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Kuznetsova M, Kim AY, Scully DA, Wolski P, Syrowatka A, Bates DW, Dykes PC. Implementation of a Continuous Patient Monitoring System in the Hospital Setting: A Qualitative Study. Jt Comm J Qual Patient Saf 2024; 50:235-246. [PMID: 38101994 DOI: 10.1016/j.jcjq.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Technology can improve care delivery, patient outcomes, and staff satisfaction, but integration into the clinical workflow remains challenging. To contribute to this knowledge area, this study examined the implementation continuum of a contact-free, continuous monitoring system (CFCM) in an inpatient setting. CFCM monitors vital signs and uses the information to alert clinicians of important changes, enabling early detection of patient deterioration. METHODS Data were collected throughout the entire implementation continuum at a community teaching hospital. Throughout the study, 3 group and 24 individual interviews and five process observations were conducted. Postimplementation alarm response data were collected. Analysis was conducted using triangulation of information sources and two-coder consensus. RESULTS Preimplementation perceived barriers were alarm fatigue, questions about accuracy and trust, impact on patient experience, and challenges to the status quo. Stakeholders identified the value of CFCM as preventing deterioration and benefitting patients who are not good candidates for telemetry. Educational materials addressed each barrier and emphasized the shared CFCM values. Mean alarm response times were below the desired target of two minutes. Postimplementation interview analysis themes revealed lessened concerns of alarm fatigue and improved trust in CFCM than anticipated. Postimplementation challenges included insufficient training for secondary users and impact on patient experience. CONCLUSION In addition to understanding the preimplementation anticipated barriers to implementation and establishing shared value before implementation, future recommendations include studying strategies for optimal tailoring of education to each user group, identifying and reinforcing positive process changes after implementation, and including patient experience as the overarching element in frameworks for digital tool implementation.
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van Noort HHJ, Becking-Verhaar FL, Bahlman-van Ooijen W, Pel M, van Goor H, Huisman-de Waal G. Three Years of Continuous Vital Signs Monitoring on the General Surgical Ward: Is It Sustainable? A Qualitative Study. J Clin Med 2024; 13:439. [PMID: 38256573 PMCID: PMC10816891 DOI: 10.3390/jcm13020439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Continuous monitoring of vital signs using a wireless wearable device was implemented in 2018 at a surgical care unit of an academic hospital. This study aimed at gaining insight into nurses' and patients' perspectives regarding the use and innovation of a continuous vital signs monitoring system, three years after its introduction. This qualitative study was performed in a surgical, non-intensive care unit of an academic hospital in 2021. Key-user nurses (nurses with additional training and expertise with the device) and patients were selected for semi-structured interviews, and nurses from the ward were selected for a focus group interview using a topic list. Transcripts of the audio tapes were deductively analysed using four dimensions for adoptions of information and communication technologies (ICT) devices in healthcare. The device provided feelings of safety for nurses and patients. Nurses and patients had a few issues with the device, including the size and the battery life. Nurses gained knowledge and skills in using the system for measurement and interpretations. They perceived the system as a tool to improve the recognition of clinical decline. The use of the system could be further developed regarding the technical device's characteristics, nurses' interpretation of the data and the of type of alarms, the information needs of patients, and clarification of the definition and standardization of continuous monitoring. Three years after the introduction, wireless continuous vital signs monitoring is the new standard of care according to the end-users at the general surgical ward.
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Affiliation(s)
- Harm H. J. van Noort
- Department of Surgery, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (F.L.B.-V.); (W.B.-v.O.); (M.P.); (G.H.-d.W.)
| | | | | | | | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (F.L.B.-V.); (W.B.-v.O.); (M.P.); (G.H.-d.W.)
