Continuous versus intermittent, non-invasive monitoring of vital signs in hospitalised, ward based adult patients: A systematic review and narrative synthesis

Abstract

Background: Intermittent monitoring (IM) of vital signs remains the standard of care for hospitalised ward patients, yet this approach creates gaps during which patient deterioration may go unrecognised. Wearable wireless devices capable of continuously measuring physiological parameters offer the potential for earlier detection of clinical decline and prevention of intensive care unit admissions. This systematic review aimed to compare continuous, non-invasive vital signs monitoring with standard IM for the identification of deterioration and prevention of complications in adult, ward-based hospitalised patients. Methods: A comprehensive search of PubMed, MEDLINE, EMBASE and the Cochrane database was conducted for English-language studies published from January 1980 to December 2025. Eligible studies compared continuous, non-invasive vital signs monitoring with IM in adult ward patients and reported clinical outcomes related to deterioration. Randomised controlled trials were assessed using the Cochrane risk of bias tool and non-randomised studies using the Newcastle-Ottawa scale. Outcomes of interest included mortality, hospital and ICU length of stay, ICU transfers, rapid response or escalation calls, time-critical treatment delivery and clinical complications. Results: Following removal of duplicates, 2028 records were screened, yielding 96 articles for full-text review. Thirty-one studies met the eligibility criteria. Two of these compared algorithm-generated monitoring outputs with periodically calculated early warning scores and were excluded from the primary analysis, leaving 29 studies (7 randomised controlled trials, 12 before-and-after studies, 10 observational cohort studies) in the final synthesis. Several studies reported reductions in mortality, ICU transfers or length of stay with continuous monitoring, but few of these reached statistical significance. Some reported earlier escalation and fewer postoperative complications in continuously monitored patients. Differences between studies in design, monitoring system and outcome definition prevented meta-analysis and limited direct comparison. Conclusions: Current evidence does not demonstrate superiority of continuous over intermittent vital signs monitoring for improving clinical outcomes in ward-based patients, although trends suggest possible reductions in deterioration, mortality and hospital length of stay. To clarify these effects, larger standardised randomised trials are required. Future research should evaluate continuous monitoring in combination with decision-support tools and automated alert systems.