For hospitalized patients with unexpected clinical deterioration, delayed or suboptimal intervention is associated with increased morbidity and mortality. (1) The current nurse-to-patient ratio is 1:40, which is well over the recommended ratios (1:4 in a high-dependency unit and 1:2 in a step-down unit). (2) In India, continuous monitoring is not commonly used in the ward environment, despite a study suggesting that it would be possible and cost-effective in surgical wards, with the potential to improve patient outcomes when compared to intermittent monitoring. (3)

The patients benefit from frequent monitoring of vital signs and pulse oximetry, continuous electrocardiography monitoring, and higher nurse-to-patient ratios. (1) Among the growing possibilities to improve and simplify patient monitoring in hospital wards are contact-free sensors that enable early detection of clinical deterioration, which may avoid significant adverse events such as cardiac arrest. Secondary benefits may include cost saving from reduced high dependency/intensive care and improved patient health outcomes. Furthermore, a gap between ICU monitoring and home monitoring could be closed by upgrading monitoring strategies on hospital wards. (4)

Turtle Shell Technologies Pvt. Ltd. has developed a non-invasive continuous remote monitoring system Dozee. Salient features of Dozee include a) Rapid conversion of an existing ward bed into step-down ICU in under 10 minutes, b) Enabling continuous and remote monitoring of vital parameters (Heart Rate, Respiratory Rate, Oxygen Saturation and Blood Pressure) by healthcare providers within and outside the hospital), and c) Early Warning System to triage patients and alert health care providers about trends of deterioration seen in patients along with customizable alerts and user-friendly dashboard to monitor multiple beds from a single location.

This exploratory investigation will be conducted in four high-volume medicine wards of King George’s Medical University, Lucknow, to understand the effectiveness of the Dozee system. Among the 4 study wards, one male and one female wards will have Dozee deployed in them and compared to one male and one female control wards (without Dozee). This protocol is developed to assess and explore the improvements in patient outcomes, timely and unplanned ICU transfers, operational costs, patient out-of-pocket costs, healthcare provider time spent per patient specifically on vital monitoring, and health care providers satisfaction between the interventional device Dozee versus the standard of care.

1. Brown H, Terrence J, Vasquez P, Bates DW, Zimlichman E. Continuous monitoring in an inpatient medical-surgical unit: A controlled clinical trial. American Journal of Medicine. 2014 Mar;127(3):226–32. https://doi.org/10.1016/j.amjmed.2013.12.004 PMID: 24342543

2. Sharma S, Rani R. Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks. Journal of Family Medicine and Primary Care. 2020;9(6):2631. https://doi.org/10.4103/jfmpc.jfmpc_248_20

3. Sun L, Joshi M, Khan SN, Ashrafian H, Darzi A. Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis. J R Soc Med. 2020 Jun 1;113(6):217–24. https://doi.org/10.1177/0141076820925436 PMID: 32521195

4. Continuous Monitoring Beyond the ICU [Internet]. The impact of continuous versus intermittent vital signs monitoring in hospitals: A systematic review and narrative synthesis.