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van Goor HMR, Breteler MJM, Schoonhoven L, Kalkman CJ, van Loon K, Kaasjager KAH. Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study. PLoS One 2023; 18:e0286080. [PMID: 37228047 DOI: 10.1371/journal.pone.0286080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Continuous monitoring of vital signs is introduced at general hospital wards to detect patient deterioration. Interpretation and response currently rely on experience and expert opinion. This study aims to determine whether consensus exist among hospital professionals regarding the interpretation of vital signs of COVID-19 patients. In addition, we assessed the ability to recognise respiratory insufficiency and evaluated the interpretation process. METHODS We performed a mixed methods study including 24 hospital professionals (6 nurses, 6 junior physicians, 6 internal medicine specialists, 6 ICU nurses). Each participant was presented with 20 cases of COVID-19 patients, including 4 or 8 hours of continuously measured vital signs data. Participants estimated the patient's situation ('improving', 'stable', or 'deteriorating') and the possibility of developing respiratory insufficiency. Subsequently, a semi-structured interview was held focussing on the interpretation process. Consensus was assessed using Krippendorff's alpha. For the estimation of respiratory insufficiency, we calculated the mean positive/negative predictive value. Interviews were analysed using inductive thematic analysis. RESULTS We found no consensus regarding the patient's situation (α 0.41, 95%CI 0.29-0.52). The mean positive predictive value for respiratory insufficiency was high (0.91, 95%CI 0.86-0.97), but the negative predictive value was 0.66 (95%CI 0.44-0.88). In the interviews, two themes regarding the interpretation process emerged. "Interpretation of deviations" included the strategies participants use to determine stability, focused on finding deviations in data. "Inability to see the patient" entailed the need of hospital professionals to perform a patient evaluation when estimating a patient's situation. CONCLUSION The interpretation of continuously measured vital signs by hospital professionals, and recognition of respiratory insufficiency using these data, is variable, which might be the result of different interpretation strategies, uncertainty regarding deviations, and not being able to see the patient. Protocols and training could help to uniform interpretation, but decision support systems might be necessary to find signs of deterioration that might otherwise go unnoticed.
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Affiliation(s)
- Harriët M R van Goor
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine J M Breteler
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Digital Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cor J Kalkman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim van Loon
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin A H Kaasjager
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Becking-Verhaar FL, Verweij RPH, de Vries M, Vermeulen H, van Goor H, Huisman-de Waal GJ. Continuous Vital Signs Monitoring with a Wireless Device on a General Ward: A Survey to Explore Nurses' Experiences in a Post-Implementation Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105794. [PMID: 37239523 DOI: 10.3390/ijerph20105794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/10/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Nurse engagement, perceived need and usefulness affect healthcare technology use, acceptance and improvements in quality, safety and accessibility of healthcare. Nurses' opinions regarding continuous monitoring appear to be positive. However, facilitators and barriers were little studied. This study explored nurses' post-implementation experiences of the facilitators and barriers to continuously monitoring patients' vital signs using a wireless device on general hospital wards. METHODS This study employed a cross-sectional survey. Vocational and registered nurses from three general wards in a Dutch tertiary university hospital participated in a survey comprising open and closed questions. The data were analysed using thematic analysis and descriptive statistics. RESULTS Fifty-eight nurses (51.3%) completed the survey. Barriers and facilitators were identified under four key themes: (1) timely signalling and early action, (2) time savings and time consumption, (3) patient comfort and satisfaction and (4) preconditions. CONCLUSIONS According to nurses, early detection and intervention for deteriorating patients facilitate the use and acceptance of continuously monitoring vital signs. Barriers primarily concern difficulties connecting patients correctly to the devices and system.
