远程心脏监测系统设计对严重心律失常响应时间的影响。

Effect of Remote Cardiac Monitoring System Design on Response Time to Critical Arrhythmias.

机构信息

From the Department of Anesthesiology (N.S.), Duke University School of Medicine, Durham; Textile Engineering, Chemistry, and Science (J.A.J.), North Carolina State University, Raleigh; Duke University Health System (R.D.B., J.R.E.); Duke Office of Clinical Research (D.B.), Duke University School of Medicine, Durham, NC; Rush University College of Nursing (L.G.C.), Chicago, IL; Saint Alphonsus Regional Medical Center (S.J.), Boise; and College of Pharmacy (M.C.W.), Idaho State University, Pocatello, ID.

出版信息

Simul Healthc. 2022 Apr 1;17(2):112-119. doi: 10.1097/SIH.0000000000000610.

DOI:10.1097/SIH.0000000000000610

PMID:34506366

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8904642/

Abstract

INTRODUCTION

In many hospitals across the country, electrocardiograms of multiple at-risk patients are monitored remotely by telemetry monitor watchers in a central location. However, there is limited evidence regarding best practices for designing these cardiac monitoring systems to ensure prompt detection and response to life-threatening events. To identify factors that may affect monitoring efficiency, we simulated critical arrhythmias in inpatient units with different monitoring systems and compared their efficiency in communicating the arrhythmias to a first responder.

METHODS

This was a multicenter cross-sectional in situ simulation study. Simulation participants were monitor watchers and first responders (usually nurses) in 2 inpatient units in each of 3 hospitals. Manipulated variables included: (1) number of communication nodes between monitor watchers and first responders; (2) central monitoring station location-on or off the patient care unit; (3) monitor watchers' workload; (4) nurses' workload; and (5) participants' experience.

RESULTS

We performed 62 arrhythmia simulations to measure response times of monitor watchers and 128 arrhythmia simulations to measure response times in patient care units. We found that systems in which an intermediary between monitor watchers and nurses communicated critical events had faster response times to simulated arrhythmias than systems in which monitor watchers communicated directly with nurses. Responses were also faster in units colocated with central monitoring stations than in those located remotely. As the perceived workload of nurses increased, response latency also increased. Experience did not affect response times.

CONCLUSIONS

Although limited in our ability to isolate the effects of these factors from extraneous factors on central monitoring system efficiency, our study provides a roadmap for using in situ arrhythmia simulations to assess and improve monitoring performance.

摘要

简介

在全国许多医院，远程遥测监测员在中央位置远程监测多个高危患者的心电图。然而，关于设计这些心脏监测系统以确保及时检测和响应危及生命的事件的最佳实践，证据有限。为了确定可能影响监测效率的因素，我们在具有不同监测系统的住院病房中模拟了严重心律失常，并比较了它们将心律失常传达给第一响应者的效率。

方法

这是一项多中心横断面现场模拟研究。模拟参与者是来自 3 家医院的每个住院病房的 2 名监测员和 1 名第一响应者（通常是护士）。操作变量包括：（1）监测员与第一响应者之间的通信节点数量；（2）中央监测站的位置——在患者护理单元内或外；（3）监测员的工作量；（4）护士的工作量；和（5）参与者的经验。

结果

我们进行了 62 次心律失常模拟，以测量监测员的响应时间，并进行了 128 次心律失常模拟，以测量患者护理单元的响应时间。我们发现，在有中间人与护士沟通危急事件的系统中，模拟心律失常的响应时间快于监测员直接与护士沟通的系统。中央监测站所在的病房的反应速度也快于远程病房。随着护士感知工作量的增加，响应延迟也增加。经验并未影响响应时间。