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首页> 外文期刊>JMIR Medical Informatics >Challenges With Continuous Pulse Oximetry Monitoring and Wireless Clinician Notification Systems After Surgery: Reactive Analysis of a Randomized Controlled Trial
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Challenges With Continuous Pulse Oximetry Monitoring and Wireless Clinician Notification Systems After Surgery: Reactive Analysis of a Randomized Controlled Trial

机译：手术后连续脉搏血氧测量监测和无线临床医生通知系统的挑战：随机对照试验的反应分析

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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.
机译：背景技术已经表明，引入电子健康（eHealth）患者监测干预措施可以提高医疗效率和临床结果。警惕（在手术后连续脉搏血氧血管和无线临床医生通知的生命体征监测）研究是一个随机对照试验（n = 2049），旨在评估连续生命标志监测与纳尔诺酮呼吸复苏时发送给护理人员的警报的影响，代码蓝调和重症监护单位转移发生在病房环境中的后勤患者队列中发生。本报告确定并评估与在警惕eHealth干预实施中将无线监测系统引入复杂医院基础设施的关键问题和挑战。提出了未来实施研究的潜在解决方案和建议。客观本研究的目标是：（1）确定与警惕性研究eHEPHEATH干预系统部署有关的问题; （2）评估这些问题对干预采纳的影响。方法在警惕期间，在报告表格，报警事件表格和护理用户反馈问卷调查问卷上记录了影响eHealth干预的实施的问题。这些数据由研究和护理人员进行，并提交给研究协调员。在该评估报告中，临床采用框架被用作组织所发现的问题的指南，并评估其影响。结果采用临床采用框架，我们在MESO级别的人员，组织和实施内的框架维度内确定了问题，以及宏观水平的标准和资助问题。关键问题包括：护理工作流程与空白报警表（24/1030,2.33％）和缺失的报警表格（236/1030,22.91％），患者提取（110/1030,10.68％），无线网络连接，误报（ 318/1030，30.87％），监测故障（36/1030,3.49％），探测问题（16/1030,1.55％）和无线网络标准。在微观层面，这些问题在提供的支持方面影响了服务的质量，监视器所产生的信息的质量以及监控系统的功能，可靠性和性能。结果，这些问题通过降低护士的能力来处理了这些问题，通过减少效果，通过减少效果来完成试验干预的受影响的护理品质，并通过干扰进行处理的影响，从而降低了临床采用监视系统。结论外科病房中eHealth技术的患者监测有可能改善患者的结果。然而，包括前线护士参与，安装适当的无线网络基础设施以及使用舒适无线电设备的措施来最大限度地规划，以最大限度地规划，以最大限度地提高电子医疗监控的潜力。

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