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Affiliation(s)
- Femke L Becking-Verhaar
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Robin P H Verweij
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Marjan de Vries
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Hester Vermeulen
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Huispost 160, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Getty J Huisman-de Waal
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Huispost 160, Postbus 9101, 6500 HB Nijmegen, The Netherlands
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Ocampo W, Sola DY, Baylis BW, Conly JM, Hogan DB, Kaufman J, Kiplagat L, Stelfox HT, Ghali WA, Ho C. Healthcare provider and patient/family perceptions of continuous pressure imaging technology for prevention of pressure injuries: A secondary analysis of patients enrolled in a randomized control trial. PLoS One 2022; 17:e0278019. [PMID: 36445905 PMCID: PMC9707747 DOI: 10.1371/journal.pone.0278019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Despite the availability of various pressure injury (PI) prevention strategies (e.g., risk identification, use of pressure re-distribution surfaces, frequent repositioning), they persist as a significant issue for healthcare systems worldwide. Continuous pressure imaging (CPI) is a novel technology that could be integrated within a comprehensive approach to the prevention of PIs. We studied the perceptions of healthcare providers and patients/families to identify facilitators and barriers to the use of this technology. METHODS Hospitalized patients/family members from a randomized controlled trial assessing the efficacy of CPI in preventing PIs completed a survey after 72 hours (or upon discharge from hospital) of CPI monitoring. They were asked questions about prior and current experience with CPI technology. For healthcare providers, perceptions on the use of the device and its impact on care were explored through a survey distributed by email or hard copies. RESULTS A total of 125 healthcare providers and 525 patients/family members completed the surveys. Of the healthcare providers, 95% either agreed/strongly agreed that the CPI technology was easy to use and 65% stated that the device improved how they provided pressure relief for patients. Identified issues with the device were cost, the fitting of the mattress cover, and the fixation of the patients/families on the device. Over a quarter of the patient/family respondents agreed/strongly agreed that the device influenced how pressure relief was provided. This response was statistically associated with whether the monitor was turned on (intervention arm; 52.7%) or off (control arm; 4.2%). DISCUSSION AND CONCLUSION CPI technology was positively perceived by healthcare providers. Most patients/families felt it influenced care when the CPI monitor was turned on. Concerns raised around cost and the ease of use of these devices by healthcare providers may affect the decisions of healthcare system administrators to adopt and implement this technology.
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Affiliation(s)
- Wrechelle Ocampo
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Darlene Y. Sola
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Barry W. Baylis
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - John M. Conly
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Synder Institute for Chronic Diseases, Cumming School of Medicine, Calgary, AB, Canada
| | - David B. Hogan
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jaime Kaufman
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Linet Kiplagat
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Departments of Critical Care Medicine and Community Health Sciences, Calgary, AB, Canada
| | - William A. Ghali
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Chester Ho
- W21C, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Downey C, Brown J, Jayne D, Randell R. Nursing staff perspectives of continuous remote vital signs monitoring on surgical wards: Theory elicitation for a realist evaluation. J Eval Clin Pract 2022; 28:394-403. [PMID: 35368138 PMCID: PMC9325470 DOI: 10.1111/jep.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/23/2022] [Accepted: 03/08/2022] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Continuous remote monitoring (CRM) provides a novel solution to the challenges of monitoring patients' vital signs in hospital, but the results of quantitative studies have been mixed. Acceptance by staff is a crucial determinant of the success of healthcare technologies and may explain these discrepancies. Drawing on the approach of realist evaluation, this paper aims to identify theories about how, why and in what conditions nursing staff perceptions vary regarding the CRM of patients' vital signs. METHODS Multiple methods were used to elicit theories about factors likely to facilitate or impede the successful implementation of continuous remote vital signs monitoring. This included a literature review, consultation with patients and observational work conducted during a randomized controlled trial (RCT) of CRM. In addition, a priori theories developed through informal interactions with patients and ward staff during the day-to-day set-up of the trial were included. RESULTS The findings suggest that the perceptions of nursing staff regarding remote monitoring can be influenced by the type of patients under their care and their previous experience of telemetry. Factors which may undermine the engagement of staff are perceived staff burden, which can be dependent on contextual factors such as staffing levels, time of day and senior staff attitudes. Staff attitudes are also likely to be influenced by patient perspectives and the utility of the devices associated with remote monitoring. The successful implementation of CRM may be dependent on staff training, research staff input and hospital culture. CONCLUSIONS Theories regarding nursing staff engagement with remote monitoring are numerous, varied and contradictory. The theories elicited in this initial phase will be refined during interviews with the nursing staff involved with the RCT.
