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Aagaard N, Larsen AT, Aasvang EK, Meyhoff CS. The impact of continuous wireless monitoring on adverse device effects in medical and surgical wards: a review of current evidence. J Clin Monit Comput 2023; 37:7-17. [PMID: 35917046 DOI: 10.1007/s10877-022-00899-x] [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: 05/30/2022] [Accepted: 07/16/2022] [Indexed: 01/25/2023]
Abstract
Novel technologies allow continuous wireless monitoring systems (CWMS) to measure vital signs and these systems might be favorable compared to intermittent monitoring regarding improving outcomes. However, device safety needs to be validated because uncertain evidence challenges the clinical implementation of CWMS. This review investigates the frequency of device-related adverse events in patients monitored with CWMS in general hospital wards. Systematic literature searches were conducted in PubMed and Embase. We included trials of adult patients in general hospital wards monitored with CWMS. Our primary outcome was the frequency of unanticipated serious adverse device effects (USADEs). Secondary outcomes were adverse device effects (ADEs) and serious adverse device effects (SADE). Data were extracted from eligible studies and descriptive statistics were applied to analyze the data. Seven studies were eligible for inclusion with a total of 1485 patients monitored by CWMS. Of these patients, 54 patients experienced ADEs (3.6%, 95% CI 2.8-4.7%) and no USADEs or SADEs were reported (0%, 95% CI 0-0.31%). The studies of the SensiumVitals® patch, the iThermonitor, and the ViSi Mobile® device reported 28 (9%), 25 (5%), and 1 (3%) ADEs, respectively. No ADEs were reported using the HealthPatch, WARD 24/7 system, or Coviden Alarm Management. Current evidence suggests that CWMS are safe to use but systematic reporting of all adverse device effects is warranted.
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Affiliation(s)
- Nikolaj Aagaard
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | | | - Eske K Aasvang
- Department of Anesthesia, CKO, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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León MA, Pannunzio V, Kleinsmann M. The Impact of Perioperative Remote Patient Monitoring on Clinical Staff Workflows: Scoping Review. JMIR Hum Factors 2022; 9:e37204. [PMID: 35666574 PMCID: PMC9210199 DOI: 10.2196/37204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/04/2022] [Accepted: 04/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) interventions are being increasingly implemented in health care environments, given their benefits for different stakeholders. However, the effects of these interventions on the workflow of clinical staff are not always considered in RPM research and practice. OBJECTIVE This review explored how contemporary RPM interventions affect clinical staff and their workflows in perioperative settings. METHODS We conducted a scoping review of recent articles reporting the impact of RPM interventions implemented in perioperative settings on clinical staff and their workflow. The databases accessed were Embase and PubMed. A qualitative analysis was performed to identify the main problems and advantages that RPM brings to staff, in addition to the approaches taken to evaluate the impact of those interventions. Different themes were identified in terms of the challenges of RPM for clinical staff as well as in terms of benefits, risk-reduction strategies, and methods for measuring the impact of these interventions on the workflow of clinical staff. RESULTS A total of 1063 papers were found during the initial search, of which 21 (1.98%) met the inclusion criteria. Of the 21 included papers, 15 (71%) focused on evaluating new RPM systems, 4 (19%) focused on existing systems, and 2 (10%) were reviews. CONCLUSIONS The reviewed literature shows that the impact on staff work experience is a crucial factor to consider when developing and implementing RPM interventions in perioperative settings. However, we noticed both underdevelopment and lack of standardization in the methods for assessing the impact of these interventions on clinical staff and their workflow. On the basis of the reviewed literature, we recommend the development of more robust methods for evaluating the impact of RPM interventions on staff experience in perioperative care; the adoption of a stronger focus on transition management when introducing these interventions in clinical practice; and the inclusion of longer periods of assessment, including the evaluation of long-term goals.
