(367) Implementation of wireless continuous vital sign monitoring after cesarean delivery in Uganda

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: To determine the feasibility of using a wearable wireless vital sign system for post-cesarean monitoring at a tertiary facility in Uganda

Study Design: We recruited women ≥18 undergoing emergency cesarean section to wear an upper-arm wireless monitor (Current Health™), capturing continuous heart rate (HR), temperature (Tp), respiratory rate (RR), and oxygen saturation (SPO₂) for the first 24-hour(hr)s post-delivery. Captured data transmits via Wi-Fi to cloud storage, allowing real-time clinician access to vital sign data via the web or a smartphone app and the triggering of phone alerts for pre-defined abnormalities in vital signs. Feasibility measures included the proportion of participants with vital sign capture by duration (i.e, number of hrs of monitoring) and the proportion of participants with greater than 4-hr gaps in monitoring. We also assessed the number of alerts received by clinicians per 8-hr shift, time to acknowledge alerts, and if participants with alerts were assessed by clinicians.

Results: Over 26 weeks of enrolment, 1,882 women were recruited, of which 82% (n=1551) had a monitor placed. Of these 96% (n=1496) had at least observation, of which 78% (n=1174) had 20+ hrs of monitoring (Figure 1) with an overall median length of 24 hrs (IQR 21-26) (Figure 1). 5.6% (n=84) of participants had a greater than 4-hr gap in monitoring. Clinicians reported a mean of 0.4 ±1.2 alerts per 8-hr shift, with 9%, 16%, 62% and 1% due to abnormalities in HR, Tp, RR and SPO₂respectively. Clinicians acknowledged alerts within 5, 15, and 30 minutes for 43%, 20% and 22% of alerts received, respectively, and assessed 90% of participants after the first alert with a trend to decreasing rates of assessment for increasing number of alerts received (Figure 2).

Conclusion:

We demonstrate success in implementing a wearable wireless vital sign monitoring system in a busy tertiary facility in Uganda. Future work to assess algorithms for clinician alert is important to maximize sensitivity for complications and minimize alert fatigue.

Primary & Presenting Author(s)

Adeline A. Boatin, MD, MPH (she/her/hers)
Assistant Professor
Massachusetts General Hospital, Harvard Medical School
Boston, Massachusetts, United States

Coauthor(s)

PD
Paola Del Cueto, MD
Research Fellow
Massachusetts General Hospital
Boston, Massachusetts, United States
LB
Lisa M. Bebell, MD
Massachusetts General Hospital, Infectious Diseases Division
Boston, Massachusetts, United States
Henry Mark Mark Lugobe, MBBCH
Obstetrician and Gynecologist
Mbarara University of Science and Technology
Mbarara, Uganda, Uganda
KM
Kenia Martinez, MBBS
Mbarara University of Science and Technology
Mbarara, Uganda, Uganda
SM
Sudi Mohamed, MBBS
Mbarara University of Science and Technology
Mbarara, Uganda, Uganda
Blair Wylie, MD, MPH (she/her/hers)
Columbia University
New York, New York, United States
GM
Godfrey R. Mugengyi, MBBS
Senior Lecturer
Mbarara University of Science and Technology
Mbarara, Uganda, Uganda
NM
Nicholas Musinguzi, MSc
Center for Global Health
Boston, Massachusetts, United States
JM
Joshua Metlay, MD, PhD
Professor of Medicine
Massachusetts General Hospital
Boston, Massachusetts, United States
BH
Bethany Hedt-Gauthier, PhD
Associate Professor of Global Health and Social Medicine
Harvard Medical School
Boston, Massachusetts, United States
JH
Jessica Haberer, MD
Professor of Medicine
Massachusetts General Hospital/Harvard Medical School
Boston, Massachusetts, United States
JN
Joseph Ngonzi, MBBCH
Mbarara University of Science and Technology
Mbarara, Uganda, Uganda