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Affiliation(s)
- Candice Downey
- Leeds Institute of Medicine at St. James's, St. James's University Hospital, University of Leeds, Leeds, UK
| | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Medicine at St. James's, St. James's University Hospital, University of Leeds, Leeds, UK
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
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Dykes PC, Lowenthal G, Lipsitz S, Salvucci SM, Yoon C, Bates DW, An PG. Reducing ICU Utilization, Length of Stay, and Cost by Optimizing the Clinical Use of Continuous Monitoring System Technology in the Hospital. Am J Med 2022; 135:337-341.e1. [PMID: 34717901 DOI: 10.1016/j.amjmed.2021.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Continuous monitoring system technology (CMST) aids in earlier detection of deterioration of hospitalized patients, but whether improved outcomes are sustainable is unknown. METHODS This interrupted time series evaluation explored whether optimized clinical use of CMST was associated with sustained improvement in intensive care unit (ICU) utilization, hospital length of stay, cardiac arrest rates, code blue events, mortality, and cost across multiple adult acute care units. RESULTS A total of 20,320 patients in the postoptimized use cohort compared with 16,781 patients in the preoptimized use cohort had a significantly reduced ICU transfer rate (1.73% vs 2.25%, P = .026) corresponding to 367.11 ICU days saved over a 2-year period, generating an estimated cost savings of more than $2.3 million. Among patients who transferred to the ICU, hospital length of stay was decreased (8.37 vs 9.64 days, P = .004). Cardiac arrest, code blue, and mortality rates did not differ significantly. CONCLUSION Opportunities exist to promote optimized adoption and use of CMST at acute care facilities to sustainably improve clinical outcomes and reduce cost.
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Affiliation(s)
- Patricia C Dykes
- Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Graham Lowenthal
- Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Mass
| | - Stuart Lipsitz
- Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | | | - Catherine Yoon
- Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Mass
| | - David W Bates
- Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Perry G An
- Adult In-patient Medicine, Newton-Wellesley Hospital, Newton, Mass
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Abstract
During the course of surgical interventions, complications mostly occur in the postoperative period. Slight clinical indications can be observed, which precede a significant deterioration of the patient's condition. On the general ward vital parameters, such as heart and breathing frequencies are measured every 4-8 h. Even if the monitoring of critically ill patients is increased to every 2 h and the measurement of vital functions takes 10 min, the patient is only monitored for 120 min in a 24 h period and remains postoperatively on the general ward without monitoring for 22 out of 24 h. New wireless monitoring systems are available to continuously register some vital functions with the aid of wearable sensors. These systems can alert and alarm ward personnel if the patient's condition deteriorates. Although the optimal monitoring system does not yet exist and implementation of these new wireless monitoring systems might involve some risks, these new methods offer a great opportunity to optimize surveillance of postoperative patients on the general ward.
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Affiliation(s)
- B Preckel
- Academisch Medisch Centrum AMC, Afdeling Anesthesiologie, Amsterdam Universitair Medische Centra, Meibergdreef 9, 1105 AZ, Amsterdam, Niederlande.
| | - L M Posthuma
- Academisch Medisch Centrum AMC, Afdeling Anesthesiologie, Amsterdam Universitair Medische Centra, Meibergdreef 9, 1105 AZ, Amsterdam, Niederlande
| | - M J Visscher
- Academisch Medisch Centrum AMC, Afdeling Anesthesiologie, Amsterdam Universitair Medische Centra, Meibergdreef 9, 1105 AZ, Amsterdam, Niederlande
| | - M W Hollmann
- Academisch Medisch Centrum AMC, Afdeling Anesthesiologie, Amsterdam Universitair Medische Centra, Meibergdreef 9, 1105 AZ, Amsterdam, Niederlande
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Can continuous remote vital sign monitoring reduce the number of room visits to patients suspected of COVID-19: A quasi-experimental study. Int J Nurs Stud 2021; 115:103868. [PMID: 33465579 PMCID: PMC7778830 DOI: 10.1016/j.ijnurstu.2020.103868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 01/16/2023]
Abstract