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Affiliation(s)
- Maria Alejandra León
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Valeria Pannunzio
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Maaike Kleinsmann
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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3
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Rosic T, Petrina N, Baysari M, Ritchie A, Poon SK. Patient and clinician use characteristics and perceptions of pulse oximeter use: A scoping review. Int J Med Inform 2022; 162:104735. [PMID: 35325661 PMCID: PMC9487519 DOI: 10.1016/j.ijmedinf.2022.104735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES The need to monitor patients outside of a formal clinical setting, such as a hospital or ambulatory care facility, has become increasingly important since COVID-19. It introduces significant challenges to ensure accurate and timely measurements, maintain strong patient engagement, and operationalise data for clinical decision-making. Remote Patient Monitoring (RPM) devices like the pulse oximeter help mitigate these difficulties, however, practical approaches to successfully integrate this technology into existing patient-clinician interactions that ensure the delivery of safe and effective care are vital. The objective of this scoping review was to synthesise existing literature to provide an overview of the variety of user perceptions associated with pulse oximeter devices, which may impact patients' and clinicians' acceptance of the devices in a RPM context. METHODS A search over three databases was conducted between April 2021 - June 2021 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. A total of 16 articles were included in this scoping review. RESULTS Results indicate there has been an increase in use of pulse oximeters across hospital and community settings for continuous vital signs monitoring and remote monitoring of patients over time. Research in this area is shifting towards increasing accessibility of care through the development and implementation of telehealth systems and phone oximeters. Aspects of pulse oximeter UX most frequently investigated are usability and acceptability, however, these terms are often undefined, or definitions vary across studies. Perceived effectiveness, opportunity costs, and attitude towards use remain unexplored areas of UX. Overall, patients and clinicians view the pulse oximeter positively and find it user-friendly. A high level of learnability was found for the device and additional benefits included increasing patient self-efficacy and clinician motivation to work. However, issues getting an accurate reading due to device usability are still experienced by some patients and clinicians. CONCLUSION This scoping review is the first to summarise user perceptions of the pulse oximeter in a healthcare context. It showed that both patients and clinicians hold positive perceptions of the pulse oximeter and important factors to consider in designing user-focused services include ease-of-use and wearability of devices; context of use including user's prior health and IT knowledge; attitude towards use and perceived effectiveness; impact on user motivation and self-efficacy; and finally, potential user costs like inconvenience or increased anxiety. With the rapid increase in research studies examining pulse oximeter use for RPM since COVID-19, a systematic review is warranted as the next step to consolidate evidence and investigate the impact of these factors on pulse oximeter acceptance and effectiveness.
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Affiliation(s)
- Tamara Rosic
- School of Computer Science, Faculty of Engineering, The University of Sydney, Australia
| | - Neysa Petrina
- School of Computer Science, Faculty of Engineering, The University of Sydney, Australia
| | - Melissa Baysari
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Angus Ritchie
- Sydney Local Health District, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Simon K Poon
- School of Computer Science, Faculty of Engineering, The University of Sydney, Australia.
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Zhang Y, Zhang L, Liu W. Effect of Intelligent Vital Sign Monitoring System on Postoperative Nursing Care of Severe Patients. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:1593005. [PMID: 34887707 PMCID: PMC8616669 DOI: 10.1155/2021/1593005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022]
Abstract
In order to study the observation of postoperative vital sign data of critically ill patients, this paper developed a set of vital sign data acquisition system based on intelligence and realized the design of vital sign data acquisition system APP based on Android Studio programming software, which was used to realize the information collection of vital sign data of patients. PDA is connected with a vital sign measuring equipment through Bluetooth. The patient's wristband is scanned with PDA to read the patient's information, and then the measured vital sign data are obtained automatically by measuring APP. The initial alarm value is set to be greater than 1%, and it needs more than 60 and less than or equal to 120 RR interval data to judge apnea. Information collection of intelligent vital sign detection can not only save the time of nursing staff but also improve the nursing quality.
