Implementation of a Continuous Patient Monitoring System in the Hospital Setting: A Qualitative Study
Masha Kuznetsovaa, Alice Y. Kimb✉, Darren A. Scullyc, Paula Wolskic, Ania Syrowatkab d, David Westfall Batesb d, Patricia C. Dykesb d
- aFormerly, at the time of research: Harvard University, Cambridge, MA
- bDivision of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
- cBrigham and Women's Faulkner Hospital, Boston, MA
- dHarvard Medical School, Boston, MA
- ✉
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Abstract
Background: Technology can improve care delivery, patient outcomes, and staff satisfaction, but integration into the clinical workflow remains challenging. To contribute to this knowledge area, this study examined the implementation continuum of a contact-free, continuous monitoring system (CFCM) in an inpatient setting. CFCM monitors vital signs and uses the information to alert clinicians of important changes, enabling early detection of patient deterioration. Methods: Data were collected throughout the entire implementation continuum at a community teaching hospital. Throughout the study, 3 group and 24 individual interviews and five process observations were conducted. Postimplementation alarm response data were collected. Analysis was conducted using triangulation of information sources and two-coder consensus. Results: Preimplementation perceived barriers were alarm fatigue, questions about accuracy and trust, impact on patient experience, and challenges to the status quo. Stakeholders identified the value of CFCM as preventing deterioration and benefitting patients who are not good candidates for telemetry. Educational materials addressed each barrier and emphasized the shared CFCM values. Mean alarm response times were below the desired target of two minutes. Postimplementation interview analysis themes revealed lessened concerns of alarm fatigue and improved trust in CFCM than anticipated. Postimplementation challenges included insufficient training for secondary users and impact on patient experience. Conclusion: In addition to understanding the preimplementation anticipated barriers to implementation and establishing shared value before implementation, future recommendations include studying strategies for optimal tailoring of education to each user group, identifying and reinforcing positive process changes after implementation, and including patient experience as the overarching element in frameworks for digital tool implementation.