Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study.

Autor: van Goor HMR; Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands., Breteler MJM; Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.; Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands.; Department of Digital Health, University Medical Center Utrecht, Utrecht, The Netherlands., Schoonhoven L; Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands., Kalkman CJ; Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands., van Loon K; Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands., Kaasjager KAH; Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 May 25; Vol. 18 (5), pp. e0286080. Date of Electronic Publication: 2023 May 25 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0286080
Abstrakt: Background: Continuous monitoring of vital signs is introduced at general hospital wards to detect patient deterioration. Interpretation and response currently rely on experience and expert opinion. This study aims to determine whether consensus exist among hospital professionals regarding the interpretation of vital signs of COVID-19 patients. In addition, we assessed the ability to recognise respiratory insufficiency and evaluated the interpretation process.
Methods: We performed a mixed methods study including 24 hospital professionals (6 nurses, 6 junior physicians, 6 internal medicine specialists, 6 ICU nurses). Each participant was presented with 20 cases of COVID-19 patients, including 4 or 8 hours of continuously measured vital signs data. Participants estimated the patient's situation ('improving', 'stable', or 'deteriorating') and the possibility of developing respiratory insufficiency. Subsequently, a semi-structured interview was held focussing on the interpretation process. Consensus was assessed using Krippendorff's alpha. For the estimation of respiratory insufficiency, we calculated the mean positive/negative predictive value. Interviews were analysed using inductive thematic analysis.
Results: We found no consensus regarding the patient's situation (α 0.41, 95%CI 0.29-0.52). The mean positive predictive value for respiratory insufficiency was high (0.91, 95%CI 0.86-0.97), but the negative predictive value was 0.66 (95%CI 0.44-0.88). In the interviews, two themes regarding the interpretation process emerged. "Interpretation of deviations" included the strategies participants use to determine stability, focused on finding deviations in data. "Inability to see the patient" entailed the need of hospital professionals to perform a patient evaluation when estimating a patient's situation.
Conclusion: The interpretation of continuously measured vital signs by hospital professionals, and recognition of respiratory insufficiency using these data, is variable, which might be the result of different interpretation strategies, uncertainty regarding deviations, and not being able to see the patient. Protocols and training could help to uniform interpretation, but decision support systems might be necessary to find signs of deterioration that might otherwise go unnoticed.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 van Goor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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