Improvements in Patient Monitoring in the Intensive Care Unit: Survey Study

Akira-Sebastian Poncette, Lina Mosch, Claudia Spies, Malte Schmieding, Fridtjof Schiefenhövel, Henning Krampe, Felix Balzer, Akira-Sebastian Poncette, Lina Mosch, Claudia Spies, Malte Schmieding, Fridtjof Schiefenhövel, Henning Krampe, Felix Balzer

Abstract

Background: Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development.

Objective: This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups.

Methods: This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups.

Results: In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring.

Conclusions: This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine.

Trial registration: ClinicalTrials.gov NCT03514173; https://ichgcp.net/clinical-trials-registry/NCT03514173.

Keywords: REDCap; digital health; email; intensive care medicine; intensive care unit; monitoring; online survey; patient monitoring; technological innovation; transdisciplinary; usability; user-centered.

Conflict of interest statement

Conflicts of Interest: CS and FB report funding from Medtronic. The other authors do not have conflicts to declare.

©Akira-Sebastian Poncette, Lina Mosch, Claudia Spies, Malte Schmieding, Fridtjof Schiefenhövel, Henning Krampe, Felix Balzer. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.06.2020.

Figures

Figure 1
Figure 1
ICU staff experience with current patient monitoring. An asterisk indicates statistical significance. ICU: intensive care unit.
Figure 2
Figure 2
Aspects of patient monitoring disturbing patient care in the ICU. An asterisk indicates statistical significance. ICU: intensive care unit.
Figure 3
Figure 3
Improvements for future patient monitoring in the ICU. An asterisk indicates statistical significance. ICU: intensive care unit.
Figure 4
Figure 4
Suggestions for remote patient monitoring display devices in intensive care medicine for usage on hospital premises. An asterisk indicates statistical significance.
Figure 5
Figure 5
Use cases for remote patient monitoring on hospital premises for intensive care medicine. An asterisk indicates statistical significance.
Figure 6
Figure 6
Use cases for clinical decision support systems based on artificial intelligence in the ICU. An asterisk indicates statistical significance. ICU: intensive care unit.
Figure 7
Figure 7
Aspects that promote the usage of clinical decision support systems based on artificial intelligence in the ICU. An asterisk indicates statistical significance. ICU: intensive care unit.
Figure 8
Figure 8
Attitude of ICU staff towards novel digital technology. An asterisk indicates statistical significance. ICU: intensive care unit.

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