JMIR Publications

ABSTRACT

Background:

Continuous monitoring of vital signs (CMVS) using wearable, wireless sensors is increasingly available to general ward patients, and has the potential to improve outcomes and reduce nurse workload. In order to assess the potential impact of such systems successful implementation is important. We developed a CMVS intervention and implementation strategy and evaluated its success on two general wards.

Objective:

To assess and compare intervention fidelity on two wards (internal medicine and general surgery) in a large teaching hospital.

Methods:

A mixed-methods sequential explanatory design was used. After thorough training and preparation, CMVS was implemented -in parallel to the standard intermittent manual measurements- and executed for six months at each ward. Heart rate and respiratory rate were measured by a chest-worn wearable sensor and vital signs trends were visualized in a digital platform. Trends were routinely assessed and reported each nursing shift without the use of automated alarms. Primary outcome was intervention fidelity defined as proportion written reports and related nurse activities in case of deviating trends comparing early (month 1-2), mid (month 3-4) and late (month 5-6) implementation periods. Explanatory interviews with nurses were conducted.

Results:

The implementation strategy was executed as planned on both wards. A total of 358 patients were included, resulting in 45,113 monitored hours during 6,142 nurse shifts. Ten percent of the sensors were replaced prematurely due to technical failure. Mean intervention fidelity was 71%±20% and higher on the surgical ward (74% vs. 64%;P<.001). Fidelity decreased over the implementation period on the internal medicine ward (76% at early vs. 57% at mid;P<.001 vs. 48% at late implementation;P<.001) but not significantly on the surgical ward (76% at early vs. 74%;P=.561 at mid vs. 70.7% at late implementation;P=.071). In 69% of patients (n=246) no nursing activities were needed based on vital sign trends. In 174 reports of 112 patients, observed deviating trends led to 101 additional bedside assessments of patients and 73 consults of physicians. Main themes that emerged during interviews (n=21) comprehended the relative priority of CMVS in nurse work, the importance of nursing assessment, the relatively limited perceived benefits for patient care, experienced mediocre usability of the technology and future perspectives for application of CMVS.

Conclusions:

We successfully implemented a system for CMVS at scale on two hospital wards, but our results show that intervention fidelity decreased over time, to a larger extent on the internal medicine ward than on the surgical ward. This decrease appears to be dependent on multiple ward-specific factors. Perceptions of nurses regarding the value and benefits of the intervention were variable. Implications for optimal implementation of CMVS on general wards are including engaging nurses early, seamless integration into the Electronic Health Records, and developing more sophisticated decision support tools for vital sign trend interpretation and alarms.