1
|
Liu Q, Xie C, Tan J, Xu L, Zhou F, Peng L. Exploring the nurses' experiences in recognising and managing clinical deterioration in emergency patients: A qualitative study. Aust Crit Care 2024; 37:309-317. [PMID: 37455210 DOI: 10.1016/j.aucc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Emergency Department (ED) patients are particularly at a high risk of deterioration. The frontline nurses are key players in identifying and responding to deterioration events; however, few studies have sought to explore the whole process of recognition and management of clinical deterioration by emergency nurses. OBJECTIVES The aim of this study was to explore the experiences of emergency nurses and provide a whole picture of how they recognise and manage clinical deterioration. METHODS A qualitative descriptive study involving 11 senior nurses and seven junior nurses was conducted in the ED of a 3000-bed tertiary general hospital using semistructured interviews. The interviews were transcribed and thematically analysed. FINDINGS Four salient themes emerged from the data analysis. The first, 'early recognition and response', revealed the importance of vital signs assessment in recognising and responding to clinical deterioration. The second, 'information transfer', depicted the skills and difficulties of transferring information in escalations of care. The third, 'abilities, education, and training', presented the abilities that emergency nurses should have and their perspectives on training. The fourth, 'support culture', described the major role of senior nurses in collaboration with colleagues in the ED. CONCLUSIONS This study explored the experiences of emergency nurses in recognising and managing clinical deterioration. The findings illuminate the need to support the critical role of emergency nurses, with an emphasis on their abilities and continuous interprofessional collaboration training to improve the recognition and management of clinical deterioration.
Collapse
Affiliation(s)
- Qingqing Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China; Orthopedics Department, Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Changning Xie
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China.
| | - Jianwen Tan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; Organ Transplantation Center, Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Laiyu Xu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; Orthopedics Department, Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Fangyi Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; Emergency Department, Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Lingli Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China; Orthopedics Department, Xiangya Hospital of Central South University, Changsha, Hunan, China.
| |
Collapse
|
2
|
Shin H. Deep convolutional neural network-based signal quality assessment for photoplethysmogram. Comput Biol Med 2022; 145:105430. [PMID: 35339844 DOI: 10.1016/j.compbiomed.2022.105430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022]
Abstract
Quality assessment of bio-signals is important to prevent clinical misdiagnosis. With the introduction of mobile and wearable health care, it is becoming increasingly important to distinguish available signals from noise. The goal of this study was to develop a signal quality assessment technology for photoplethysmogram (PPG) widely used in wearable healthcare. In this study, we developed and verified a deep neural network (DNN)-based signal quality assessment model using about 1.6 million 5-s segment length PPG big data of about 29 GB from the MIMIC III PPG waveform database. The DNN model was implemented through a 1D convolutional neural network (CNN). The number of CNN layers, number of fully connected nodes, dropout rate, batch size, and learning rate of the model were optimized through Bayesian optimization. As a result, 6 CNN layers, 1,546 fully connected layer nodes, 825 batch size, 0.2 dropout rate, and 0.002 learning rate were needed for an optimal model. Performance metrics of the result of classifying waveform quality into 'Good' and 'Bad', the accuracy, specificity, sensitivity, area under the receiver operating curve, and area under the precision-recall curve were 0.978, 0.948, 0.993, 0.985, 0.980, and 0.969, respectively. Additionally, in the case of simulated real-time application, it was confirmed that the proposed signal quality score tracked the decrease in pulse quality well.
Collapse
Affiliation(s)
- Hangsik Shin
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
| |
Collapse
|
3
|
A scoping review of barriers, facilitators and tools to escalation of care processes in the emergency department. CAN J EMERG MED 2022; 24:300-312. [DOI: 10.1007/s43678-022-00268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/14/2022] [Indexed: 11/02/2022]
|
4
|
Remote Monitoring of Chronic Critically Ill Patients after Hospital Discharge: A Systematic Review. J Clin Med 2022; 11:jcm11041010. [PMID: 35207287 PMCID: PMC8879658 DOI: 10.3390/jcm11041010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/29/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Over the past few decades, critical care has seen many advancements. These advancements resulted in a considerable increase in the prevalence of chronically critically ill patients requiring prolonged medical care, which led to a massive increase in healthcare utilization. Methods: We performed a search for suitable articles using PubMed and Google Scholar from the inception of these databases to 15 May 2021. Results: Thirty-four articles were included in the review and analyzed. We described the following characteristics and problems with chronic critically ill patient management: the patient population, remote monitoring, the monitoring of physiological parameters in chronic critically ill patients, the anatomical location of sensors, the barriers to implementation, and the main technology-related issues. The main challenges in the management of these patients are (1) the shortage of caretakers, (2) the periodicity of vital function monitoring (e.g., episodic measuring of blood pressure leads to missing important critical events such as hypertension, hypotension, and hypoxia), and (3) failure to catch and manage critical physiological events at the right time, which can result in poor outcomes. Conclusions: The prevalence of critically ill patients is expected to grow. Technical solutions can greatly assist medical personnel and caregivers. Wearable devices can be used to monitor blood pressure, heart rate, pulse, respiratory rate, blood oxygen saturation, metabolism, and central nervous system function. The most important points that should be addressed in future studies are the performance of the remote monitoring systems, safety, clinical and economic outcomes, as well as the acceptance of the devices by patients, caretakers, and healthcare professionals.
