- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03764709
Continuous Wireless Monitoring in Internal Medicine Unit: the Green Line From Hospital to Territory (GreenLightHT)
The Technological Challenge of Continuous Wireless Monitoring in Internal Medicine Unit to Improve Management of Complex Patients: the Green Line From Hospital to Territory (Green Line H-T Study)
Study Information Indication* This is a prospective, randomized, controlled, open-label, monocentric study for the evaluation of two different settings of critically ill patients recovered in Internal Medicine unit (IMU) and subsequently sent to subacute managed care unit or to earlier discharge, in order to evaluate the effectiveness of a wireless monitoring of clinical conditions vs. a traditional clinical monitoring on outcomes (critical adverse events, clinical exacerbations).
Phase*: 4, observational prospective
Number of subjects*:
GROUP A and GROUP B: N=300 patients (150 per arm)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background and Rationale* In IMU there is an increasing concentration of patients with serious illness, under acute exacerbation of previous diseases, elderly patients with co-morbidities and/or fragility, needing high intensity care. Those patients need an overall evaluation of the rank of severity, complexity and dependence of their pathology, together with an evaluation of their risk of clinical deterioration, to implement a stratification of optimal treatments, intensity of care, length of stay. This could allow to optimize the approach to the complexity of the patients while helping containing costs, not only on the patients who are evaluated during their stay in IMUs, but also in those patients who undergo protected hospital discharge or transition to subacute intensive care unit.
Objectives*
Some preliminary data on wireless monitoring in IMU have shown that the timely identification of clinical instability could led to a shorter length of stay. Monitoring on clinically unstable patients lets to prevent the deterioration of adverse events, thus allowing a rapid onset of intervention. There are some expected outcomes following the adoption of a wireless clinical monitoring system:
- Shorter length of stay and earlier discharge
- Lower transition rate to Intensive Care Unit (ICU)
- Earlier transition of patients from higher to lower intensity of care
- Shorter time needed by nurses for the detection of vital signs and clinical parameters, and possibility to dedicate to high-quality activities
Therefore the present study aims to provide data regarding the impact of a specific and oriented integrated remote system for the monitoring of vital status of critically ill patients in the improvement of outcomes and in a more efficient prevision of length of stay and costs, and to verify whether the regular use of a wireless remote monitoring system could improve the quality of the assistance and reduce major complications vs. a traditional monitoring of clinical status executed by the nursing staff, in two specific settings of critically ill patients referring to Internal Medicine with acute conditions:
GROUP A: Patients who undergo a transition to a subacute intensive care unit, in terms of reduction of re-exacerbation, re-access to emergency department or need of intervention by Internal Medicine unit specialists by the use of wireless monitoring vs. traditional monitoring.
GROUP B: Patients who are selected for an earlier discharge from Internal Medicine Unit, in terms of non-inferiority in the incidence of major clinical complications.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Filomena Pietrantonio, MD
- Phone Number: 3291710748
- Email: filomena.pietrantonio@gmail.com
Study Contact Backup
- Name: Antonella Valerio, PHD
- Phone Number: 345 6645907
- Email: antonella.valerio@fadoi.org
Study Locations
-
-
Roma
-
Albano Laziale, Roma, Italy, 00040
- ASL Roma6
-
Contact:
- Filomena Pietrantonio
- Phone Number: 3291710748
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
1. All patients admitted to the Internal Medicine Unit regardless of the reason for admission.
2. For GROUP A: eligibility to the transition towards subacute managed care unit (based on clinical evaluation).
3. For GROUP B: eligibility to early discharge based on clinical evaluation and stable MEWS/NEWS scores.
Exclusion Criteria:
- - Inability to discernment
- Lack of informed consent/unwillingness to participate
- MEWS/NEWS out of range
- Transition to rehabilitation, Hospice, RSA or other Acute unit
- Pacemaker carriers
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Vital signs wireless monitoring system GROUP A
GROUP A clinical hypothesis: reduction in the number of exacerbations in stable inpatients who transit towards subacute managed care unit. The experimental arm will wear wireless monitoring for 5 days after transfer in subacute care unit |
WIN@Hospital wireless remote monitoring is a modern light monitoring medical device with no need for continuous presence of a dedicated person.
WIN@Hospital is based on an innovative modular and wearable device laid out for remote monitoring of several vital parameters 24/7.
Dexcom G6 is a continuous glucose monitoring system which measures interstitial fluid glucose levels in people with diabetes from a sensor applied to the skin as an alternative to routine finger-prick blood glucose testing, and can produce a -continuous record of measurements which can be checked using an App.
It can also indicate glucose level trends over time.