Background Continuous remote monitoring of vital signs on the hospital ward gained popularity during the Severe Acute Respiratory Syndrome coronavirus 2 pandemic due to its ability to support early detection of respiratory failure, and the possibility to do so without physical contact between patient and clinician. The effect of continuous monitoring on patient room visits has not been established yet. Objectives To assess the impact of continuous monitoring on the number of patient room visits for patients suspected of Corona Virus Disease 2019 (COVID-19) and the use of personal protection equipment. Design and methods We performed a before-after study at a ward with private rooms for patients suspected of COVID-19 at a tertiary hospital in Nijmegen, The Netherlands. Non-participant observers observed hospital staff during day, evening and night shifts to record patient room visits and personal protection equipment usage. After eleven days, wearable continuous vital sign monitoring was introduced. An interrupted time series analysis was applied to evaluate the effect of continuous monitoring on the number of patient room visits, visits for obtaining vital signs (Modified Early Warning Score visits) and the amount of personal protection equipment used. Results During the 45 day study period, 86 shifts were observed. During each shift, approximately six rooms were included. A total of 2347 patient room visits were recorded. The slope coefficient for the number of patient room visits did not change after introducing continuous vital sign monitoring (B -0.003, 95% confidence interval -0.022/0.016). The slope coefficients of the number of Modified Early Warning Score visits and the amount of personal protection equipment used did not change either (B -0.002, 95% confidence interval -0.021/0.017 and B 0.046, 95% confidence interval -0.008/0.099). The number of Modified Early Warning Score visits did show a decline over the entire study period, however this decline was not influenced by the intervention. Evening and night shifts were associated with fewer patient room visits compared to day shifts. Conclusion Introduction of continuous vital sign monitoring at a general ward for patients with suspected COVID-19 did not reduce the number of patient room visits or the usage of personal protection equipment by hospital staff. The number of Modified Early Warning Score visits declined over time, but this was not related to the introduction of continuous monitoring. Detailed analysis of the influence of continuous monitoring on the workflow of hospital staff reveals key points to increase efficacy of this intervention.
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Ede J, Vollam S, Darbyshire JL, Gibson O, Tarassenko L, Watkinson P. Non-contact vital sign monitoring of patients in an intensive care unit: A human factors analysis of staff expectations. APPLIED ERGONOMICS 2021; 90:103149. [PMID: 32866689 DOI: 10.1016/j.apergo.2020.103149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/12/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Infra-red and thermal imaging enable wireless systems to monitor patients' vital signs and absence of wires may improve patient experiences. No studies have explored staff perceptions of the concept of this specific type of technology in the adult population. Understanding existing working systems before introducing technology could improve adoption. METHODS We conducted semi-structured interviews with Intensive Care Unit (ICU) staff exploring perceptions of wireless patient monitoring. We used the Systems Engineering Initiative for Patient Safety (SEIPS) model to guide thematic analysis. RESULTS We identified usability themes relating to staff perceptions of current patient monitoring experiences, staff perceptions of patient/relative expectations of ICU care, troubleshooting, hierarchy of monitoring, and consensus of trust. CONCLUSION The concept of wireless monitoring has perceived benefits for patients and staff. The Systems Engineering Initiative for Patient Safety model guided a systems-based exploratory evaluation. Results highlight the social and environmental factors which may influence usability, adoption, or abandonment of wireless technology in the ICU.
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12
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McGillion M, Ouellette C, Good A, Bird M, Henry S, Clyne W, Turner A, Ritvo P, Ritvo S, Dvirnik N, Lamy A, Whitlock R, Lawton C, Walsh J, Paterson K, Duquette J, Sanchez Medeiros K, Elias F, Scott T, Mills J, Harrington D, Field M, Harsha P, Yang S, Peter E, Bhavnani S, Devereaux PJ. Postoperative Remote Automated Monitoring and Virtual Hospital-to-Home Care System Following Cardiac and Major Vascular Surgery: User Testing Study. J Med Internet Res 2020; 22:e15548. [PMID: 32186521 PMCID: PMC7113803 DOI: 10.2196/15548] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 01/20/2023] Open
Abstract