Collapse
|
5
|
Leenen JPL, Dijkman EM, van Dijk JD, van Westreenen HL, Kalkman C, Schoonhoven L, Patijn GA. Feasibility of continuous monitoring of vital signs in surgical patients on a general ward: an observational cohort study. BMJ Open 2021; 11:e042735. [PMID: 33597138 PMCID: PMC7893648 DOI: 10.1136/bmjopen-2020-042735] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine feasibility, in terms of acceptability and system fidelity, of continuous vital signs monitoring in abdominal surgery patients on a general ward. DESIGN Observational cohort study. SETTING Tertiary teaching hospital. PARTICIPANTS Postoperative abdominal surgical patients (n=30) and nurses (n=23). INTERVENTIONS Patients were continuously monitored with the SensiumVitals wearable device until discharge in addition to usual care, which is intermittent Modified Early Warning Score measurements. Heart rate, respiratory rate and axillary temperature were monitored every 2 min. Values and trends were visualised and alerts sent to the nurses. OUTCOMES System fidelity was measured by analysis of the monitoring data. Acceptability by patients and nurses was assessed using questionnaires. RESULTS Thirty patients were monitored for a median duration of 81 hours (IQR 47-143) per patient, resulting in 115 217 measurements per parameter. In total, 19% (n=21 311) of heart rate, 51% (n=59 184) of respiratory rate and 9% of temperature measurements showed artefacts (n=10 269). The system algorithm sent 972 alerts (median alert rate of 4.5 per patient per day), of which 90.3% (n=878) were system alerts and 9.7% (n=94) were vital sign alerts. 35% (n=33) of vital sign alerts were true positives. 93% (n=25) of patients rated the patch as comfortable, 67% (n=18) felt safer and 89% (n=24) would like to wear it next time in the hospital. Nurses were neutral about usefulness, with a median score of 3.5 (IQR 3.1-4) on a 7-point Likert scale, ease of use 3.7 (IQR 3.2-4.8) and satisfaction 3.7 (IQR 3.2-4.8), but agreed on ease of learning at 5.0 (IQR 4.0-5.8). Neutral scores were mostly related to the perceived limited fidelity of the system. CONCLUSIONS Continuous monitoring of vital signs with a wearable device was well accepted by patients. Nurses' ratings were highly variable, resulting in on average neutral attitude towards remote monitoring. Our results suggest it is feasible to monitor vital signs continuously on general wards, although acceptability of the device among nurses needs further improvement.
