Department of Internal Medicine, division Acute Internal Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands.
Department of Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands.
Int J Nurs Stud. 2021 Mar;115:103868. doi: 10.1016/j.ijnurstu.2020.103868. Epub 2021 Jan 3.
Continuous remote monitoring of vital signs on the hospital ward gained popularity during the Severe Acute Respiratory Syndrome coronavirus 2 pandemic due to its ability to support early detection of respiratory failure, and the possibility to do so without physical contact between patient and clinician. The effect of continuous monitoring on patient room visits has not been established yet.
To assess the impact of continuous monitoring on the number of patient room visits for patients suspected of Corona Virus Disease 2019 (COVID-19) and the use of personal protection equipment.
We performed a before-after study at a ward with private rooms for patients suspected of COVID-19 at a tertiary hospital in Nijmegen, The Netherlands. Non-participant observers observed hospital staff during day, evening and night shifts to record patient room visits and personal protection equipment usage. After eleven days, wearable continuous vital sign monitoring was introduced. An interrupted time series analysis was applied to evaluate the effect of continuous monitoring on the number of patient room visits, visits for obtaining vital signs (Modified Early Warning Score visits) and the amount of personal protection equipment used.
During the 45 day study period, 86 shifts were observed. During each shift, approximately six rooms were included. A total of 2347 patient room visits were recorded. The slope coefficient for the number of patient room visits did not change after introducing continuous vital sign monitoring (B -0.003, 95% confidence interval -0.022/0.016). The slope coefficients of the number of Modified Early Warning Score visits and the amount of personal protection equipment used did not change either (B -0.002, 95% confidence interval -0.021/0.017 and B 0.046, 95% confidence interval -0.008/0.099). The number of Modified Early Warning Score visits did show a decline over the entire study period, however this decline was not influenced by the intervention. Evening and night shifts were associated with fewer patient room visits compared to day shifts.
Introduction of continuous vital sign monitoring at a general ward for patients with suspected COVID-19 did not reduce the number of patient room visits or the usage of personal protection equipment by hospital staff. The number of Modified Early Warning Score visits declined over time, but this was not related to the introduction of continuous monitoring. Detailed analysis of the influence of continuous monitoring on the workflow of hospital staff reveals key points to increase efficacy of this intervention.
由于能够支持早期发现呼吸衰竭，并且可以在患者和临床医生之间无需身体接触的情况下进行，因此在严重急性呼吸系统综合症冠状病毒 2 大流行期间，对医院病房生命体征的连续远程监测变得流行起来。但是，连续监测对患者病房就诊次数的影响尚未确定。
评估连续监测对疑似 2019 年冠状病毒病（COVID-19）患者的病房就诊次数以及个人防护设备使用的影响。
我们在荷兰奈梅亨的一家设有私人房间的疑似 COVID-19 患者病房进行了一项前后研究。非参与者观察者在白天，傍晚和夜间轮班观察医院工作人员，以记录患者的病房就诊次数和个人防护设备的使用情况。在 11 天后，引入了可穿戴式连续生命体征监测。应用中断时间序列分析来评估连续监测对病房就诊次数，获取生命体征的就诊次数（改良早期预警评分就诊次数）和个人防护设备使用量的影响。
在 45 天的研究期间，观察了 86 个班次。每个班次大约包括 6 个房间。总共记录了 2347 次病房就诊。引入连续生命体征监测后，病房就诊次数的斜率系数没有变化（B-0.003，95％置信区间-0.022/0.016）。改良早期预警评分就诊次数和个人防护设备使用量的斜率系数也没有变化（B-0.002，95％置信区间-0.021/0.017 和 B0.046，95％置信区间-0.008/0.099）。但是，改良早期预警评分就诊次数确实显示出整个研究期间的下降趋势，但这种下降与干预无关。与白天班次相比，傍晚和夜间班次的病房就诊次数较少。
在疑似 COVID-19 患者的普通病房中引入连续生命体征监测并未减少医院工作人员的病房就诊次数或个人防护设备的使用。改良早期预警评分就诊次数随时间下降，但这与连续监测的引入无关。对连续监测对医院工作人员工作流程的影响进行详细分析，揭示了提高该干预措施效果的关键要点。
