Respiratory Rate in Patient Monitoring: A Season of Neglect

August 30, 2019

by Dr. Steven Plunkett
Keenly Health Medical Advisor

The respiratory rate of the patient has been consistently shown to be a critically important component in assessing clinical status.  Many consider the respiratory rate to be the most significant early indicator of patient decline and critical illness. 

Although critical in predicting unstable patients and clinical decline, respiratory rate is the most poorly measured, recorded, and documented vital sign. Many health care workers admit that they estimate rather than actually record respiratory rate. Health care workers demonstrate significant variations in their recording of respiratory rate, with inaccurate readings taken at least 50% of the time. It has also been shown that a patient’s respiratory rate may change if the patient knows that their respirations are being recorded by a healthcare worker.   

Change in respiratory rate is an excellent means of discriminating patients at risk from those patients who are stable.   

Altered respiratory rate can signal not only respiratory insufficiency, but also the onset of cardiac events, sepsis, pulmonary embolus, shock, opioid overdose, and other critical medical conditions.  A change in the baseline respiratory rate has been shown to be an early indicator of many cardiac arrests, and a respiratory rate greater than 24 breaths per minute indicates a serious adverse event.  Many of these patients could have been identified 24 hours before the adverse event if they had been effectively monitored.  In unstable patients, relative changes in respiratory rate are much greater than changes in heart rate or systolic blood pressure.

In both the US and the UK, early warning systems have been developed to provide early indications of patient decline. The respiratory rate is a critical component in all of these early warning systems.  The developers of these systems understand that adverse patient outcomes can be minimized with effective utilization of early warning signs.                                                

There is a glaring inconsistency between the proven clinical importance of respiratory rate and the accuracy and consistency in which it is monitored and recorded.  Clearly, a more effective approach is needed.

Keenly Health has developed an accurate, continuous, non-contact method for recording and monitoring respiratory rate. Using ultra wide band radar, the Keenly Virtual Medical Assistant™ provides a continuous monitoring system completely free of any physical contact.

The continuous monitoring establishes the baseline respiratory rate for each patient over a period of time, taking data at 20 times per second. The information is then securely transferred to a dashboard for interpretation and display.  Multiple patients can be monitored on one dashboard, and alarms can be set to alert the staff of any significant change in the patient’s status. The system operates on a simple WiFi connection and a power source. 

The Keenly VMA™ is an affordable, innovative system that will improve efficiency and compliance, and will allow for more effective allocation of staff and resources.

SOURCE:
MJA

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