JMIR Publications

ABSTRACT

Background:

In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in the patients’ health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s.

Objective:

Aim of this study was to evaluate statements of ICU staff on the current patient monitoring and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of a future patient monitoring.

Methods:

This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff (5 physicians, 6 nurses and 4 respiratory therapists) were recorded, transcribed and analyzed using the grounded theory approach.

Results:

We identified twelve theories within three categories that reflect the requirements of a future patient monitoring from the view of ICU staff: I) Current situation: monitoring of vital parameters intuitive, but advanced features difficult to set up; graphical visualization preferred over numeric display; trend analysis not used in patient monitoring; insufficient alarm management due to lack of resources and unsatisfactory training leads to false alarms, induces stress and endangers patient safety; entanglement of monitoring cables endangers patients. II) Future situation: in an emergency, intuitive patient monitoring more important than functionality; wireless, non-invasive and interoperable monitoring sensors needed; small tablets as remote patient monitoring could mitigate noise pollution and optimize alarm management; ambivalent attitudes towards clinical decision support systems, but if plausible – to estimate its validity – it could reduce false alarms. III) Barriers to implementation: lack of trust in novel technology; fear of losing clinical skills and increasing workload despite novel technology; lack of awareness of available digital technologies.

Conclusions:

This is the first qualitative study on patient monitoring that involves core statements of ICU staff. Findings may foster research projects and accelerate medical product development. Focusing on user-derived findings and enhancing digital literacy on ICU may promote a rapid and sustainable implementation of digital health solutions for a future patient monitoring in the ICU. Clinical Trial: NCT03514173