Scaling Wireless Continuous Vital Sign Monitoring Across an 8-Hospital Health System: Digital Health Implementation Report

Background: Frequent vital sign (VS) monitoring is central to inpatient safety but is traditionally performed manually every 4 hours, a century-old practice that can miss early clinical deterioration, disrupt patient sleep, and impose a heavy documentation burden on nursing staff. Continuous VS monitoring (CVSM) using wearable remote patient monitoring devices enables near real-time, high-frequency VS measurement while reducing manual workload and preserving patient rest. Objective: This implementation report describes the large-scale implementation of CVSM across an 8-hospital health system. The initiative aimed to (1) enhance earlier detection of patient health deterioration through continuous, algorithm-driven monitoring; (2) improve nursing workflow efficiency by reducing reliance on manual VS checks; and (3) minimize nighttime disruptions to support patient rest and recovery. Methods: The program was designed for system-wide scalability and executed from 2022 to 2024 using a 4-phase framework: strategic program design, program planning, go-live preparation, and implementation and optimization. A Food and Drug Administration–cleared wearable device (BioButton) continuously measured heart rate, respiratory rate, and skin temperature, with data integrated into Epic and monitored 24×7 through a centralized virtual operations center. Rollout followed a staggered playbook across approximately 2700 adult non–intensive care unit beds and was supported by leadership engagement, supply chain readiness, staff training, and phased superuser-led adoption. Implementation (Results): All 8 hospitals achieved full deployment between April 2023 and February 2024, with more than 95% device use rates and 100% nursing staff training completion. A standardized escalation workflow filtered approximately 50% of the alerts at the virtual operations center review stage, substantially reducing frontline alert burden. Operational refinements included revised heart rate and respiratory rate alert thresholds and the removal of temperature as a single alert trigger. Several units extended overnight manual VS intervals from every 4 hours to every 6 to 8 hours, with staff estimating approximately 4 hours saved per nursing shift. Patient care assistants redirected time toward patient mobility and personal care needs, while staff reported growing confidence in device performance over time. Conclusions: This initiative represents the first system-wide deployment of CVSM across a diverse, multihospital health system. Success was enabled by early strategic alignment, phased rollout, robust IT and monitoring infrastructure, and iterative optimization. The program demonstrates the feasibility of embedding CVSM into routine inpatient care to improve efficiency and patient experience. Transferable strategies, including phased rollouts, centralized monitoring, and structured change management, may inform other health systems pursuing digital VS redesign. Future work should rigorously evaluate impacts on patient outcomes, cost-effectiveness, and applicability to postacute and ambulatory care settings.