[MA 2023 07] Measuring vital signs: Supportive or not? An evaluation of the relative advantage of the Philips Healthdot biosensor in support of nurses in the hematology ward.
Amsterdam UMC, location University of Amsterdam, Department of Medical Informatics, eHealth Living & Learning Lab
Proposed by: Harm Gijsbers, MSc, Assistant professor [h.j.gijsbers@amsterdamumc.nl ]
Introduction
During hospitalisation, patients' vital signs are monitored in order to detect clinical deterioration. On intensive care units (ICU), vital signs are continuously monitored, whereas patients on clinical wards are often examined intermittently [1], minimally once a day, but in AmsterdamUMC usually every 8 hours [2, 3]. During these routine observations, a number of variables are measured, including respiration rate, and heart rate. These measurements are often performed by nursing staff in person, which takes time.[2] A Modified Early Warning Score (MEWS), a scoring system that incorporates all intermittent measurements and other observations, is frequently used to aid in the diagnosis of clinical deterioration in nursing wards. [4-6]
A promising approach is continuous vital sign monitoring in nursing wards using wireless wearable sensors, which may help with earlier patient deterioration diagnosis, early intervention, length of stay reduction, and fewer ICU days[7]. Additionally, it might reduce nurses' workloads[8].
Wearable sensors come in a variety of forms [1]. Some provide functionality similar to that of monitors on the Intensive Care Unit. Other sensors record fewer vital indicators, such as heart rate and breathing rate, but come in more manageable forms, such as adhesive patches that can be placed on a patient's chest.[9] These are better suited for monitoring on the nursing ward and might also be used at home [10]. The use and implementation of these sensors will probably have an impact on hospital staff members' jobs.
Description of the SRP Project/Problem
In August 2023, AmsterdamUMC's haematology department will start a pilot of measuring vital signs using the Healthdot smart patch. The set-up of the pilot consists of:
- applying and commissioning the Healthdot patch
- linking the patch to Philips software
- receiving notifications in case of abnormal vital signs, and
- acting on the information available in Epic.
The main objective is to find out whether continuous measurement of vital signs supports the nurse’s workflow. A basic evaluation will be initiated by researchers at ELLL
Research questions
- What are the overall experiences of nurses in this pilot?
- What are nurses’ experiences on work-support via continuous vital signs measurement during their shift?
- What are barriers and facilitators for adoption in this pilot?
- What are the nurses’ user experiences with the Philips healthdot application
Further research questions will be determined later, based on the student’s input.
Various research methods are possible in this assignment. For example, interviews, questionnaires, usability think aloud methods and quantitative analysis on adoption. In the first phase of this assignment, the student is expected to spend several days in the nursing ward to observe the nurses. Once the student has gained a good impression of the work process, he is expected to make an informed choice on the research question and research methods in close consultation with the client.
The student is expected to conduct a literature review on evaluation methods for digital healthcare applications in clinical care. In addition, the student is expected to analyse basic evaluations and conduct in-depth evaluations.
Expected results
This proposed study aims to evaluate the healthdot pilot by:
1. evaluating the overall experiences of nurses working with the healthdot
2. evaluating the nurses’ user experience with the health application on the Zebra smartphone
3. evaluating the support for nurses in their workflow
4. evaluating the barriers and facilitators to adopt the healthdot biosensors.
As a result, we expect a report with recommendations on whether or not to continue working with continuous measurements (with or without the current sensor) and recommendations on implementation and upscaling to other departments in AmsterdamUMC. All findings from the observations on the clinical ward, the literature review and evaluation analyses, supplemented by the recommendations from the advisory report, are described in the student's thesis.
Time period
7 months
References
1. Joshi, M., et al., Wearable sensors to improve detection of patient deterioration. Expert Rev Med Devices, 2019. 16(2): p. 145-154.
2. Brown, H., et al., Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial. Am J Med, 2014. 127(3): p. 226-32.
3. AmsterdamUMC, Vitaal bedreigde patiënt (MEWS/PEWS/MEOWS) – Amsterdam UMC (versie 11) (iprova.nl).
4. Gardner-Thorpe, J., et al., The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study. Ann R Coll Surg Engl, 2006. 88(6): p. 571-5.
5. Constantinescu, C., et al., The Predictive Role of Modified Early Warning Score in 174 Hematological Patients at the Point of Transfer to the Intensive Care Unit. J Clin Med, 2021. 10(20).
6. Allarakia, J., et al., Modified Early Warning Score (MEWS) as a predictor of intensive care unit admission in cancer patient on chemotherapy with positive blood culture: A retrospective cohort study. J Infect Public Health, 2023. 16(6): p. 865-869.
7. Eddahchouri, Y., et al., Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: a before-and-after study. Br J Anaesth, 2022. 128(5): p. 857-863.
8. Weenk, M., et al., Continuous Monitoring of Vital Signs in the General Ward Using Wearable Devices: Randomized Controlled Trial. J Med Internet Res, 2020. 22(6): p. e15471.
9. Jacobs, F., et al., Reliability of heart rate and respiration rate measurements with a wireless accelerometer in postbariatric recovery. PLoS One, 2021. 16(4): p. e0247903.
10. Leenen, J.P.L., et al., Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review. J Med Internet Res, 2020. 22(6): p. e18636.