Project Summary: Automated continuous vital signs bedside monitoring is used to detect the physiologic deterioration associated with a clinically meaningful event in high-income countries (HIC); yet, many low-and middle-income countries (LMIC) still rely on manual intermittent vital sign monitoring systems. As a result, the current usual care monitoring system often misses opportunities to detect clinically meaningful events in a timely manner, and results in high in-hospital complications and mortality rates. Consumer wearable devices (CWD) offer an outstanding opportunity to address these challenges and provide a wireless vital signs monitoring system. CWDs, e.g., Fitbit and Xiaomi band, provide vital signs data comparable to clinical grade bedside monitors in both children and adults for temperature, heart rate (HR), pulse oximetry (SPO2), and respiratory rate (RR). In this application, we propose to develop (R21 phase) and scale up (R33 phase) a CONsumer-grade wearable monitoring System to improve Outcomes in Low resource settings (CONSOL) in Ghana to enhance the triage of pediatric patients who present for trauma evaluation in the emergency department (ED), and to enhance the postoperative vital signs monitoring processes of children who undergo surgery for appendicitis by the clinical care team. CONSOL is a CWD-based platform that collects CWD data and displays them, in near-real time, on an IPad to clinicians in the hospital, and simultaneously on the smartphone to surgeons remotely, and shows HR, skin temperature, RR, and SPO2 trends transmitted to the monitoring clinicians in near-real time. We hypothesize that CONSOL data will correlate well with usual care vital signs data and will be equivalent to or better than usual care hospital monitoring in detecting physiologic deterioration associated with clinically meaningful events. Trauma and postoperative appendectomy children suffer physiologic deterioration associated with clinically meaningful events and are less communicative about their condition than adults, and thus would greatly benefit from continuous vital signs monitoring. The R21 specific aims are to: Aim 1: Replicate our previous methodology to validate CONSOL VS data in pediatric trauma and postoperative appendicitis patients to detect abnormal VSs indicative of clinically meaningful events at the Korle-Bu Teaching Hospital (KBTH) in Ghana; Aim 2: Prospectively deploy CONSOL in the ED and surgery unit at KBTH to provide near real-time vital sign information to clinical and nursing teams; and improve CONSOL usability by (1) conducting focus groups/interviews and observations to elucidate failures in detecting clinically meaningful events; and (2) modifying the clinician user interface. The R33 specific aims are to: Aim 3: Prepare for the implementation process by identifying moderators, mediators, and mechanisms of action of CONSOL in Ghana hospitals, and Aim 4: Implement the enhanced CONSOL in near real time at the 37 Military Hospital and Greater Accra Regional Hospital, and evaluate the effectiveness of CONSOL in capturing clinically meaningful events.

Project Narrative: Public hospitals in most of West Africa, including Ghana, rely on intermittent manual monitoring to detect physiologic deterioration associated with complications, resulting in missed complications. We propose validating and implementing a continuous monitoring system based on widely available consumer wearable devices to be used in the hospitals for timely detection of physiologic deterioration.