一种新型 ICU 连续实时生命体征监测仪：设计与评估研究。

A Novel Continuous Real-Time Vital Signs Viewer for Intensive Care Units: Design and Evaluation Study.

机构信息

Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States.

Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States.

出版信息

JMIR Hum Factors. 2024 Jan 5;11:e46030. doi: 10.2196/46030.

DOI:10.2196/46030

PMID:38180791

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10799282/

Abstract

BACKGROUND

Clinicians working in intensive care units (ICUs) are immersed in a cacophony of alarms and a relentless onslaught of data. Within this frenetic environment, clinicians make high-stakes decisions using many data sources and are often oversaturated with information of varying quality. Traditional bedside monitors only depict static vital signs data, and these data are not easily viewable remotely. Clinicians must rely on separate nursing charts-handwritten or electric-to review physiological patterns, including signs of potential clinical deterioration. An automated physiological data viewer has been developed to provide at-a-glance summaries and to assist with prioritizing care for multiple patients who are critically ill.

OBJECTIVE

This study aims to evaluate a novel vital signs viewer system in a level 1 trauma center by subjectively assessing the viewer's utility in a high-volume ICU setting.

METHODS

ICU attendings were surveyed during morning rounds. Physicians were asked to conduct rounds normally, using data reported from nurse charts and briefs from fellows to inform their clinical decisions. After the physician finished their assessment and plan for the patient, they were asked to complete a questionnaire. Following completion of the questionnaire, the viewer was presented to ICU physicians on a tablet personal computer that displayed the patient's physiologic data (ie, shock index, blood pressure, heart rate, temperature, respiratory rate, and pulse oximetry), summarized for up to 72 hours. After examining the viewer, ICU physicians completed a postview questionnaire. In both questionnaires, the physicians were asked questions regarding the patient's stability, status, and need for a higher or lower level of care. A hierarchical clustering analysis was used to group participating ICU physicians and assess their general reception of the viewer.

RESULTS

A total of 908 anonymous surveys were collected from 28 ICU physicians from February 2015 to June 2017. Regarding physicians' perception of whether the viewer enhanced the ability to assess multiple patients in the ICU, 5% (45/908) strongly agreed, 56.6% (514/908) agreed, 35.3% (321/908) were neutral, 2.9% (26/908) disagreed, and 0.2% (2/908) strongly disagreed.

CONCLUSIONS

Morning rounds in a trauma center ICU are conducted in a busy environment with many data sources. This study demonstrates that organized physiologic data and visual assessment can improve situation awareness, assist clinicians with recognizing changes in patient status, and prioritize care.

摘要

背景

在重症监护病房（ICU）工作的临床医生置身于警报声和数据的狂轰滥炸之中。在这种狂热的环境中，临床医生使用多种数据源做出高风险决策，并且经常被各种质量的信息淹没。传统的床边监测器仅显示静态生命体征数据，并且这些数据不易远程查看。临床医生必须依靠单独的护理图表（手写或电子）来查看生理模式，包括潜在临床恶化的迹象。已经开发出一种自动生理数据查看器，以提供一目了然的摘要，并帮助对多个重病患者进行护理优先级排序。

目的

本研究旨在通过主观评估新型生命体征查看器系统在大容量 ICU 环境中的实用性，评估一级创伤中心中的新型生命体征查看器系统。

方法

在晨间查房期间对 ICU 主治医生进行调查。医生被要求正常进行查房，使用从护士图表和研究员简报中报告的数据来告知他们的临床决策。在医生完成对患者的评估和计划后，要求他们完成一份问卷。完成问卷后，将查看器在平板电脑上呈现给 ICU 医生，该平板电脑显示患者的生理数据（即休克指数、血压、心率、体温、呼吸频率和脉搏血氧饱和度），最多可汇总 72 小时。检查完查看器后，ICU 医生完成了一份查看后问卷。在两份问卷中，医生都被问到有关患者稳定性、状况以及是否需要更高或更低级别护理的问题。使用层次聚类分析将参与的 ICU 医生进行分组，并评估他们对查看器的总体接受程度。

结果

2015 年 2 月至 2017 年 6 月期间，共从 28 名 ICU 医生处收集了 908 份匿名调查。关于医生认为查看器是否增强了他们在 ICU 中评估多个患者的能力，5%（45/908）强烈同意，56.6%（514/908）同意，35.3%（321/908）表示中立，2.9%（26/908）表示不同意，0.2%（2/908）强烈不同意。