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Background
Timely recognition of patient deterioration remains challenging. Ambulatory monitoring systems (AMSs) may provide support to current monitoring practices; however, they need to be thoroughly tested before implementation in the clinical environment for early detection of deterioration.
Objective
The objective of this study was to assess...
Contexts in source publication
Context 1
... on these requirements, we selected the following monitors: 2 chest-worn patches, that is, VitalPatch (VitalConnect) and Peerbridge Cor (Peerbridge); 4 wrist-worn devices with finger probe, that is, Nonin WristOx2 3150 (Nonin), Checkme O2+ (Viatom Technology), PC-68B, and AP-20 (both from Creative Medical); and 1 solely wrist-worn device, that is, Wavelet (Wavelet Health). Nonin WristOx2 3150 is named Nonin hereafter (Figure 1). ...
Context 2
... on these requirements, we selected the following monitors: 2 chest-worn patches, that is, VitalPatch (VitalConnect) and Peerbridge Cor (Peerbridge); 4 wrist-worn devices with finger probe, that is, Nonin WristOx2 3150 (Nonin), Checkme O2+ (Viatom Technology), PC-68B, and AP-20 (both from Creative Medical); and 1 solely wrist-worn device, that is, Wavelet (Wavelet Health). Nonin WristOx2 3150 is named Nonin hereafter (Figure 1). ...
Similar publications
Background: Timely recognition of patient deterioration remains challenging. Ambulatory monitoring systems (AMSs) mayprovide support to current monitoring practices; however, they need to be thoroughly tested before implementation in the clinicalenvironment for early detection of deterioration.Objective: The objective of this study was to assess th...
Citations
... Wired systems have significant limitations as they restrict movement and can be uncomfortable to wear (Sahandi et al., 2010;Weenk et al., 2017). Evolving technology has allowed the development of comfortable wireless wearable devices that allow for continuous vital sign measurement without restricting movement (Areia et al., 2020). These devices have the potential to bridge the gap between intermittent monitoring and the need for wired bedside monitoring (Areia et al., 2020). ...
... Evolving technology has allowed the development of comfortable wireless wearable devices that allow for continuous vital sign measurement without restricting movement (Areia et al., 2020). These devices have the potential to bridge the gap between intermittent monitoring and the need for wired bedside monitoring (Areia et al., 2020). ...
... The ambulatory monitoring system (AMS) utilized in this service evaluation was part of the ongoing virtual High-Dependency Unit (vHDU) project. This project aims to develop a wearable monitoring system for use in high-risk patients on general surgical wards, with the aim of rapid detection of clinical deteriorations (Areia et al., 2020). This has included wearability and accuracy testing of many devices to inform selection of the final devices used in the system Santos et al., 2022). ...
Aim
To gain staff feedback on the implementation and impact of a novel ambulatory monitoring system to support coronavirus patient management on an isolation ward.
Design
Qualitative service evaluation.
Methods
Semi‐structured interviews were conducted with 15 multidisciplinary isolation ward staff in the United Kingdom between July 2020 and May 2021. Interviews were audio‐recorded, transcribed and analysed using thematic analysis.
Findings
Adopting Innovation to Assist Patient Safety was identified as the overriding theme. Three interlinked sub‐themes represent facets of how the system supported patient safety. Patient Selection was developed throughout the pandemic, as clinical staff became more confident in choosing which patients would benefit most. Trust In the System described how nurses coped with discrepancies between the ambulatory system and ward observation machines. Finally, Resource Management examined how, once trust was built, staff perceived the ambulatory system assisted with caseload management. This supported efficient personal protective equipment resource use by reducing the number of isolation room entries. Despite these reported benefits, face‐to‐face contact was still highly valued, despite the risk of coronavirus exposure.
Conclusion
Hospital wards should consider using ambulatory monitoring systems to support caseload management and patient safety. Patients in isolation rooms or at high risk of deterioration may particularly benefit from this additional monitoring. However, these systems should be seen as an adjunct to nursing care, not a replacement.
Implications for the Profession and/or Patient Care
Nurses valued ambulatory monitoring as a means of ensuring the safety of patients at risk of deterioration and prioritizing their workload.
Impact
The findings of this research will be useful to all those developing or considering implementation of ambulatory monitoring systems in hospital wards.
Reporting Method
This manuscript follows the Consolidated criteria for Reporting Qualitative Research (COREQ) guidelines with inclusion of relevant SQUIRE guidelines for reporting quality improvement.
Patient or Public Contribution
No Patient or Public Contribution.
... All participants visited the laboratory twice-on the first day and after wearing the electronic wrist bracelet for 5 consecutive days. The wearing period was decided based on the result of a previous study (Areia et al., 2020), where when healthy adult volunteers were required to wear different commercial wristband-type ambulatory vital sign monitoring devices for 72 h each, they ended up wearing them only for 70.6-90.0% of the planned wearing duration, when they were allowed to remove the device. On the other hand, criminals must keep on an electronic wrist bracelet in their daily lives with no option to remove it. ...