Background Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascular surgery. However, the science of deploying and evaluating these systems is complex and subject to risk of implementation failure. Objective As a precursor to a randomized controlled trial (RCT), this user testing study aimed to examine user performance and acceptance of a RAM and virtual hospital-to-home care intervention, using Philip’s Guardian and Electronic Transition to Ambulatory Care (eTrAC) technologies, respectively. Methods Nurses and patients participated in systems training and individual case-based user testing at two participating sites in Canada and the United Kingdom. Participants were video recorded and asked to think aloud while completing required user tasks and while being rated on user performance. Feedback was also solicited about the user experience, including user satisfaction and acceptance, through use of the Net Promoter Scale (NPS) survey and debrief interviews. Results A total of 37 participants (26 nurses and 11 patients) completed user testing. The majority of nurse and patient participants were able to complete most required tasks independently, demonstrating comprehension and retention of required Guardian and eTrAC system workflows. Tasks which required additional prompting by the facilitator, for some, were related to the use of system features that enable continuous transmission of patient vital signs (eg, pairing wireless sensors to the patient) and assigning remote patient monitoring protocols. NPS scores by user group (nurses using Guardian: mean 8.8, SD 0.89; nurses using eTrAC: mean 7.7, SD 1.4; patients using eTrAC: mean 9.2, SD 0.75), overall NPS scores, and participant debrief interviews indicated nurse and patient satisfaction and acceptance of the Guardian and eTrAC systems. Both user groups stressed the need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems. Conclusions User testing indicated a high degree of user acceptance of Philips’ Guardian and eTrAC systems among nurses and patients. Key insights were provided that informed refinement of clinical workflow training and systems implementation. These results were used to optimize workflows before the launch of an international RCT of in-hospital RAM and virtual hospital-to-home care for patients undergoing cardiac and major vascular surgery.
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Affiliation(s)
- Michael McGillion
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | | | - Amber Good
- Population Health Research Institute, Hamilton, ON, Canada
| | - Marissa Bird
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Wendy Clyne
- Hope for the Community CIC, Coventry, United Kingdom
| | | | | | | | - Nazari Dvirnik
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - Andre Lamy
- Population Health Research Institute, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Richard Whitlock
- Population Health Research Institute, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Jake Walsh
- Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Janine Duquette
- Cardiac and Vascular Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Fadi Elias
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - Ted Scott
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Joseph Mills
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Mark Field
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Elizabeth Peter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Bhavnani
- Scripps Clinic & Research Foundation, San Diego, CA, United States
| | - P J Devereaux
- Population Health Research Institute, Hamilton, ON, Canada.,Departments of Health Research Methods, Evidence, and Impact (HEI) and Medicine, McMaster University, Hamilton, ON, Canada
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13
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Posthuma LM, Downey C, Visscher MJ, Ghazali DA, Joshi M, Ashrafian H, Khan S, Darzi A, Goldstone J, Preckel B. Remote wireless vital signs monitoring on the ward for early detection of deteriorating patients: A case series. Int J Nurs Stud 2020; 104:103515. [PMID: 32105974 DOI: 10.1016/j.ijnurstu.2019.103515] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Remote wireless monitoring is a new technology that allows the continuous recording of ward patients' vital signs, supporting nurses by measuring vital signs frequently and accurately. A case series is presented to illustrate how these systems might contribute to improved patient surveillance. METHODS AND RESULTS Five hospitals in three European countries installed a remote wireless vital signs monitoring system on medical or surgical wards. Heart rate, respiratory rate and temperature were measured by the system every 2 min. Four cases of (paroxysmal) atrial fibrillation are presented, two cases of sepsis and one case each of pyrexia, cardiogenic pulmonary edema and pulmonary embolisms. All cases show that the remote monitoring system revealed the first signs of ventilatory and circulatory deterioration before a change in the trends of the respective values became obvious by manual vital signs measurement. DISCUSSION This case series illustrates that a wireless remote vital signs monitoring system on medical and surgical wards has the potential to reduce time to detect deteriorating patients.
