility’s patient care capabilities (and, thus, its business footprint).

The white paper authors spoke to a former administrator at Houston’s Concierge long-term care facility, who told them that EarlySense contact-free continuous monitoring gave them “the opportunity to work with pulmonologists who would love to send their patients to a facility with respiratory services where patients would be closely monitored.”

In effect, contact-free continuous monitoring provides facilities “with the ability to deliver a higher level of patient care, which will allow them to thrive in an increasingly competitive and cost-conscious marketplace,” the white paper authors explain.

“Integrating CFCM into their facilities allows post-acute care providers to improve both patient outcomes and their overall experience,” they add. “The technology has proven effective at reducing the rate of falls and identifying patients who are deteriorating, all while avoiding audible alarms in the patient room and disrupting a patient’s sleep and privacy.”

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For more information about the importance of respiratory rate monitoring and how EarlySense technology can help your facility better measure this essential vital sign, we invite you to contact us here to schedule a complimentary consultation with an EarlySense expert.

Sources

  1. Philip KEJ, Pack E, Cambiano V, Rollmann H, Weil S, O’Beirne J. The accuracy of respiratory rate assessment by doctors in a London teaching hospital: a cross-sectional study. J Clin Monit Comput. 2015;29(4):455-460. doi:10.1007/s10877-014-9621-3.
  2. Mochizuki K, Shintani R, Mori K, et al. Importance of respiratory rate for the prediction of clinical deterioration after emergency department discharge: a single‐center, case–control study. Acute Med Surg. 2017;4(2):172-178. doi:10.1002/ams2.252.
  3. Cretikos MA, Bellomo R, Hillman K, Chen J, Finfer S, Flabouris A. Respiratory rate: the neglected vital sign. Med J Aust 2008; 188 (11): 657-659.