Monitoring devices will be applied to all patients randomly assigned to the wireless monitoring arm, with a continuous monitoring setting over the first 5 days after the initiation of monitoring, corresponding to the starting of the observation (i.e.
transition to subacute unit for GROUP A, discharge for GROUP B).
|
Active Comparator: Control arm GROUP A
GROUP A clinical hypothesis: reduction in the number of exacerbations in stable inpatients who transit towards subacute managed care unit. The active comparator arm will be monitored by nursing staff. |
WIN@Hospital wireless remote monitoring is a modern light monitoring medical device with no need for continuous presence of a dedicated person.
WIN@Hospital is based on an innovative modular and wearable device laid out for remote monitoring of several vital parameters 24/7.
Dexcom G6 is a continuous glucose monitoring system which measures interstitial fluid glucose levels in people with diabetes from a sensor applied to the skin as an alternative to routine finger-prick blood glucose testing, and can produce a -continuous record of measurements which can be checked using an App.
It can also indicate glucose level trends over time.
Monitoring devices will be applied to all patients randomly assigned to the wireless monitoring arm, with a continuous monitoring setting over the first 5 days after the initiation of monitoring, corresponding to the starting of the observation (i.e.
transition to subacute unit for GROUP A, discharge for GROUP B).
|
Experimental: Vital signs wireless monitoring system GROUP B
GROUP B clinical hypothesis: non-inferiority in the number of major clinical complications that, if treated at an earlier stage, can improve outcomes in stable patients who are selected for earlier discharge and are followed by a remote wireless monitoring at home. The experimental arm will wear wireless monitoring for 5 days after discharge at home |
WIN@Hospital wireless remote monitoring is a modern light monitoring medical device with no need for continuous presence of a dedicated person.
WIN@Hospital is based on an innovative modular and wearable device laid out for remote monitoring of several vital parameters 24/7.
Dexcom G6 is a continuous glucose monitoring system which measures interstitial fluid glucose levels in people with diabetes from a sensor applied to the skin as an alternative to routine finger-prick blood glucose testing, and can produce a -continuous record of measurements which can be checked using an App.
It can also indicate glucose level trends over time.
Monitoring devices will be applied to all patients randomly assigned to the wireless monitoring arm, with a continuous monitoring setting over the first 5 days after the initiation of monitoring, corresponding to the starting of the observation (i.e.
transition to subacute unit for GROUP A, discharge for GROUP B).
|
Active Comparator: Control Arm GROUP B
GROUP B clinical hypothesis: non-inferiority in the number of major clinical complications that, if treated at an earlier stage, can improve outcomes in stable patients who are selected for earlier discharge and are followed by a remote wireless monitoring at home. The active comparator arm will perform usual checks by caregivers at home. |
WIN@Hospital wireless remote monitoring is a modern light monitoring medical device with no need for continuous presence of a dedicated person.
WIN@Hospital is based on an innovative modular and wearable device laid out for remote monitoring of several vital parameters 24/7.
Dexcom G6 is a continuous glucose monitoring system which measures interstitial fluid glucose levels in people with diabetes from a sensor applied to the skin as an alternative to routine finger-prick blood glucose testing, and can produce a -continuous record of measurements which can be checked using an App.
It can also indicate glucose level trends over time.
Monitoring devices will be applied to all patients randomly assigned to the wireless monitoring arm, with a continuous monitoring setting over the first 5 days after the initiation of monitoring, corresponding to the starting of the observation (i.e.
transition to subacute unit for GROUP A, discharge for GROUP B).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Major complications' reduction
Time Frame: 24 months
|
Difference in the incidence of major complications 30 days after the transfer from the acute to the subacute areas and from the hospital to home among the patients subjected to continuous telemonitoring and those subjected to standard monitoring.
|
24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
% of early discharge
Time Frame: 24 months
|
Percentage of patients admitted to acute medicine who reach the 7-day transfer criteria in the ward for subacutes and percentage of patients admitted to acute medicine who reach the criteria for discharge at home within 7 days
|
24 months
|
% of late major complications
Time Frame: 24 months
|
3. Difference in the incidence of major complications at the conclusion of the standard telemonitoring / clinical monitoring phase 30 after the transfer from the acute to the subacute UOC and from the hospital to the home among the patients subjected to continuous telemonitoring and those subjected to standard monitoring .
|
24 months
|
Complications' risk factors
Time Frame: 24 months
|
Patients'characteristics who predispose to major complications
|
24 months
|
Collaborators and Investigators
Collaborators
Publications and helpful links
General Publications
- F. Pietrantonio, L. Piasini, F. Spandonaro. Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis. Italian Journal of Medicine Italian Journal of Medicine 2016; volume 10:157-167
- Blais R, Sears NA, Doran D, Baker GR, Macdonald M, Mitchell L, Thales S. Assessing adverse events among home care clients in three Canadian provinces using chart review. BMJ Qual Saf. 2013 Dec;22(12):989-97. doi: 10.1136/bmjqs-2013-002039. Epub 2013 Jul 4.
- Sears N, Baker GR, Barnsley J, Shortt S. The incidence of adverse events among home care patients. Int J Qual Health Care. 2013 Feb;25(1):16-28. doi: 10.1093/intqhc/mzs075. Epub 2013 Jan 2.
