The technology

VitalPAC (The Learning Clinic) is a mobile software information system for monitoring the vital signs of adults, including pregnant women, and children in hospital. Using manually entered or automatically captured vital sign data, it is designed to quickly identify deterioration in their condition and alert clinical staff. VitalPAC can also be used to guide decisions about when people are well enough for discharge.

The main VitalPAC system is an integrated suite of 5 VitalPAC applications:

  • CORE is a mobile app, used for entering patient data onto an iPod, iPhone or iPad at the bedside, for viewing patient data and giving patient alerts. Cannula insertion can also be recorded if the appropriate module is enabled.

  • WARD is a web-based application, optimised for the web browser on an iPad, that can be used for reviewing patient data, location, observations schedule, early warning score (EWS), clinical information and alerts for patients on a particular ward or patients under the care of one or more consultants.

  • CLINICAL is a web-based browser application that can be used to review patient data and record some assessments.

  • PERFORMANCE is a web-based browser application that can be used by clinical and performance managers to see process, performance and reporting data.

  • ADMINISTRATOR is a web-based browser application, used to configure and maintain the system.

Additional clinical modules are available, including infection control; pain escalation alerts; systemic inflammatory response alerts for possible sepsis (if the pathology data integration function is locally enabled); and assessment modules for venous thromboembolism, dementia, alcohol and malnutrition. Other options that can be implemented by local sites include:

  • barcode identification of users and patients

  • integration with radiology data

  • customisation of observational intervals.

Nurses using the system can enter a patient's vital signs with other clinical observations and assessments at the bedside. VitalPAC automatically calculates a person's risk score based on clinical observations, immediately alerting staff of deterioration and advising on appropriate actions. VitalPAC also supports trust-specific scores for paediatric and maternity services so that the responses to EWS are appropriate to each trust.

The VitalPAC system uses the National Early Warning Score (NEWS) in its most recent version. A range of paediatric early warning scores (PEWS) are available as options with VitalPAC.

VitalPAC can integrate with several patient administration systems and electronic patient record systems, including Cerner, Meditech and Silverlink. The hardware needed to use the VitalPAC software must be purchased separately.

The innovation

The VitalPAC system automatically analyses vital sign data and this could reduce errors in paper-based recording and calculating EWS.

By alerting clinical staff to worsening vital signs, VitalPAC could help to improve care by prompting staff to escalate care. The VitalPAC system can also incorporate other clinical observations, screening tools, assessments and alerts. The system also enables organisation-wide audit and performance monitoring.

Current NHS pathway

Currently, nursing staff record the vital signs of people in hospital who are at risk of deterioration, and use them to calculate scores for each patient at that time point. The vital signs recorded are temperature, pulse, blood pressure, respiratory rate, responsiveness and oxygen levels. The scores indicate whether the person needs a higher level of care to prevent further worsening in their condition, and monitoring of these scores can reduce the number of cardiac and respiratory arrests, length of stay, and intensive care unit admissions (Smith et al. 2013).

The NICE guideline on recognising and responding to deterioration in adults who are acutely ill in hospital recommends that:

  • physiological track and trigger systems should be used to monitor all adults in acute hospital settings

  • track and trigger systems should use multiple-parameter or aggregate weighted scoring systems, which allow a graded response and:

    • define the parameters to be measured and the frequency of observations

    • include a clear and explicit statement of the parameters, cut-off points or scores that should trigger a response.

Such weighted scoring systems are known as early warning scores (EWS). The Royal College of Physicians has recommended that the National Early Warning Score (NEWS) system for standardising the assessment of acute-illness severity in the NHS be adopted. The Royal College of Nursing has issued guidance on standards for measuring vital signs in infants, children and young people. VitalPAC offers a number of paediatric EWS with different models adapted to different age ranges. No evidence is currently available on VitalPAC for a paediatric group.

NICE is aware of the following CE-marked devices that appear to fulfil a similar function to VitalPAC:

  • Patientrack (Patientrack)

  • Nervecentre (Nervecentre Software)

  • Wardware (Airslie)

  • Visensia (OBS Medical)

  • IntelliVue Guardian EWS (Philips)

NICE has produced a medtech innovation briefing on Visensia for early detection of deteriorating vital signs in adults in hospital and EarlySense for heart and respiratory monitoring and predicting patient deterioration.

Population, setting and intended user

The technology is intended to be used in acute care settings for adults and children. It would be used by nurses who manually record vital signs.

If a patient's health deteriorates, nurses should inform the clinical decision makers of their concerns according to their local protocol. The manufacturer's deployment and implementation guide recommends that hospitals using VitalPAC should have a defined route of escalation to provide Executive Board Assurance in order to mitigate risks and maximise benefits from the use of VitalPAC. The VitalPAC system can also provide information to support these activities.

VitalPAC has been used to remotely monitor the health of people in their homes but this use is beyond the scope of this briefing.

Costs

Device costs

The annual licence cost for the VitalPAC software is 70p per hospital bed per day (excluding VAT). A more basic version of the system is available at a cost of 50p per hospital bed per day; this version does not include the function to automatically escalate care to doctors and other clinicians. There are no restrictions on the number of users or on the level of use. The price includes deployment, training and ongoing support.

The software operates on Apple iPod touches, iPads and iPhones, which must be bought separately by the hospital. The hospital must also hold an annual Apple Enterprise Licence at a cost of $299 USD (Apple website June 2016; around £225 at exchange rate 1 USD to £0.76).

Secure sockets layer (SSL) certificates are needed for data encryption to securely send data securely to The Learning Clinic servers located in the Trust. The SSL certificate can be generated by the trust or can be purchased at a cost of less than £100. No other consumables or materials are needed to use the system.

Costs of standard care

High-quality A3 colour printed observation charts are needed for paper-based recording of vital signs and calculation of EWS.

Resource consequences

The manufacturer has stated that the VitalPAC system is in use in 52 NHS sites in 26 NHS trusts. The price of the core system includes deployment, training and ongoing support. However, an NHS trust implementing the VitalPAC system would need to:

  • consider whether changes to IT infrastructure are needed

  • revise policies on patient observation and escalation

  • consider any training requirements additional to that provided by VitalPAC.