Electronic monitoring systems have been globally adopted to track criminals to ensure
public safety efficiently. In this study, we aimed to assess the wearability of an electronic
bracelet using multiple evaluation methods, including the evaluation of range
of motion (ROM), air gap (AG), and clothing pressure (CP) at the wearer’s wrist, as well
as self-scoring of subjective comfort (SC). We recruited eight Korean male participants
(N = 8) who were in their 30 s and did not have any musculoskeletal problems at data
collection. We compared the test results collected on the first day with those obtained
after wearing the electronic wrist bracelet for 5 consecutive days. We also examined
the differences between the normal-weight and overweight groups. Overall, the data
evinced a decrease in the wrist ROM, AG, and SC, but an increase in the CP after it was
worn for 5 days. And, the results were more observable in the overweight group, as
compared to the normal-weight group. Furthermore, this study proposed a novel and
effective assessment tool that could be used to measure the wearability of devices
or systems intended to be worn on the human body—not only the electronic wrist
bracelet for criminal monitoring but also popular commercial electronic bracelets for
sportswear or health-related monitoring system.
... Four more were development studies that described the design and development of a new phone-oximeter and evaluated its usability [17][18][19][20]. Three more were qualitative studies evaluating: 1) the wearability of multiple monitoring devices; 2) the effect of prior health knowledge on the usability of a pulse oximeter; and 3) clinicians' perceptions, beliefs, and motivations to use pulse oximeters [4,21,22]. ...
... Four of the included studies (25%) examined the use of pulse oximeters as a tool to increase availability of care through pairing with a smartphone application [17][18][19][20]. Other applications included: as a diagnostic tool for children with pneumonia [15,16]; a monitoring tool in paediatric telehomecare [11]; remote risk-based monitoring tool for patients at risk of Cardiovascular disease (CVD) [8,10]; a general monitoring tool for blood oxygenation levels [21,22]; post-operative continuous vital sign monitoring for patients recovering from surgery [14]; data capture and transmission to streamline clinical trials [9]; long-term oxygen therapy (LTOT) optimization [12]; and as a digital health intervention for managing Chronic Obstructive Pulmonary Disease (COPD) patients, either as a diagnostic tool or during rehabilitation [4,13]. ...
... Lopez Segui et al., [11] used the UX dimension satisfaction, however, did not define what this meant in the context of using the system. Areia et al., [21] assessed wearability, but also did not provide a definition and only listed the types of measurements collected. Finally, three studies [4,14,20] gathered general user experience feedback to assess the pulse oximeter. ...
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.
... This review is part of a wider phased project in our research programme, the virtual High Dependency Unit (vHDU) study. So far, we have selected [61] and tested a number of wearable devices [62,63], prior to selection and integration in a final WMS, which will be evaluated in a pilot study and then a full multicentre RCT. ...
Background
Timely recognition of the deteriorating inpatient remains challenging. Wearable monitoring systems (WMS) may augment current monitoring practices. However, there are many barriers to implementation in the hospital environment, and evidence describing the clinical impact of WMS on deterioration detection and patient outcome remains unclear.
Objective
To assess the impact of vital-sign monitoring on detection of deterioration and related clinical outcomes in hospitalised patients using WMS, in comparison with standard care.
Methods
A systematic search was conducted in August 2020 using MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL, Health Technology Assessment databases and grey literature. Studies comparing the use of WMS against standard care for deterioration detection and related clinical outcomes in hospitalised patients were included. Deterioration related outcomes (primary) included unplanned intensive care admissions, rapid response team or cardiac arrest activation, total and major complications rate. Other clinical outcomes (secondary) included in-hospital mortality and hospital length of stay. Exploratory outcomes included alerting system parameters and clinical trial registry information.
Results
Of 8706 citations, 10 studies with different designs met the inclusion criteria, of which 7 were included in the meta-analyses. Overall study quality was moderate. The meta-analysis indicated that the WMS, when compared with standard care, was not associated with significant reductions in intensive care transfers (risk ratio, RR 0.87; 95% confidence interval, CI 0.66–1.15), rapid response or cardiac arrest team activation (RR 0.84; 95% CI 0.69–1.01), total (RR 0.77; 95% CI 0.44–1.32) and major (RR 0.55; 95% CI 0.24–1.30) complications prevalence. There was also no statistically significant association with reduced mortality (RR 0.48; 95% CI 0.18–1.29) and hospital length of stay (mean difference, MD − 0.09; 95% CI − 0.43 to 0.44).
