# Implementation of Remote Patient Monitoring and Earlier CERT Activation: Effects on ICU Transfer and Mortality

## TL;DR

Using remote patient monitoring with rapid response teams may help detect patient decline earlier, leading to less severe ICU admissions and lower mortality.

## Contribution

The study demonstrates that integrating RPM into clinical workflows improves outcomes for patients requiring ICU transfer.

## Key findings

- Patients with RPM had lower APACHE-IV scores at ICU transfer compared to those without RPM.
- RPM was associated with reduced in-hospital mortality and shorter hospital stays.
- RPM integration improved early recognition of clinical deterioration.

## Abstract

Introduction: Timely detection of clinical deterioration in hospitalized patients remains a challenge, often limited by intermittent vital signs (VS) monitoring and delayed escalation. Remote patient monitoring (RPM) offers a medium of high-frequency surveillance of patient VS and may facilitate earlier recognition of deterioration. This study evaluated whether RPM integration into rapid response workflows improves clinical outcomes among patients requiring clinical emergency response team (CERT) activation and subsequent intensive care unit (ICU) transfer. Methods: A retrospective study was conducted to assess the impact of RPM implementation on severity of illness and mortality in adult patients who experienced CERT activation followed by ICU transfer. The primary outcomes were severity of illness at ICU admission and in-hospital mortality. We hypothesized that patients in the post-intervention group would demonstrate better outcomes compared to pre-intervention. Results: A total of 1120 patients were included (PRE: n = 656; POST: n = 464). The POST group, which received continuous monitoring via the BioButton® device and augmented workflows, demonstrated a lower mean APACHE-IV score at ICU transfer (83.96 vs. 90.01; p = 0.0016 and reduced in-hospital mortality (7.75% vs. 11.48%; p = 0.084). Median ICU stay in the PRE group was 5.85 (3.00–11.58) and 5.07 (2.59–9.22) in the POST group (p: 0.0565). Total LOS was 11.95 (6.57–20.40) and 10.50 (6.01–18.17), respectively [p = 0.0278]. Conclusions: Integration of RPM into hospital care pathways was associated with earlier recognition of clinical deterioration, reduced illness severity at ICU admission, and lower in-hospital mortality. These findings may support the utility of RPM as part of a comprehensive, multicomponent, rapid response model to recognize early physiological deterioration and may improve patient safety and outcomes in acute care settings.