Collapse
Affiliation(s)
- Jobbe P L Leenen
- Department of Surgery, Isala, Zwolle, The Netherlands
- Connected Care Center, Isala, Zwolle, The Netherlands
| | | | | | | | - Cor Kalkman
- Anesthesiology, UMC Utrecht, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | |
Collapse
|
6
|
Leenen JPL, Leerentveld C, van Dijk JD, van Westreenen HL, Schoonhoven L, Patijn GA. Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review. J Med Internet Res 2020; 22:e18636. [PMID: 32469323 PMCID: PMC7351263 DOI: 10.2196/18636] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/07/2020] [Accepted: 05/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Continuous monitoring of vital signs by using wearable wireless devices may allow for timely detection of clinical deterioration in patients in general wards in comparison to detection by standard intermittent vital signs measurements. A large number of studies on many different wearable devices have been reported in recent years, but a systematic review is not yet available to date. OBJECTIVE The aim of this study was to provide a systematic review for health care professionals regarding the current evidence about the validation, feasibility, clinical outcomes, and costs of wearable wireless devices for continuous monitoring of vital signs. METHODS A systematic and comprehensive search was performed using PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 2009 to September 2019 for studies that evaluated wearable wireless devices for continuous monitoring of vital signs in adults. Outcomes were structured by validation, feasibility, clinical outcomes, and costs. Risk of bias was determined by using the Mixed Methods Appraisal Tool, quality assessment of diagnostic accuracy studies 2nd edition, or quality of health economic studies tool. RESULTS In this review, 27 studies evaluating 13 different wearable wireless devices were included. These studies predominantly evaluated the validation or the feasibility outcomes of these devices. Only a few studies reported the clinical outcomes with these devices and they did not report a significantly better clinical outcome than the standard tools used for measuring vital signs. Cost outcomes were not reported in any study. The quality of the included studies was predominantly rated as low or moderate. CONCLUSIONS Wearable wireless continuous monitoring devices are mostly still in the clinical validation and feasibility testing phases. To date, there are no high quality large well-controlled studies of wearable wireless devices available that show a significant clinical benefit or cost-effectiveness. Such studies are needed to help health care professionals and administrators in their decision making regarding implementation of these devices on a large scale in clinical practice or in-home monitoring.
Collapse
Affiliation(s)
| | | | | | | | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | | |
Collapse
|
7
|
Sun L, Joshi M, Khan SN, Ashrafian H, Darzi A. Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis. J R Soc Med 2020; 113:217-224. [PMID: 32521195 PMCID: PMC7439595 DOI: 10.1177/0141076820925436] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/21/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Delayed response to clinical deterioration as a result of intermittent vital sign monitoring is a cause of preventable morbidity and mortality. This review focuses on the clinical impact of multi-parameter continuous non-invasive monitoring of vital signs (CoNiM) in non-intensive care unit patients. DESIGN Systematic review and meta-analysis of primary studies. Embase, MEDLINE, HMIC, PsycINFO and Cochrane were searched from April 1964 to 18 June 2019 with no language restriction. SETTING The search was limited to hospitalised, non-intensive care unit adult patients who had two or more vital signs continuously monitored. PARTICIPANTS All primary studies that evaluated the clinical impact of using multi-parameter CoNiM in adult hospital wards outside of the intensive care unit. MAIN OUTCOME MEASURES Clinical impact of multi-parameter CoNiM. RESULTS This systematic review identified 14 relevant studies from 3846 search results. Five studies were classified as Group A - associations found between measured vital signs and clinical parameters. Nine studies were classified as Group B - comparison between clinical outcomes of patients with and without multi-parameter CoNiM. Vital signs data from CoNiM were found to associate with type of presenting complaint, level of renal function and incidence of major clinical events. CoNiM also assisted in diagnosis by differentiating between patients with acute heart failure, stroke and sepsis (with sub-clustering of septic patients). In the meta-analysis, patients on multi-parameter CoNiM had a 39% decrease in risk of mortality (risk ratio [RR] 0.61; 95% confidence interval [95% CI] -0.39-0.95) when compared to patients with regular intermittent monitoring. There was a trend of reduced intensive care unit transfer (RR 0.86; 95% CI -0.67-1.11) and reduced rapid response team activation (RR 0.61; 95% CI 0.26-1.43). A trend towards reduced hospital length of stay was also found using weighted mean difference (WMD -3.32 days; 95% CI -8.82-2.19 days). CONCLUSION There is evidence of clinical benefit in implementing CoNiM in non-intensive care unit patients. This review supports the use of multi-parameter CoNiM outside of intensive care unit with further large-scale RCTs required to further affirm clinical impact.
