Process Evaluation of a Wireless Wearable Continuous Vital Signs Monitoring Intervention in 2 General Hospital Wards: Mixed Methods Study.
Jobbe P L Leenen, Henriëtte J M Rasing, Cor J Kalkman and 2 others
PMID 37140977WHAT IT FOUND
Wearable continuous heart and breathing-rate monitoring was used on two hospital wards, but nurses documented trend checks on only 70.7% of required shift reports, and the rate fell most in internal medicine.
Manual vital-sign checks continued alongside it.
Key findings
01Written nurse reports of continuous monitoring trend assessments reached 70.7% overall, 73.6% on surgery and 64.1% on internal medicine, against a 100% target of 3 reports per patient per 24 hours.
02For 246 of 358 patients (68.7%), no nursing activities were documented after trend assessments, and nurses said trend checks often did not alter their care.
03Artifacts occurred in 26.91% of heart-rate measurements, 10.3% of sensors were replaced early for technical failure, and nurses rated usability as marginal while describing separate-phone pairing and poor EHR integration as barriers.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Effectiveness on patient outcomes was not analyzed in this paper; it was a process evaluation of implementation. Exposure to the intervention was limited, so nurses worked with both intermittent and continuous monitoring systems. The intervention and implementation strategy were developed on the surgical ward, so they may fit surgical patients better than internal medicine patients. The project manager was a former nurse on the surgical ward, which may have improved fidelity there through goodwill. The study could not determine whether vital-sign trends actually influenced diagnostic or treatment decisions, because other factors also drove actions. Variation between nurses interpreting similar trends was not measured. Individual nurse exposure to the intervention was not included in the regression analysis. Interviews were conducted by trained nursing students, and no field notes were taken.
Declared interests
The wearable sensor and platform manufacturer, Philips Healthcare, did not play a role in design, implementation, interpretation, or reporting. The sensors were provided at a reduced price.
The easy way to misread this
Do not read this as evidence that continuous wearable monitoring improves patient outcomes or reduces deterioration. This paper evaluated implementation process only, and effectiveness was reported separately. Nurses continued manual vital-sign measurements, and trend-reporting fidelity fell over time, especially on internal medicine.