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Affiliation(s)
- Yanhong Zhang
- ICU Unit 1, Harbin Medical University Cancer Hospital, Haerbin 150000, Heilongjiang, China
| | - Lifen Zhang
- Pharmacy Intravenous Admixture Service Center, Harbin Medical University Cancer Hospital, Haerbin 150000, Heilongjiang, China
| | - Wei Liu
- PET/CT-MR Center, Harbin Medical University Cancer Hospital, Haerbin 150000, Heilongjiang, China
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McGillion M, Dvirnik N, Yang S, Belley-Côté E, Lamy A, Whitlock R, Marcucci M, Borges F, Duceppe E, Ouellette C, Bird M, Carroll SL, Conen D, Tarride JE, Harsha P, Scott T, Good A, Gregus K, Sanchez K, Benoit P, Owen J, Harvey V, Peter E, Petch J, Vincent J, Graham M, Devereaux PJ. Continuous non-invasive remote automated blood pressure monitoring with novel wearable technology: A Validation Study. JMIR Mhealth Uhealth 2021; 10:e24916. [PMID: 34876396 PMCID: PMC8922156 DOI: 10.2196/24916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/21/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Wearable continuous monitoring biosensor technologies have the potential to transform postoperative care with early detection of impending clinical deterioration. Objective Our aim was to validate the accuracy of Cloud DX Vitaliti continuous vital signs monitor (CVSM) continuous noninvasive blood pressure (cNIBP) measurements in postsurgical patients. A secondary aim was to examine user acceptance of the Vitaliti CVSM with respect to comfort, ease of application, sustainability of positioning, and aesthetics. Methods Included participants were ≥18 years old and recovering from surgery in a cardiac intensive care unit (ICU). We targeted a maximum recruitment of 80 participants for verification and acceptance testing. We also oversampled to minimize the effect of unforeseen interruptions and other challenges to the study. Validation procedures were according to the International Standards Organization (ISO) 81060-2:2018 standards for wearable, cuffless blood pressure (BP) measuring devices. Baseline BP was determined from the gold-standard ICU arterial catheter. The Vitaliti CVSM was calibrated against the reference arterial catheter. In static (seated in bed) and supine positions, 3 cNIBP measurements, each 30 seconds, were taken for each patient with the Vitaliti CVSM and an invasive arterial catheter. At the conclusion of each test session, captured cNIBP measurements were extracted using MediCollector BEDSIDE data extraction software, and Vitaliti CVSM measurements were extracted to a secure laptop through a cable connection. The errors of these determinations were calculated. Participants were interviewed about device acceptability. Results The validation analysis included data for 20 patients. The average times from calibration to first measurement in the static position and to first measurement in the supine position were 133.85 seconds (2 minutes 14 seconds) and 535.15 seconds (8 minutes 55 seconds), respectively. The overall mean errors of determination for the static position were –0.621 (SD 4.640) mm Hg for systolic blood pressure (SBP) and 0.457 (SD 1.675) mm Hg for diastolic blood pressure (DBP). Errors of determination were slightly higher for the supine position, at 2.722 (SD 5.207) mm Hg for SBP and 2.650 (SD 3.221) mm Hg for DBP. The majority rated the Vitaliti CVSM as comfortable. This study was limited to evaluation of the device during a very short validation period after calibration (ie, that commenced within 2 minutes after calibration and lasted for a short duration of time). Conclusions We found that the Cloud DX’s Vitaliti CVSM demonstrated cNIBP measurement in compliance with ISO 81060-2:2018 standards in the context of evaluation that commenced within 2 minutes of device calibration; this device was also well-received by patients in a postsurgical ICU setting. Future studies will examine the accuracy of the Vitaliti CVSM in ambulatory contexts, with attention to assessment over a longer duration and the impact of excessive patient motion on data artifacts and signal quality. Trial Registration ClinicalTrials.gov NCT03493867; https://clinicaltrials.gov/ct2/show/NCT03493867
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Affiliation(s)
- Michael McGillion
- School of Nursing, McMaster University, 1280 Main St W, Hamilton, CA
| | - Nazari Dvirnik
- Faculty of Health Sciences, McMaster University, Hamilton, CA
| | | | | | - Andre Lamy
- Population Health Research Institute, Hamilton, CA
| | | | | | | | | | - Carley Ouellette
- School of Nursing, McMaster University, 1280 Main St W, Hamilton, CA
| | - Marissa Bird
- School of Nursing, McMaster University, 1280 Main St W, Hamilton, CA
| | - Sandra L Carroll
- School of Nursing, McMaster University, 1280 Main St W, Hamilton, CA
| | - David Conen
- Population Health Research Institute, Hamilton, CA
| | | | - Prathiba Harsha
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | - Ted Scott
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | - Amber Good
- Population Health Research Institute, Hamilton, CA
| | - Krysten Gregus
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | | | - Pamela Benoit
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | - Julian Owen
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA
| | | | | | - Jeremy Petch
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, CA.,University of Toronto, Toronto, CA.,Faculty of Health Sciences, McMaster University, Hamilton, CA.,Population Health Research Institute, Hamilton, CA
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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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