Poncette Akira-Sebastian, Mosch Lina, Spies Claudia, Schmieding Malte, Schiefenhövel Fridtjof, Krampe Henning, Balzer Felix
Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Einstein Center Digital Future, Berlin, Germany.
J Med Internet Res. 2020 Jun 19;22(6):e19091. doi: 10.2196/19091.
Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development.
This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups.
This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups.
In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring.
This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine.
ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173.
由于人口结构变化，以及最近的冠状病毒病（COVID-19），现代重症监护病房（ICU）的重要性日益凸显。ICU的关键组成部分之一是对患者生命体征参数的持续监测。然而，信息学、信号处理或工程领域现有的可减轻ICU负担的进展尚未得到应用。这可能是由于研发过程中缺乏用户参与。
本研究聚焦于ICU工作人员对当前患者监测的满意度以及他们对未来改进的建议。我们旨在确定干扰患者护理的监测方面、远程监测的显示设备、人工智能（AI）的用例，以及ICU工作人员是否愿意提高其数字素养或为改善患者监测做出贡献。我们还旨在确定不同专业群体在回答上的差异。
2019年11月至2020年1月期间，对德国一家大学医院4个ICU的工作人员进行了这项调查研究。通过分析之前对ICU工作人员的定性访谈研究中关于未来患者监测的临床需求，我们开发了一份基于网络的包含36个条目的调查问卷。问卷结果的统计分析包括中位数及其自抽样95%置信区间，以及用于比较专业群体项目回答分布的卡方检验。
270名ICU医生和护士中共有86人完成了调查问卷。大多数人表示他们对使用患者监测设备有信心，但高比例的误报和众多传感器电缆干扰了患者护理。关于未来的改进，受访者要求使用无线传感器、减少误报数量以及制定医院警报管理标准操作程序。对于提议的远程患者监测显示设备的反应不一。大多数受访者表示，这对于早期警报或当他们负责多个病房时会很有用。ICU中的AI对于早期发现并发症和增加的死亡风险将很有用；此外，AI可以提出治疗和诊断指南。透明度、互操作性、可用性和人员培训对于促进AI的使用至关重要。大多数人希望更多地了解ICU的新技术，并需要更多时间学习。与护士相比，医生对基于AI的智能警报管理和使用手机进行远程监测的保留意见较少。
这项对ICU工作人员的调查研究揭示了重症监护医学中患者监测的关键改进之处。医院供应商和医疗设备制造商应专注于减少误报、实施医院警报标准操作程序、引入无线传感器、为使用AI做好准备以及提高ICU工作人员的数字素养。我们的结果可能有助于以用户为中心将数字技术转化为实践，以缓解重症监护医学中的挑战。
ClinicalTrials.gov NCT03514173；https://clinicaltrials.gov/ct2/show/NCT03514173
