Remote vital sign monitoring in admission avoidance hospital at home – a systematic review

Objectives: To examine randomised controlled trials (RCTs) of ‘hospital at home’ (HAH) for admission avoidance in adults presenting with acute physical illness to identify the use of vital sign monitoring approaches and evidence for their effectiveness. Design: Systematic review Setting and participants: This review compared strategies for vital sign monitoring in admission avoidance HAH for adults presenting with acute physical illness. Vital sign monitoring can support HAH acute multidisciplinary care by contributing to safety, determining requirement of further assessment and guiding clinical decisions. There are a wide range of systems currently available, including reliable and automated continuous remote monitoring using wearable devices. Methods: Eligible studies were identified through updated database and trial registries searches (2 March 2016 to 15 February 2023), and existing systematic reviews. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Random effects meta-analyses were performed, and narrative summaries provided stratified by vital sign monitoring approach. Results: 21 eligible RCTs (3459 participants) were identified. Two approaches to vital sign monitoring were characterised: manual and automated. Reporting was insufficient in the majority of studies for classification. For HAH compared to hospital 3 care, 6-monthly mortality risk ratio (RR) was 0.94 (95% CI 0.78 to 1.12), 3-monthly readmission to hospital RR 1.02 (0.77 to 1.35) and length of stay mean difference 1.91 days (0.71 to 3.12). Readmission to hospital was reduced in the automated monitoring subgroup (RR 0.30 95%CI 0.11 to 0.86). Conclusions and Implications: This review highlights gaps in the reporting and evidence-base informing remote vital sign monitoring in alternatives to admission for acute illness, despite expanding implementation in clinical practice. Although continuous vital sign monitoring using wearable devices may offer added benefit, its use in existing RCTs is limited. Recommendations for the implementation and evaluation of remote monitoring in future clinical trials are proposed.