The promise and pragmatics of wearable continuous monitoring on hospital wards

The valid and reliable detection of clinical deterioration on hospital wards remains an unfinished project in patient safety. From the vantage point of the intensive care unit (ICU), patients too often arrive with warning signs documented hours earlier in charts that no one was watching. These signs may have triggered decisive action in our wards but slipped past the widely spaced rhythm of routine vital sign collection. Intermittent observations, combined with early warning scores designed to flag trajectories toward cardiac arrest or ICU transfer, remain the cornerstone of ward-level surveillance. But such monitoring, by definition, overlooks clinical changes during the interval periods, and becomes even less reliable when staffing pressures are high.

Against this backdrop, the scoping review by Van Slambrouck and colleagues in this issue of Intensive and Critical Care Nursing offers a timely synthesis of evidence about a promising monitoring alternative. Across 25 studies from five countries and 14 different devices, the authors examined the emerging evidence for wearable, wireless, continuous monitoring in high-risk adults on general wards and intermediate care units. By integrating findings related to technical validation, clinical outcomes, and the experiences of patients and nurses, the review provides contemporary guidance to clinicians and scientists faced with a challenging task.

As critical care clinicians, we approach these findings with a particular lens. Continuous monitoring remains the bedrock of our practice in the ICU. We know its power to reveal deterioration in its earliest expression, and we know its costs: alarm fatigue, data overload, and the persistent tension between signal and noise. We also know its limitations and biases. Pulse oximetry, for example, systematically overestimates oxygen saturation in patients with darker skin tones, nearly tripling the frequency of occult hypoxemia and potentially delaying recognition and treatment. It is from this dual vantage point that several features of the review deserve comment.

Kathryn A Connell, Gary E Weissman