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Affiliation(s)
- L M Posthuma
- Department of Anaesthesiology, Amsterdam UMC, location AMC, H1-148, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C Downey
- Leeds Institute of Medical Research at St. James's, University of Leeds, United Kingdom
| | - M J Visscher
- Department of Anaesthesiology, Amsterdam UMC, location AMC, H1-148, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - D A Ghazali
- Emergency Department, University Hospital of Bichat, Paris, France
| | - M Joshi
- Department of Surgery & Cancer, Academic Surgical Unit, St Mary's Hospital, Imperial College London, London, United Kingdom; Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, United Kingdom
| | - H Ashrafian
- Department of Surgery & Cancer, Academic Surgical Unit, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - S Khan
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, United Kingdom
| | - A Darzi
- Department of Surgery & Cancer, Academic Surgical Unit, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - J Goldstone
- Chief Intensivist, King Edward VII Hospital, The London Clinic and University College London Hospitals NHS Trust, London, United Kingdom
| | - B Preckel
- Department of Anaesthesiology, Amsterdam UMC, location AMC, H1-148, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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14
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Harsha P, Paul JE, Chong MA, Buckley N, Tidy A, Clarke A, Buckley D, Sirko Z, Vanniyasingam T, Walsh J, McGillion M, Thabane L. Challenges With Continuous Pulse Oximetry Monitoring and Wireless Clinician Notification Systems After Surgery: Reactive Analysis of a Randomized Controlled Trial. JMIR Med Inform 2019; 7:e14603. [PMID: 31661079 PMCID: PMC6913744 DOI: 10.2196/14603] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/05/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Research has shown that introducing electronic Health (eHealth) patient monitoring interventions can improve healthcare efficiency and clinical outcomes. The VIGILANCE (VItal siGns monItoring with continuous puLse oximetry And wireless cliNiCian notification aftEr surgery) study was a randomized controlled trial (n=2049) designed to assess the impact of continuous vital sign monitoring with alerts sent to nursing staff when respiratory resuscitations with naloxone, code blues, and intensive care unit transfers occurred in a cohort of postsurgical 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 The goals of this study were to: (1) identify issues related to the deployment of the eHealth intervention system of the VIGILANCE study; and (2) evaluate the influence of these issues on intervention adoption. 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 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 with blank alarm forms (24/1030, 2.33%) and missing alarm forms (236/1030, 22.91%), patient withdrawal (110/1030, 10.68%), wireless network connectivity, false alarms (318/1030, 30.87%), monitor malfunction (36/1030, 3.49%), probe issues (16/1030, 1.55%), 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 the decreased ability of nurses to make complete use of the monitors, impacted care quality of the trial intervention through decreased effectiveness, and impacted productivity through interference in the coordination of care, thus decreasing clinical adoption of the monitoring system. CONCLUSIONS 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 is required to maximize the potential of eHealth monitoring. TRIAL REGISTRATION ClinicalTrials.gov NCT02907255; https://clinicaltrials.gov/ct2/show/NCT02907255.
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Affiliation(s)
- Prathiba Harsha
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - James E Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | | | - Norm Buckley
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Antonella Tidy
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Anne Clarke
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Diane Buckley
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Zenon Sirko
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | | | - Jake Walsh
- Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Lehana Thabane
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Anesthesia, McMaster University, Hamilton, ON, Canada
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15
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Downey CL, Chapman S, Randell R, Brown JM, Jayne DG. The impact of continuous versus intermittent vital signs monitoring in hospitals: A systematic review and narrative synthesis. Int J Nurs Stud 2018; 84:19-27. [PMID: 29729558 DOI: 10.1016/j.ijnurstu.2018.04.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Continuous vital signs monitoring on general hospital wards may allow earlier detection of patient deterioration and improve patient outcomes. This systematic review will assess if continuous monitoring is practical outside of the critical care setting, and whether it confers any clinical benefit to patients. METHODS MEDLINE®, MEDLINE® In-Process, EMBASE, CINAHL and The Cochrane Library were searched for articles that evaluated the clinical or non-clinical outcomes of continuous vital signs monitoring in adults outside of the critical care setting. The protocol was registered with PROSPERO (CRD42017058098). FINDINGS Twenty-four studies met the inclusion criteria and reported outcomes on a total of 40,274 patients and 59 ward staff in nine countries. The majority of studies showed benefits in terms of critical care use and length of hospital stay. Larger studies were more likely to demonstrate clinical benefit, particularly critical care use and length of hospital stay. Three studies showed cost-effectiveness. Barriers to implementation included nursing and patient satisfaction and the burden of false alerts. CONCLUSIONS Continuous vital signs monitoring outside the critical care setting is feasible and may provide a benefit in terms of improved patient outcomes and cost efficiency. Large, well-controlled studies in high-risk populations are required to evaluate the clinical benefit of continuous monitoring systems.