Conclusion
This systematic review indicates that there is no current evidence that implementation of WMS impacts early deterioration detection and associated clinical outcomes, as differing design/quality of available studies and diversity of outcome measures make it difficult to reach a definite conclusion. Our narrative findings suggested that alarms should be adjusted to minimise false alarms and promote rapid clinical action in response to deterioration.
PROSPERO Registration number : CRD42020188633 .
... While it is unlikely that laboratory-based PSG would be used for wide-scale screening or health planning, the emergence of new, low-burden portable technologies for in-home sleep assessments make objective measurements of targeted dimensions of sleep feasible. The PSG measures that were most predictive (SE and T90) are relatively simple metrics that can be captured using single-channel electroencephalogram and overnight oximetry (e.g., see Areia et al., 2020;Lunsford-Avery et al., 2020). SE can also be captured using wearables that estimate sleep-wake time from accelerometry (e.g., see Kubala et al., 2020). ...
Clarifying whether physiological sleep measures predict mortality could inform risk screening; however, such investigations should account for complex and potentially non‐linear relationships among health risk factors. We aimed to establish the predictive utility of polysomnography (PSG)‐assessed sleep measures for mortality using a novel permutation random forest (PRF) machine learning framework. Data collected from the years 1995 to present are from the Sleep Heart Health Study (SHHS; n = 5,734) and the Wisconsin Sleep Cohort Study (WSCS; n = 1,015), and include initial assessments of sleep and health, and up to 15 years of follow‐up for all‐cause mortality. We applied PRF models to quantify the predictive abilities of 24 measures grouped into five domains: PSG‐assessed sleep (four measures), self‐reported sleep (three), health (eight), health behaviours (four), and sociodemographic factors (five). A 10‐fold repeated internal validation (WSCS and SHHS combined) and external validation (training in SHHS; testing in WSCS) were used to compute unbiased variable importance metrics and associated p values. We observed that health, sociodemographic factors, and PSG‐assessed sleep domains predicted mortality using both external validation and repeated internal validation. The PSG‐assessed sleep efficiency and the percentage of sleep time with oxygen saturation <90% were among the most predictive individual measures. Multivariable Cox regression also revealed the PSG‐assessed sleep domain to be predictive, with very low sleep efficiency and high hypoxaemia conferring the highest risk. These findings, coupled with the emergence of new low‐burden technologies for objectively assessing sleep and overnight oxygen saturation, suggest that consideration of physiological sleep measures may improve risk screening.
... A recent option is utilising wearable continuous monitoring that may reduce the nursing workload spent performing regular vital signs observation rounds. 68 Other significant clinical effects of high workloads may be a reduction in staff ability to detect deterioration in patients who are not triggering, losing the human safety net for false negative (non-triggering) patients. When mental capacity is limited with reduced team resources, this will directly affect an individual's situational awareness of the environment as mental resources reduce as cognitive demands increase. ...
Background
Identifying how human factors affect clinical staff recognition and managment of the deteriorating ward patient may inform process improvements. We systematically reviewed the literature to identify (1) how human factors affect ward care escalation (2) gaps in the current literature and (3) critique literature methodologies.
Methods
We undertook a Qualitative Evidence Synthesis of care escalation studies. We searched MEDLINE, EMBASE and CINHAL from inception to September 2019. We used the Critical Appraisal Skills Programme and the Grading of Recommendations Assessment-Development and Evaluation and Confidence in Evidence from Reviews of Qualitative Research tool to assess study quality.
Results
Our search identified 24 studies meeting the inclusion criteria. Confidence in findings was moderate (20 studies) to high (4 studies). In 16 studies, the ability to recognise changes in the patient’s condition (soft signals), including skin colour/temperature, respiratory pattern, blood loss, personality change, patient complaint and fatigue, improved the ability to escalate patients. Soft signals were detected through patient assessment (looking/listening/feeling) and not Early Warning Scores (eight studies). In contrast, 13 studies found a high workload and low staffing levels reduced staff’s ability to detect patient deterioration and escalate care. In eight studies quantifiable deterioration evidence (Early Warning Scores) facilitated escalation communication, particularly when referrer/referee were unfamiliar. Conversely, escalating concerning non-triggering patients was challenging but achieved by some clinical staff (three studies). Team decision making facilitated the clinical escalation (six studies).
Conclusions
Early Warning Scores have clinical benefits but can sometimes impede escalation in patients not meeting the threshold. Staff use other factors (soft signals) not captured in Early Warning Scores to escalate care. The literature supports strategies that improve the escalation process such as good patient assessment skills.
PROSPERO registration number
CRD42018104745.
