Mosch Lina Katharina, Poncette Akira-Sebastian, Spies Claudia, Weber-Carstens Steffen, Schieler Monique, Krampe Henning, Balzer Felix
Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
JMIR Form Res. 2022 Apr 8;6(4):e22866. doi: 10.2196/22866.
Digital health technologies such as continuous remote monitoring and artificial intelligence-driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU.
This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU.
This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer-based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework.
This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention's adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU.
Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU's need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care.
ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173.
诸如持续远程监测和人工智能驱动的临床决策支持系统等数字健康技术可以改善重症监护医学的临床结局。然而，将数字健康技术成功应用于重症监护病房（ICU）等特定临床环境的全面证据和指南却很匮乏。我们评估了一个远程患者监测平台的实施情况，并得出了在ICU中实施数字健康技术的框架建议。
本研究旨在调查实施远程患者监测技术的障碍和促进因素，并为ICU中数字健康技术的实施框架制定建议。
本研究在2018年5月至2020年3月期间进行，期间实施了基于平板电脑的远程患者监测系统。该系统作为辅助监测设备安装在一家大型德国大学医院的ICU中。采用具有归纳和演绎元素的混合定性方法，我们使用实施研究综合框架和实施变革专家建议来分析对ICU临床利益相关者进行的7次半结构化访谈的记录以及描述性问卷数据。定性分析结果，连同非正式会议、实地观察和先前探索的结果，为推导提议的框架提供了基础。
本研究揭示了由于缺乏工作人员参与以及对新解决方案的感知益处较少，导致实施过程不充分。进一步的实施障碍包括ICU中工作人员在场率高和监测覆盖率高。实施框架包括在实施前和实施期间应用的策略，通过让所有ICU利益相关者参与来针对实施环境，评估干预措施的适应性，促进实施过程，并保持重要的反馈文化。设立一个负责实施的单位，考虑实施顾问的指导，并利用现有的机构能力，可以改善ICU中实施项目的机构环境。
在ICU中实施数字健康应包括对ICU的创新需求及其变革准备情况进行全面的实施前评估，以及对实施条件进行持续评估。所有利益相关者的参与、透明的沟通以及在平等氛围中的持续反馈至关重要，但必须明确界定并妥善填补领导角色。我们提议的框架可为医疗保健提供者提供具体、基于证据且逐步的实施实践建议，促进重症监护中数字健康的引入。
ClinicalTrials.gov NCT03514173；https://clinicaltrials.gov/ct2/show/NCT03514173