Collapse
Affiliation(s)
- Lin Sun
- Department of Surgery and Cancer,
Imperial
College London, London SW7 2AZ, UK
| | - Meera Joshi
- Department of Surgery and Cancer,
Imperial
College London, London SW7 2AZ, UK
| | - Sadia N Khan
- West Middlesex University Hospital,
Isleworth TW7 6AF, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer,
Imperial
College London, London SW7 2AZ, UK
| | - Ara Darzi
- Department of Surgery and Cancer,
Imperial
College London, London SW7 2AZ, UK
| |
Collapse
|
8
|
Sprogis SK, Currey J, Considine J. Patient acceptability of wearable vital sign monitoring technologies in the acute care setting: A systematic review. J Clin Nurs 2019; 28:2732-2744. [PMID: 31017338 DOI: 10.1111/jocn.14893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 03/19/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine patient acceptability of wearable vital sign monitoring devices in the acute setting. BACKGROUND Wearable vital sign monitoring devices may improve patient safety, yet hospital patients' acceptability of these devices is largely unreported. DESIGN A systematic review. METHODS Cumulative Index to Nursing and Allied Health Literature Complete, MEDLINE Complete and EMBASE were searched, supplemented by reference list hand searching. Studies were included if they involved adult hospital patients (≥18 years), a wearable monitoring device capable of assessing ≥1 vital sign, and measured patient acceptability, satisfaction or experience of wearing the device. No date restrictions were enforced. Quality assessments of quantitative and qualitative studies were undertaken using the Downs and Black Checklist for Measuring Study Quality and the Critical Appraisal Skills Programme Qualitative Research Checklist, respectively. Meta-analyses were not possible given data heterogeneity and low research quality. Reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was completed. RESULTS Of the 427 studies screened, seven observational studies met the inclusion criteria. Six studies were of low quality and one was of high quality. In two studies, patient satisfaction was investigated. In the remaining studies, patient experience, patient opinions and experience, patient perceptions and experience, device acceptability, and patient comfort and concerns were investigated. In four studies, patients were mostly accepting of the wearable devices, reporting positive experiences and satisfaction relating to their use. In three studies, findings were mixed. CONCLUSION There is limited high-quality research examining patient acceptability of wearable vital sign monitoring devices as an a priori focus in the acute setting. Further understanding of patient perspectives of these devices is required to inform their continued use and development. RELEVANCE TO CLINICAL PRACTICE The provision of patient-centred nursing care is contingent on understanding patients' preferences, including their acceptability of technology use.
Collapse
Affiliation(s)
- Stephanie K Sprogis
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research-Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Judy Currey
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Deakin Learning Futures, Office of the Deputy Vice Chancellor (Education), Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research-Eastern Health Partnership, Box Hill, Victoria, Australia.,Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
9
|
Birrenkott DA, Pimentel MA, Watkinson PJ, Clifton DA. A Robust Fusion Model for Estimating Respiratory Rate From Photoplethysmography and Electrocardiography. IEEE Trans Biomed Eng 2018; 65:2033-2041. [DOI: 10.1109/tbme.2017.2778265] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Charlton PH, Birrenkott DA, Bonnici T, Pimentel MAF, Johnson AEW, Alastruey J, Tarassenko L, Watkinson PJ, Beale R, Clifton DA. Breathing Rate Estimation From the Electrocardiogram and Photoplethysmogram: A Review. IEEE Rev Biomed Eng 2017; 11:2-20. [PMID: 29990026 PMCID: PMC7612521 DOI: 10.1109/rbme.2017.2763681] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breathing rate (BR) is a key physiological parameter used in a range of clinical settings. Despite its diagnostic and prognostic value, it is still widely measured by counting breaths manually. A plethora of algorithms have been proposed to estimate BR from the electrocardiogram (ECG) and pulse oximetry (photoplethysmogram, PPG) signals. These BR algorithms provide opportunity for automated, electronic, and unobtrusive measurement of BR in both healthcare and fitness monitoring. This paper presents a review of the literature on BR estimation from the ECG and PPG. First, the structure of BR algorithms and the mathematical techniques used at each stage are described. Second, the experimental methodologies that have been used to assess the performance of BR algorithms are reviewed, and a methodological framework for the assessment of BR algorithms is presented. Third, we outline the most pressing directions for future research, including the steps required to use BR algorithms in wearable sensors, remote video monitoring, and clinical practice.
Collapse
Affiliation(s)
- Peter H. Charlton
- Department of Biomedical Engineering, King’s College London, London SE1 7EH, U.K., and also with the Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, U.K
| | - Drew A. Birrenkott
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, U.K
| | - Timothy Bonnici
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, U.K., and also with the Department of Asthma, Allergy, and Lung Biology, King’s College London, London SE1 7EH, U.K
| | | | - Alistair E. W. Johnson
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA 02139 USA
| | - Jordi Alastruey
- Department of Biomedical Engineering, King’s College London, London SE1 7EH, U.K
| | - Lionel Tarassenko
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, U.K
| | - Peter J. Watkinson
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, U.K
| | - Richard Beale
- Department of Asthma, Allergy and Lung Biology, King’s College London, London SE1 7EH, U.K
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, U.K
| |
Collapse
|