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Affiliation(s)
- C L Downey
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom.
| | - S Chapman
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom
| | - R Randell
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - J M Brown
- Leeds Institute of Clinical Trials Research, Worsley Building, University of Leeds, Leeds, LS2 9NL, United Kingdom
| | - D G Jayne
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom
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16
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Downey CL, Brown JM, Jayne DG, Randell R. Patient attitudes towards remote continuous vital signs monitoring on general surgery wards: An interview study. Int J Med Inform 2018; 114:52-56. [PMID: 29673603 DOI: 10.1016/j.ijmedinf.2018.03.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/07/2017] [Accepted: 03/23/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vital signs monitoring is used to identify deteriorating patients in hospital. The most common tool for vital signs monitoring is an early warning score, although emerging technologies allow for remote, continuous patient monitoring. A number of reviews have examined the impact of continuous monitoring on patient outcomes, but little is known about the patient experience. This study aims to discover what patients think of monitoring in hospital, with a particular emphasis on intermittent early warning scores versus remote continuous monitoring, in order to inform future implementations of continuous monitoring technology. METHODS Semi-structured interviews were undertaken with 12 surgical inpatients as part of a study testing a remote continuous monitoring device. All patients were monitored with both an early warning score and the new device. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. FINDINGS Patients can see the value in remote, continuous monitoring, particularly overnight. However, patients appreciate the face-to-face aspect of early warning score monitoring as it allows for reassurance, social interaction, and gives them further opportunity to ask questions about their medical care. CONCLUSION Early warning score systems are widely used to facilitate detection of the deteriorating patient. Continuous monitoring technologies may provide added reassurance. However, patients value personal contact with their healthcare professionals and remote monitoring should not replace this. We suggest that remote monitoring is best introduced in a phased manner, and initially as an adjunct to usual care, with careful consideration of the patient experience throughout.
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Affiliation(s)
- C L Downey
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom.
| | - J M Brown
- Leeds Institute of Clinical Trials Research, Worsley Building, University of Leeds, Leeds, LS2 9NL, United Kingdom
| | - D G Jayne
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom
| | - R Randell
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, United Kingdom
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17
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Rangachari P. Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success. ACTA ACUST UNITED AC 2018; 5:1-14. [PMID: 29546884 DOI: 10.2147/ieh.s151040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
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Affiliation(s)
- Pavani Rangachari
- College of Allied Health Sciences, Augusta University, Augusta, Georgia, United States
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18
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Nilsson L, Eriksén S, Borg C. The influence of social challenges when implementing information systems in a Swedish health-care organisation. J Nurs Manag 2016; 24:789-97. [PMID: 27121147 DOI: 10.1111/jonm.12383] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2016] [Indexed: 11/28/2022]
Abstract
AIM To describe and obtain a deeper understanding of social challenges and their influence on the implementation process when implementing Information systems in a Swedish health-care organisation. BACKGROUND Despite positive effects when implementing Information systems in health-care organisations, there are difficulties in the implementation process. Nurses' experiences of being neglected have been dismissed as reasons for setbacks in implementation. METHODS An Institutional Ethnography design was used. A deductive content analysis was made influenced by empirically identified social challenges of power, professional identity and encounters. An abstraction was made of the analysis. RESULTS Nineteen nurses at macro, meso and micro levels were interviewed in focus groups. Organisational levels are lost in different ways in how to control the reformation, how to introduce Information systems as reformation strategies and in how to translate new tools and assumptions that do not fit traditional ways of working in shaping professional identities. CONCLUSION AND IMPLICATION FOR NURSE MANAGEMENT Different focus may affect the reformation of health-care organisations and implementation and knowledge processes. An implementation climate is needed where the system standards fit the values of the users. Nursing management needs to be visionary, engaged and work with risk factors in order to reform the hierarchical health-care organisation.
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Affiliation(s)
- Lina Nilsson
- Department of Health, Faculty of Health Sciences, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Sara Eriksén
- Department of Creative Technologies, Faculty of Computing, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Christel Borg
- Department of Health and Care Sciences, Faculty of Health and Life Sciences, Linneaus University, Kalmar, Sweden
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