scholarly journals Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study (Preprint)

10.2196/22866 ◽  
2020 ◽  
Author(s):  
Lina Katharina Mosch ◽  
Akira-Sebastian Poncette ◽  
Claudia Spies ◽  
Steffen Weber-Carstens ◽  
Monique Schieler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Digital Health ◽  
Health Technology ◽  
Implementation Framework

Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Lina Katharina Mosch ◽  
Akira-Sebastian Poncette ◽  
Claudia Spies ◽  
Steffen Weber-Carstens ◽  
Monique Schieler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Monitoring ◽  
Digital Health ◽  
Implementation Process ◽  
Health Technology ◽  
High Tech ◽  
Remote Patient Monitoring ◽  
Implementation Framework ◽  
Remote Patient

BACKGROUND Despite the vast potential, the digital transformation of intensive care is lagging behind. Comprehensive evidence, along with guidelines for a successful integration of digital health technologies into specific clinical settings such as the intensive care unit (ICU), are scarce—yet essential. OBJECTIVE We evaluated the implementation of a remote patient monitoring platform and derived an implementation framework proposal for digital health technology in an ICU. METHODS We conducted this study 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 seven semi-structured interviews with ICU clinical stakeholders and quantifiable questionnaire data. 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. RESULTS Inductive analysis of the interview transcripts revealed an insufficient implementation process because of a lack of staff engagement and little perceived benefits from the novel solution. The ICU was not considered the most suitable for remote patient monitoring, as the staff’s presence and monitoring coverage were high. We propose an implementation framework for digital technologies, including strategies to apply before and during implementation, targeting the implementation setting by involving all stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, taking into account the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects. CONCLUSIONS The ICU provides an exceptional setting for the introduction of digital health technology because it is a high-tech environment involving multiple professions and high-stress levels. Before implementation, the need for innovation and the ICU’s readiness to change should be assessed. During implementation, a clinical team should ensure transparent communication and continuous feedback. The establishment of an implementation unit is recommended to promote a sustainable implementation culture and to benefit from existing networks. Our proposed framework may guide health providers with concrete, evidence-based, and step-by-step recommendations for implementation practice facilitating the introduction of digital health in intensive care. CLINICALTRIAL ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

scholarly journals Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study

2020 ◽  
Author(s):  
Lina Mosch* ◽  
Akira-Sebastian Poncette* ◽  
Claudia Spies ◽  
Steffen Weber-Carstens ◽  
Monique Schieler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Monitoring ◽  
Digital Health ◽  
Implementation Process ◽  
Health Technology ◽  
High Tech ◽  
Remote Patient Monitoring ◽  
Implementation Framework ◽  
Remote Patient

Abstract BackgroundIntensive care is lagging with digital transformation. It is essential to provide evidence and guidelines for integrating digital health technologies into the intensive care unit (ICU).We evaluated the implementation of a remote patient monitoring platform and derived an implementation framework proposal for digital health technology in an ICU.MethodsWe conducted this study 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 seven semi-structured interviews with ICU clinical stakeholders and quantifiable questionnaire data. 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. Results Inductive analysis of the interview transcripts revealed an insufficient implementation process because of a lack of staff engagement and little perceived benefits from the novel solution. The ICU was not considered the most suitable for remote patient monitoring, as the staff’s presence and monitoring coverage were high. We propose an implementation framework for digital technologies, including strategies to apply before and during implementation, targeting the implementation setting by involving all stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, taking into account the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects.Conclusions The ICU provides an exceptional setting for the introduction of digital health technology because it is a high-tech environment involving multiple professions and high-stress levels. Before implementation, the need for innovation and the ICU’s readiness to change should be assessed. During implementation, a clinical team should ensure transparent communication and continuous feedback. The establishment of an implementation unit is recommended to promote a sustainable implementation culture and to benefit from existing networks.Trial registrationClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

scholarly journals Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Akira-Sebastian Poncette ◽  
Claudia Spies ◽  
Lina Mosch ◽  
Monique Schieler ◽  
Steffen Weber-Carstens ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Qualitative Study ◽  
Patient Monitoring ◽  
Digital Health ◽  
Alarm Management ◽  
Novel Technology ◽  
Future Patient

BACKGROUND In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients’ health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s. OBJECTIVE The aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring. METHODS This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff—5 physicians, 6 nurses, and 4 respiratory therapists—were recorded, transcribed, and analyzed using the grounded theory approach. RESULTS Evaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies. CONCLUSIONS This qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite. CLINICALTRIAL ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk)

scholarly journals Intensive care unit nurses' perception of the barriers to effective in-service education: A qualitative study

2020 ◽  
Vol 7 (4) ◽  
pp. 241
Author(s):  
Noushin Mousazadeh ◽  
Shahrzad Yektatalab ◽  
Marzieh Momennasab ◽  
Soroor Parvizy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Intensive Care Unit Nurses

scholarly journals Job Satisfaction Challenges Of Nurses In The Intensive Care Unit: A Qualitative Study

2019 ◽  
Vol Volume 12 ◽  
pp. 233-242
Author(s):  
Somayeh Mousazadeh ◽  
Shahrzad Yektatalab ◽  
Marzieh Momennasab ◽  
Soroor Parvizy
Keyword(s):  
Job Satisfaction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study

scholarly journals Mobile extracorporeal membrane oxygenation service for severe acute respiratory failure – A review of five years of experience

2019 ◽  
Vol 21 (2) ◽  
pp. 134-139 ◽  
Author(s):  
Ada M Krzak ◽  
Jo-Anne Fowles ◽  
Alain Vuylsteke
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Qualitative Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Equipment Failure ◽  
Quality And Safety ◽  
Regular Reflection ◽  
Membrane Oxygenation

Provision of extracorporeal membrane oxygenation as part of support escalation in severe refractory acute respiratory failure in England is provided by five specialist centres that operate within a well-defined quality and safety framework. We conducted a qualitative study of the extracorporeal membrane oxygenation retrieval service provided by one of the five centres. We analysed 176 consecutive debrief reports written between October 2013 and April 2018 by the consultant. Main identified issues were short delays in retrieval predominantly due to insufficient communication or equipment failure. All issues were addressed in subsequent practice. Our results suggest a need for improved communication between the referring intensive care unit and retrieving team. Our findings highlight the value of regular reflection-based evaluation to ensure continued provision of safe and efficient service.

scholarly journals A qualitative study of undergraduate clerkships in the intensive care unit: It’s a brand new world

2017 ◽  
Vol 6 (3) ◽  
pp. 173-181 ◽  
Author(s):  
Enda O’Connor ◽  
Michael Moore ◽  
Walter Cullen ◽  
Peter Cantillon
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
New World
Sign in / Sign up

Export Citation Format

Share Document