Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study

Akira-Sebastian Poncette, Claudia Spies, Lina Mosch, Monique Schieler, Steffen Weber-Carstens, Henning Krampe, Felix Balzer, Akira-Sebastian Poncette, Claudia Spies, Lina Mosch, Monique Schieler, Steffen Weber-Carstens, Henning Krampe, Felix Balzer

Abstract

Background: In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients' health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s.

Objective: The aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring.

Methods: This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff-5 physicians, 6 nurses, and 4 respiratory therapists-were recorded, transcribed, and analyzed using the grounded theory approach.

Results: Evaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies.

Conclusions: This qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite.

Trial registration: ClinicalTrials.gov NCT03514173; https://ichgcp.net/clinical-trials-registry/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk).

Keywords: design thinking; digital health; digital literacy; grounded theory; intensive care medicine; intensive care unit; multidisciplinary; patient monitoring; qualitative research; user-centered design.

Conflict of interest statement

Conflicts of Interest: CS and FB report funding from Medtronic. The other authors do not declare a conflict of interest.

©Akira-Sebastian Poncette, Claudia Spies, Lina Mosch, Monique Schieler, Steffen Weber-Carstens, Henning Krampe, Felix Balzer. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 30.04.2019.

Figures

Figure 1
Figure 1
A feedback loop adapted the weight and order of the interview questions through parallel data collection and evaluation as previously described [25].
Figure 2
Figure 2
Within three categories (inner ring), 12 themes (middle ring) were identified and specified (outer ring) to reflect the requirements of a novel patient monitoring technology from the view of intensive care staff. CDSS: clinical decision support system.

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