JMIR Publications

ABSTRACT

Background:

Background:

Research has shown that introducing eHealth patient monitoring interventions can improve healthcare efficiency and clinical outcomes. VIGILANCE (The VItal siGns monItoring with continuous puLse oximetry And wireless cliNiCal notification aftEr surgery) was a randomized controlled trial (n=2049) designed to assess the impact of continuous vital sign monitoring with alerts to nursing staff on the incidence of respiratory resuscitations with naloxone, code blues, and intensive care unit transfers in a cohort of post-surgical patients in a ward setting. This report identifies and evaluates key issues and challenges associated with introducing wireless monitoring systems into complex hospital infrastructure during the VIGILANCE eHealth intervention implementation. Potential solutions and suggestions for future implementation research are presented.

Objective:

Objectives: (1) to identify issues related to deployment of the eHealth intervention system of the VIGILANCE study, and (2) to evaluate the influence of these issues on intervention adoption.

Methods:

Methods:

During the VIGILANCE study, issues affecting the implementation of the eHealth intervention were documented on case report forms, alarm event forms, and a nursing user feedback questionnaire. These data were collated by the research and nursing personnel and submitted to the research coordinator. In this evaluation report, the clinical adoption framework was used as a guide to organize the identified issues and evaluate their impact.

Results:

Results:

Using the clinical adoption framework, we identified issues within the framework dimensions of ‘people’, ‘organization’ and ‘implementation’ at the meso level, as well as standards and funding issues at the macro level. Key issues included: nursing workflow changes, patient withdrawal, wireless network connectivity, false alarms, monitor malfunction, probe issues, and wireless network standards. At the micro level, these issues affected the quality of the service in terms of support provided, the quality of the information yielded by the monitors, and the functionality, reliability and performance of the monitoring system. As a result, these issues impacted ‘access’ through decreased ability of nurses to make complete use of the monitors; ‘care quality’ of the trial intervention through decreased effectiveness; and ‘productivity’ through interference in the coordination of care, and thus decreased clinical adoption of the monitoring system.

Conclusions:

Conclusion: Patient monitoring with eHealth technology in surgical wards has the potential to improve patient outcomes. However, proper planning that includes engagement of front-line nurses, installation of appropriate wireless network infrastructure, and use of comfortable cableless devices are required to maximize the potential of eHealth monitoring.