SHM Converge Scientific Abstract ePoster Gallery-Continuous Versus Intermittent Postoperative Monitoring on Surgical Ward Oxygen Interventions

Pdf Summary

This COSMOS Pilot II randomized trial examined whether continuous postoperative vital sign monitoring on surgical wards leads to more oxygen-related interventions than intermittent standard care.

The study enrolled 150 adults undergoing elective major surgery at Cleveland Clinic who were expected to stay at least two nights postoperatively. Patients were randomized on admission to either:
- <strong>Blinded monitoring</strong>: continuous vitals were recorded but hidden from clinicians
- <strong>Unblinded monitoring</strong>: continuous vitals were actively reviewed, and alerts were communicated to nurses 24/7

Nurses responded based on clinical judgment and classified each alert as informative, important, critical, or false/distractive. Alarm thresholds could be adjusted when appropriate.

Key findings:
- In the <strong>unblinded group</strong>, 73 alarms occurred in 32 patients, averaging about <strong>1 alarm per patient per day</strong>.
- Of these alarms, <strong>82%</strong> were judged informative, important, or critical, while <strong>18%</strong> were false or distracting.
- No patients had major adverse events, including in-hospital cardiac arrest.
- Oxygen-related interventions were more frequent when monitoring was unblinded:
  - <strong>44%</strong> of unblinded patients received an oxygen intervention vs <strong>32%</strong> in the blinded group
  - This corresponded to <strong>49 interventions</strong> in the unblinded group versus <strong>30</strong> in the blinded group

The most common intervention was starting or increasing supplemental oxygen, including nasal cannula, face mask oxygen, CPAP, or higher FiO2.

Overall, the trial suggests that continuously monitored and clinician-visible vital signs can prompt more oxygen therapy interventions after surgery. The authors conclude that further refinement of monitoring systems and workflows may reduce nuisance alarms and improve care, but larger studies are needed to determine whether these interventions improve patient outcomes.

Asset Subtitle

Nikola Anusic

Meta Tag

Author List Alper Gulluoglu, Deeven Karki, Elyad Ekrami, Fabio Rodriguez, John Beard, Lukas M. Müller-Wirtz, Maedeh Zokaei Nikoo, Maria-Jose Corrales-Martínez, Nikola Anusic

Category Research

Concept Continuous Postoperative Vital Sign Monitoring

Concept COSMOS Pilot II

Concept Intermittent Assessment

Concept Deterioration Detection

Concept Randomized Trial

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic Outcomes Research, Anesthesiology Institute, Cleveland, OH, USA

Presenting Author Nikola Anusic

Track Patient Safety

Keywords

COSMOS Pilot II

randomized trial

continuous vital sign monitoring

postoperative surgical wards

oxygen-related interventions

blinded monitoring

unblinded monitoring

alarm thresholds

supplemental oxygen

postoperative care

Continuous Postoperative Vital Sign Monitoring

COSMOS Pilot II

Intermittent Assessment

Deterioration Detection

Randomized Trial