Multiple underlying conditions may be responsible for evolving respiratory compromise.([FOOTNOTE=Lynn, L. A., & Curry, J. P. Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Saf Surg. 2011;5(1):3.],[ANCHOR=],[LINK=]) The likelihood for developing respiratory compromise may be influenced by a number of patient-specific or treatment-specific factors.([FOOTNOTE=Alvarez, M. P., Samayoa-Mendez, A. X., Naglak, M. C., Yuschak, J. V., & Murayama, K. M. Risk Factors for Postoperative Unplanned Intubation: Analysis of a National Database. Am Surg. 2015;81(8):820-825.],[ANCHOR=],[LINK=])
Changes in respiratory vital signs corresponding with respiratory compromise often precede in-hospital deterioration and are associated with increased mortality.([FOOTNOTE=Barfod, C., Lauritzen, M. M., Danker, J. K., et al. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2012;20:28.],[ANCHOR=],[LINK=]) ([FOOTNOTE=Buist, M., Bernard, S., Nguyen, T. V., Moore, G., & Anderson, J. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation. 2004;62(2):137-141.],[ANCHOR=],[LINK=]) ([FOOTNOTE=Chaboyer, W., Thalib, L., Foster, M., Ball, C., & Richards, B. Predictors of adverse events in patients after discharge from the intensive care unit. Am J Crit Care. 2008;17(3):255-263; quiz 264.],[ANCHOR=],[LINK=])-6 Many in-hospital declines may be preventable with better monitoring and early intervention to address evolving respiratory compromise.([FOOTNOTE=Sun, Z., Sessler, D. I., Dalton, J. E., et al. Postoperative Hypoxemia Is Common and Persistent: A Prospective Blinded Observational Study. Anesth AnalgAnesthesiology. 2010;112(2):282-287.],[ANCHOR=],[LINK=]) ([FOOTNOTE=Taenzer, A. H., Pyke, J. B., McGrath, S. P., & Blike, G. T. Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: a before-and-after concurrence study. Anesthesiology. 2010;112(2):282-287.],[ANCHOR=],[LINK=]),8
Respiratory compromise imposes substantial burdens on patient health and hospital costs.([FOOTNOTE=Andersen, L. W., Berg, K. M., Chase, M., et al. Acute respiratory compromise on inpatient wards in the United States: Incidence, outcomes, and factors associated with in-hospital mortality. Resuscitation. 2016;105:123-129.],[ANCHOR=],[LINK=]) ([FOOTNOTE=Wang, H. E., Abella, B. S., & Callaway, C. W. Risk of cardiopulmonary arrest after acute respiratory compromise in hospitalized patients. Resuscitation. 2008;79(2):234-240.],[ANCHOR=],[LINK=]),10
Evidence has demonstrated that the implementation of automated early warning score systems may improve patient outcome, and reduce the cost of implementation compared to traditional manually calculated systems. ([FOOTNOTE=Bellomo, R., Ackerman, M., Bailey, M., et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012;40(8):2349-2361.],[ANCHOR=],[LINK=]) blablabla, ([FOOTNOTE=Slight, S. P., Franz, C., Olugbile, M., Brown, H. V., Bates, D. W., & Zimlichman, E. The return on investment of implementing a continuous monitoring system in general medical-surgical units. Crit Care Med. 2014;42(8):1862-1868.],[ANCHOR=],[LINK=]),12
Changes in patient populations, along with economic and practical considerations, have led to an overall increase in patient acuity on the general care floor (GCF). Despite the presence of higher risk patients, current GCF surveillance is often limited to isolated spot checks of core vital signs, such as heart rate, respiratory rate, blood pressure and temperature, with such observations often limited to every 4 hours, which leaves patients unmonitored 96% of the time.([FOOTNOTE=Weinger, M. B., & Lee, L. A. No Patient Shall Be Harmed By Opioid-Induced Respiratory Depression. APSF Newsletter. 2011;26(2):21.],[ANCHOR=],[LINK=]) Therefore, these patients may be at increased risk for respiratory compromise.