... The VitalPatch [16] is a wireless, battery-operated chest-worn wearable biosensor that records heart rate (HR), electrocardiography (ECG), HR variability, R-R interval (the time elapsed between two successive R-waves of the QRS signal on the electrocardiogram), respiratory rate (RR), body temperature, skin temperature, fall detection, activity (including step count), and posture (body position relative to gravity including fall detection) [17,18]. This device (Figure 1) was well tolerated by users because of its wearability and low impact on activities [19,20]. However, validation studies regarding the VitalPatch showed mixed results [3]; for HR, the mean bias was within acceptable ranges for all validation studies [14,18,[21][22][23] and within acceptable limits of agreement (LoA) in 3 studies [18,21,22]. ...
BACKGROUND
Early warning scores in general wards are commonly limited by intermittent manual measurements; these are recognised as being time consuming and for impacting monitoring frequency. Wearable devices may support healthcare staff, improve patient safety and promote early deterioration detection. However available ambulatory monitoring devices need to be tested and validated before clinical implementation.
OBJECTIVE
The objective of this study is to determine the agreement between a chest-worn patch (VitalPatch®) and gold standard reference device for heart rate (HR) and respiratory rate (RR) measurements during movement and during gradual de-saturation in a controlled environment.
METHODS
After both VitalPatch and gold standard device (Philips MX450) were placed, participants performed 7 different movements: At rest, Sit-to-Stand, Tapping, Rubbing, Drinking, Turning Pages, and Using a Tablet. In a controlled environment. Participants were then made hypoxic gradually down to 80% peripheral oxygen saturations. The primary outcome measures were the accuracy, defined as the mean absolute error (MAE) of the VitalPatch estimates when compared with their gold-standards. We defined these to be clinical acceptable if within 5 beats per minute (bpm) for HR and 3 respirations per minute (rpm) for RR.
RESULTS
We acquired complete datasets of 29 participants. In the movement phase, HR estimates were within the pre-specified limits for all movements. For RR, estimates were also inside the acceptable range, with the exception of the Sit-to-Stand and Turning Pages movements, showing a MAE (95% CI) of 3.05 (2.48, 3.58) rpm and 3.45 (2.71, 4.11) rpm, respectively. For the hypoxia phase, these were always within the limits with an overall MAE for HR and RR of 0.72 (0.66, 0.78) bpm and 1.89 (1.75, 2.03) rpm, respectively. There were no significant differences in the VitalPatch performance across a range of oxygen desaturations.
CONCLUSIONS
The VitalPatch was highly accurate throughout movement tests except for its RR estimation during two movements. This device was reliable throughout the hypoxia stages, with no significant accuracy differences in normoxia (≥ 90%), mild (89.9 - 85%) and severe hypoxia (< 85%).
CLINICALTRIAL
ISRCTN61535692
Aim: To assess changes in outcomes and costs upon implementation of continuous vital sign monitoring
in postsurgical patients. Materials & methods: Retrospective analysis of clinical outcomes and in-hospital
costs comparedwith a control period. Results: During the intervention period patients were less frequently
admitted to the intensive care unit (ICU) (p = 0.004), had shorter length of stay (p < 0.001) and lower
costs (p < 0.001). The intervention was associated with a lower odds of ICU admission (odds ratio: 0.422;
p = 0.007) and ICU related costs (coefficient: -622.6; p = 0.083). Conclusion: Continuous vital sign monitoring
may have contributed to fewer ICU admissions and lower ICU costs in postsurgical patients.
Background
The use of vital signs monitoring in the early recognition of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) post-hospital discharge is limited. This study investigated whether continuous vital signs monitoring could predict an AECOPD and readmission.
Methods
35 people were recruited at discharge following hospitalisation for an AECOPD. Participants were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks and to complete the Exacerbations of Chronic Pulmonary Disease Tool (EXACT), a 14-item symptom diary, daily. The Equivital LifeMonitor recorded respiratory rate (RR), heart rate (HR), skin temperature (ST) and physical activity (PA) every 15-s. An AECOPD was classified as mild (by EXACT score), moderate (prescribed oral steroids/antibiotics) or severe (hospitalisation).
Results
Over the 6-week period, 31 participants provided vital signs and symptom data and 14 participants experienced an exacerbation, of which, 11 had sufficient data to predict an AECOPD. HR and PA were associated with EXACT score (p < 0.001). Three days prior to an exacerbation, RR increased by mean ± SD 2.0 ± 0.2 breaths/min for seven out of 11 exacerbations and HR increased by 8.1 ± 0.7 bpm for nine of these 11 exacerbations.
Conclusions
Increased heart rate and reduced physical activity were associated with worsening symptoms. Even with high-resolution data, the variation in vital signs data remains a challenge for predicting AECOPDs. Respiratory rate and heart rate should be further explored as potential predictors of an impending AECOPD.
Trial registration: ISRCTN registry; ISRCTN12855961. Registered 07 November 2018—Retrospectively registered, https://www.isrctn.com/ISRCTN12855961
