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Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study
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 inter...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212076/ https://www.ncbi.nlm.nih.gov/pubmed/37228047 http://dx.doi.org/10.1371/journal.pone.0286080 |
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author | van Goor, Harriët M. R. Breteler, Martine J. M. Schoonhoven, Lisette Kalkman, Cor J. van Loon, Kim Kaasjager, Karin A. H. |
author_facet | van Goor, Harriët M. R. Breteler, Martine J. M. Schoonhoven, Lisette Kalkman, Cor J. van Loon, Kim Kaasjager, Karin A. H. |
author_sort | van Goor, Harriët M. R. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10212076 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-102120762023-05-26 Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study van Goor, Harriët M. R. Breteler, Martine J. M. Schoonhoven, Lisette Kalkman, Cor J. van Loon, Kim Kaasjager, Karin A. H. PLoS One Research Article 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. Public Library of Science 2023-05-25 /pmc/articles/PMC10212076/ /pubmed/37228047 http://dx.doi.org/10.1371/journal.pone.0286080 Text en © 2023 van Goor et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article van Goor, Harriët M. R. Breteler, Martine J. M. Schoonhoven, Lisette Kalkman, Cor J. van Loon, Kim Kaasjager, Karin A. H. Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
title | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
title_full | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
title_fullStr | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
title_full_unstemmed | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
title_short | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
title_sort | interpretation of continuously measured vital signs data of covid-19 patients by nurses and physicians at the general ward: a mixed methods study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212076/ https://www.ncbi.nlm.nih.gov/pubmed/37228047 http://dx.doi.org/10.1371/journal.pone.0286080 |
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