- Pietrantonio F, Orlandini F, Moriconi L, La Regina M. Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients. Eur J Intern Med. 2015 Dec;26(10):759-65. doi: 10.1016/j.ejim.2015.08.011. Epub 2015 Sep 11.
- Masotti P, McColl MA, Green M. Adverse events experienced by homecare patients: a scoping review of the literature. Int J Qual Health Care. 2010 Apr;22(2):115-25. doi: 10.1093/intqhc/mzq003. Epub 2010 Feb 10.
- Doran D, Hirdes JP, Blais R, Baker GR, Poss JW, Li X, Dill D, Gruneir A, Heckman G, Lacroix H, Mitchell L, O'Beirne M, Foebel A, White N, Qian G, Nahm SM, Yim O, Droppo L, McIsaac C. Adverse events associated with hospitalization or detected through the RAI-HC assessment among Canadian home care clients. Healthc Policy. 2013 Aug;9(1):76-88.
- Vincent C, Amalberti R. Safer Healthcare: Strategies for the Real World [Internet]. Cham (CH): Springer; 2016. No abstract available. Available from http://www.ncbi.nlm.nih.gov/books/NBK481869/
- F. Pietrantonio. Analisi dei modelli esistenti: Acute Complex Care Model (ACCM). QUADERNI - Italian Journal of Medicine 2018; volume 6(3):18-29
- Brown H, Terrence J, Vasquez P, Bates DW, Zimlichman E. Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial. Am J Med. 2014 Mar;127(3):226-32. doi: 10.1016/j.amjmed.2013.12.004. Epub 2013 Dec 14.
- Tartaglia R, Albolino S, Bellandi T, Bianchini E, Biggeri A, Fabbro G, Bevilacqua L, Dell'erba A, Privitera G, Sommella L. [Adverse events and preventable consequences: retrospective study in five large Italian hospitals]. Epidemiol Prev. 2012 May-Aug;36(3-4):151-61. Erratum In: Epidemiol Prev. 2015 May-Jun;39(3):210. Italian.
- Charles V. Sicurezza del paziente. Edizione italiana a cura di Tartaglia R, Albolino S, Bellandi T. Milano, Springer-Verlag Italia, 2012
- Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000. Available from http://www.ncbi.nlm.nih.gov/books/NBK225182/
- Bellocco A. Risk management in ospedale. Risk News CINEAS (Consorzio Universitario per l'Ingegneria nelle Assicurazioni) 2002;23.
- Sensium Science MF06-01, April 2015
- Miglioramento della qualità della vita dei pazienti e riduzione del costo per il SSN attraverso l'uso di un sistema wireless di monitoraggio multi-parametrico dei parametri fisiologici. Case study sull'adozione del sistema di monitoraggio fisiologico WIN@Hospital presso l'Ospedale Campo di Marte, Lucca. Cangemi A, Turchetti B. Europe Health Summit Berlino (4-8 Maggio 2014)
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- Green Light HT 2018
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Patient Monitoring
-
GE HealthcareNot yet recruitingPatient Monitoring
-
Assiut UniversityRecruitingPatient MonitoringEgypt
-
Asan Medical CenterKorea Health Industry Development InstituteCompletedPatient MonitoringKorea, Republic of
-
University of UtahCompletedPatient Monitoring | Oxygen Delivery | Patient ComfortUnited States
-
Medtronic - MITGTerminated
-
University of UtahActive, not recruiting
-
Tel-Aviv Sourasky Medical CenterCompleted
-
Uskudar UniversityCompletedMaternal Health | Fetal Monitoring | Patient ComfortTurkey
-
Edwards LifesciencesCompleted
Clinical Trials on Vital signs wireless monitoring system
-
Cambridge University Hospitals NHS Foundation TrustUniversity of CambridgeRecruitingPreterm Infant | Low; Birthweight, Extremely (999 Grams or Less) | Infant, NewbornUnited Kingdom
-
Northwestern UniversityAnn & Robert H Lurie Children's Hospital of ChicagoCompletedAllergy | Asthma in ChildrenUnited States
-
G Medical Innovations Ltd.UnknownRespiration | Oxygen Saturation | Body Temperature | ECGIsrael
-
Fadoi Foundation, ItalyCompleted
-
Qilu Hospital of Shandong UniversityRecruiting
-
AIDAR Health, Inc.MAXIS, LLCWithdrawn
-
Northwell HealthNew York State Department of HealthRecruiting
-
University Hospital Bispebjerg and FrederiksbergRigshospitalet, Denmark; Bispebjerg Hospital; Technical University of DenmarkWithdrawnContinuous Wireless Vital Parameter Monitoring
-
Christian NickelPhilips HealthcareCompletedEmergencies | TachypneaSwitzerland
-
Johns Hopkins UniversityRecruitingCongenital Heart Disease in ChildrenUnited States